General good advice
Please note: 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.
General vulval care
- Avoid overuse of creams that have not been prescribed.
- 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 sitting in a bath with collodial oatmeal product in it made up as specified. 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 passing urine makes your symptoms worse, wash the urine away from the vulval area using a jug of warm water while on the toilet.
- If urine or chlorine 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.
Washing and bathing
- Do not use soaps, bubble-baths, deodorants or vaginal wipes in or around the vulval area.
- Clean the vulval area once a day, with water, or with emulsifying ointment, preferably using showers, not baths, and avoiding scrubbing with flannels and brushes.
- Avoid antiseptics in the bath.
- When washing your hair, avoid allowing the shampoo from coming into contact with the vulval area. Try washing your hair in the sink.
- Use unscented, unbleached tampons, sanitary towels/pads and pantyliners, such as Natracare products.
- Playtex Gentle Glide tampons are easy to insert and provide good leakage protection.
- You might wish to try some alternatives to tampons such as the Mooncup, DivaCup, Instead and the Keeper. These are small silicone, rubber or plastic cups which are worn internally and are reusable (the Instead is disposable or reusable over one menstrual cycle, depending on the model). Sea sponges are used by Sea Pearls and Luna Sponge Tampons as a reusable tampon. Alternatives to conventional sanitary towels are reusable cloth menstrual pads, such as Gladrags, Lady Days Cloth Pads and Wemoon (R) Menstrual Pads. If you like DIY and crafting, you can even learn how to make your own sanitary towels at Household How To.
Wear loose-fitting cotton underwear.
Try washing undergarments with water only. Fabric conditioners and washing powders contain potential irritants to the skin.
Some clinical trials in Italy found that wearing DermaSilk briefs reduced vulval pain, particularly when there was evidence of skin irritation or Candida infection. The briefs are available on prescription, or from the DermaSilk website if you want a more varied style.
- If sex is painful you may want to try a natural vaginal lubricant.
- If sex is still painful even with a lubricant, try using the local anaesthetic lidocaine (formerly called lignocaine) 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! 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.
- Another anaesthetic (numbing) treatment which can be applied to the vulva is EMLA cream. It contains two active ingredients, lidocaine and prilocaine, which are used to numb areas of the skin that would otherwise feel pain. The commonest indication is for use on non-general skin surfaces e.g. the arm when having blood taken, or prior to skin tattoos. Within a hospital setting, it is used for numbing the genital skin prior to skin biopsy. An advantage of using the cream is that it may produce short-term relief from pain when applied to vulval skin. The disadvantages include transient local reactions at the application site such as paleness, erythema (redness) and swelling. It is always important to use a test dose first to ensure that you do not react to the cream. Unlike the lignocaine (lidocaine) ointment described above, which can be used regularly on the vulva, with EMLA cream it is best to seek advice from your doctor as the use of EMLA long-term with respect to timing and dose of treatment is not clear. It is available on prescription only.
- If swimming or exercising vigorously protect the vulval area with a barrier cream such as Epaderm or Vaseline.
- For keen cyclists, Spongy Wonder Bicycle Seats from Canada have been specially designed to reduce physical distress to the vulval region. They allow greater circulation of air than conventional seats do. Read more about the seat on the Urological Sciences Research Foundation site. See also Bodyfit bike saddles.
- 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 online.
- See also some other useful measures at the OHSU Center for Women's Health.
If you suspect a fungal infection...
...go to Fungus Focus 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 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
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 odour when a sample of vaginal discharge is combined with a drop of potassium hydroxide on a glass slide (the "whiff test").