Vulval conditions
Diagnosis and treatment of vulval conditions: persistent itching, pain, lichen sclerosus and recurring infections.
What vulval conditions are
The vulva can develop its own conditions — of the skin, infectious, or pain-related — that often go undiagnosed for years: out of embarrassment, or because they've been masked with «thrush» treatments that weren't actually the problem. Among the most common are lichen sclerosus, recurring dermatitis and infections, and vulvodynia, vulval pain with no visible lesion.
None of them is «something you have to live with»: with the right diagnosis, most improve significantly.
When to book an appointment
- Vulval itching or stinging that lasts weeks or keeps coming back.
- Pain in the vulval area, spontaneous or during sex.
- Changes in the colour or appearance of the vulval skin.
- A lesion, lump or ulcer that won't fully heal.
- Vaginal infections that keep coming back despite treatment.
How we investigate it
The key is looking carefully and methodically: a detailed examination of the vulva, swabs when infection is suspected, and biopsy of lesions that need it. Many patients arrive after years of blind treatment attempts; the aim of the first visit is to put a name to the problem.
How we treat it
Every diagnosis has its treatment: a course of topical steroids for skin conditions like lichen sclerosus, specific treatment for infections, and a step-by-step approach to vulval pain, which is real, has a name and has options. Follow-up matters just as much: some of these conditions are chronic, and keeping them under control prevents complications.
Frequently asked questions
I have had itching for months and thrush treatments do not clear it. What could it be?
Most likely it is not thrush. Persistent vulvar itching has many causes — dermatological, hormonal, infectious — and needs a specific examination before carrying on treating it blindly.
Is lichen sclerosus serious?
It is a chronic skin condition that, properly treated and with regular check-ups, is controlled in the vast majority of cases. Without treatment it can cause discomfort and changes that are best avoided — which is why diagnosis matters.
What is the most common vulvar condition?
Infections —candidiasis and bacterial vaginosis— and vulvar skin conditions such as lichen sclerosus or eczema, which cause persistent itching and sometimes changes in skin colour. Also Bartholin's cysts and HPV warts. Itching that lasts for weeks deserves a consultation, not more creams on your own.
What types of vulvar lesions are there?
They fall into infectious, inflammatory or dermatological, cystic, premalignant and malignant lesions. Many look alike to the naked eye, which is why what guides us is the examination and, when there is doubt or the lesion does not respond to treatment, a simple biopsy in the consulting room.
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Content reviewed by Tatyana Krasnichenko