Vulvar Disorders

Vulvar cancer is relatively rare, accounting for a small percentage of gynecologic cancers, and it most frequently affects postmenopausal women. The most common warning sign is persistent itching that does not resolve with over-the-counter creams. Other signs include a visible lump, sore, or area of skin that is white, red, or darkened compared to the surrounding tissue. Any lesion that persists for more than four to six weeks, bleeds easily, or changes in size or color should be evaluated by a gynecologist for a biopsy to rule out malignancy.

During menopause, the drop in estrogen levels leads to vulvovaginal atrophy, causing the vulvar skin to become thinner, drier, and more prone to tearing and pain. While low-dose vaginal estrogen is a highly effective treatment for these symptoms, non-hormonal options include vaginal moisturizers used regularly and lubricants used during sexual activity. For patients who cannot use hormones due to a history of hormone-sensitive cancer, these mechanical aids and physical therapy for pelvic floor relaxation can significantly improve comfort and quality of life.

Vulvodynia is a chronic pain condition characterized by burning, stinging, or rawness in the vulvar area without an identifiable infection or skin disease, often triggered by touch such as during intercourse or sitting. Vulvovaginitis, in contrast, is an inflammation or infection of the vagina and vulva, typically presenting with distinct discharge, odor, and intense itching. Because vulvodynia is not caused by an infection, antifungal or antibiotic treatments used for vulvovaginitis will not help and may worsen irritation, requiring instead pain management strategies and physical therapy.

To manage itching, avoid all scented soaps, bubble baths, and douches, as these disrupt the natural pH and barrier of the vulvar skin. Instead, use lukewarm water for cleansing and pat the area dry gently rather than rubbing. Wearing loose-fitting cotton underwear and avoiding tight synthetic fabrics can reduce moisture and friction. If itching persists despite these hygiene changes, it is essential to see a provider to rule out fungal infections, lichen sclerosus, or contact dermatitis, as self-treatment can delay necessary medical intervention.