General good advice
Nothing on this site is meant to qualify as a medical diagnosis. You should consult your doctor or other medical practitioner for a diagnosis and further information.
- Do not use soaps, bubble-baths, deodorants or vaginal wipes in or around the vulval area.
- Clean the vulval area with water only, or with emulsifying ointment (available from pharmacies in 500mg tubs), preferably using showers not baths.
- If passing urine makes your symptoms worse, wash the urine away from the vulval area using a jug of warm water while on the toilet.
- Clean the vulval area only once a day, avoiding scrubbing with flannels and brushes. Avoid overuse of creams that have not been prescribed.
- Avoid antiseptics in the bath.
- Wear loose-fitting cotton underwear.
- Try washing undergarments with water only. Fabric conditioners and washing powders contain potential irritants to the skin.
- When washing your hair, avoid allowing the shampoo from coming into contact with vulval area. Try washing your hair in the sink.
- Bathe the affected area once or twice a day either using compresses of cotton wool soaked in colloidal oatmeal (such as Aveeno dissolved in water and stored in the fridge) or sit in a bath with Aveeno in it made up as specified. You can buy Aveeno colloidal oatmeal sachets from ExpressChemist (opens in new window). Your local chemist can also order Aveeno for you from their Johnson & Johnson rep. If you cannot find colloidal oatmeal, you could try plain oatmeal in the toe of a clean stocking or in a muslin bag: swirl it around in the bath before you get in. You might want to store moistened tea bags in the fridge or freezer and use them as cold compresses twice daily.
- If swimming or exercising vigorously protect the vulval area with a barrier cream such as Epaderm,Vaseline or aqueous cream.
- This article explains a bit more about acupuncture and how it can help vulval pain.
- If sex is painful you may want to try a natural vaginal lubricant called Sylk that is made from kiwi fruit extracts. For more information and a link to a site that sells it, see our natural products page.
- If sex is still painful even with a lubricant, try using the local anaesthetic lidocaine just before intercourse. Lidocaine temporarily numbs whatever it comes in contact with, so use a bit, let it sit a few minutes then rinse it off, otherwise your partner may get numb!
- Use unscented, unbleached tampons, sanitary towels/pads and pantyliners, such as Natracare products (www.natracare.co.uk)
- Playtex Gentle Glide tampons are easy to insert and provide good leakage protection.
- You might wish to try some other alternatives to tampons such as the Mooncup, DivaCup, Instead and the Keeper. They are worn internally and are re-useable, but the Instead is disposable. Alternatives to conventional sanitatory towels are Wemoon (R) Menstrual Pads and Minx Pads while Luna Wolf UK also offer cloth menstrual products and further information. Sea sponges are used by Sea Pearls and Luna Sponge Tampons as a reusable tampon.
- Sitting on specialist pressure relief cushions such as foam or gel wedges may help to reduce pain. These are available from any specialist back or medical-supply store, or you can mail order one from The Back Shop (www.thebackshop.co.uk/products/category115.html).
- If urine or chlorine, for instance, irritate your vulva further, use a barrier cream such as Vaseline or E45 to protect the skin – be sure to test it for at least 24 hours on the inside of your wrist first to make sure your skin does not react to any preservatives in any cream you might apply to the vulva
- Lidocaine ointment 5% (available now, prescription only) and lidocaine gel 2% (available from September 2005, prescription only) are both now manufactured by Teva UK Ltd (formerly APS), on 0800 590 502 or 0113 238 0099. There was also a 10% spray called Xylocaine which I think was discontinued in 2000, but AstraZeneca UK Ltd holds the patent and it may be worth ringing up on 01625 582 828 to find out if there are any plans to make it again.
- A lidocaine cream 5% called EMLA is available online from ExpressChemist.
- See also some other useful measures on US-based site Vulvar Health
If you suspect a fungal infection...
...read here for information on the prescription drugs used to treat fungal infections. Many vulval pain patients find topical anti-fungal creams and pessaries further inflame their pain, so always consider asking your doctor or pharmacist about oral anti-fungals available in the UK such as Sporanox (itraconazole, prescription only) or Diflucan (fluconazole, no prescription needed). Bear in mind that Superdrug sells Diflucan at a much lower price than does Boots.
How to distinguish between fungal and bacterial infections:
| Vaginal candidiasis (thrush) | Bacterial vaginosis (BV) | |
| Cause | fungal infection | bacterial infection |
| Sexual transmission | very rarely | often |
| Symptoms | ||
| Relation to menses | often postmenstrual | none |
| Painful urination | mild to marked | absent to mild |
| Vulval irritation | external | not usual |
| Odour | absent | fishy, amine-like |
| Signs | ||
| Labial redness | variable | no |
| Satellite lesions | yes | no |
| Vaginal tenderness | yes | no |
| Discharge | ||
| Consistency | sometimes curdy/cheeselike | homogenous, frothy |
| Colour | white | grey, white |
| pH (see note*) | <4.5 | >4.7 |
*Note that BV can be distinguished from a fungal infection immediately using either a pH test of vaginal discharge that shows low acidity (pH greater than 4.5) or a fishy odor when a sample of vaginal discharge is combined with a drop of potassium hydroxide on a glass slide (the "whiff test").