Let’s start with a slightly awkward question.
Have you ever actually looked at your vulva?
Not because something was hurting.
Not because you were checking for thrush.
Not because your doctor or nurse was examining you.
Just… looked.
If the answer is no, you are certainly not alone.
For many women, the vulva is one of those parts of the body that we don’t really look at. We wash it, we deal with periods, we have sex, we notice when something is uncomfortable but we don’t necessarily know what our own vulva actually looks like.
And that can make it surprisingly difficult to notice when something has changed.
The vulva comes in all different shapes, sizes, colours and textures. There isn’t one “normal” appearance.
The important thing is knowing what is normal for you.
That way, if something changes, you are more likely to notice it.
Your vulva isn’t your vagina
Let’s clear up one thing first.
The vulva is the external genital area. It includes the labia, clitoris and the skin around the vaginal opening.
The vagina is the internal passage leading from the vaginal opening towards the cervix.
We often use the word “vagina” to describe the whole area, but when we’re talking about changes to the skin, itching, soreness, lumps, colour changes or skin conditions, we’re often talking about the vulva.
And vulval skin can develop a surprisingly wide range of conditions.
Itching doesn’t always mean thrush
This is something I think is really important.
If you’ve ever had vulval itching or soreness, your first thought may well have been:
“I’ve got thrush.”
Sometimes you might be right.
But not every itchy or sore vulva is caused by thrush.
Vulval symptoms can have many different causes, including irritation or dermatitis, eczema, psoriasis, lichen sclerosus, lichen planus, hormonal changes and infections.
And sometimes, several things can be going on at once.
This is why repeatedly treating yourself for thrush when things aren’t improving isn’t necessarily the answer.
If symptoms keep coming back, don’t settle for the assumption that you are simply someone who “gets thrush a lot”.
It is worth finding out what is actually causing the problem.
So, what should you look out for?
Just as there is a lot of awareness around checking your breasts, checking your vulva is equally as important.
This is about becoming familiar with your own body,
When you look at your vulva, you might notice:
- a new lump or area of swelling
- a change in the colour of the skin
- a new white, pale, red or darker patch
- an area of skin that has become thicker or raised
- cracks or small splits in the skin
- sores or ulcers that don’t heal
- bleeding that isn’t expected
- a change in the shape or appearance of the vulva
- persistent itching, burning or soreness
- pain during sex
- changes in sensation
- discomfort when passing urine or opening your bowels.
Many of these symptoms can be caused by conditions that are not cancer. In fact, vulval symptoms are common and have many possible causes. But that doesn’t mean you should ignore a change that is new, persistent or unusual for you.
One condition worth knowing about: lichen sclerosus
Lichen sclerosus is a long-term inflammatory skin condition that commonly affects the vulval and anal areas.
It can occur at any age, although it is more common after the menopause.
It can cause itching, soreness and irritation, but there can also be visible changes to the skin.
You may notice white or pale patches, crinkled or thickened skin, small cracks or fissures, bruising or bleeding. Over time, untreated lichen sclerosus can cause scarring and changes to the structure of the vulva.
Some people have very obvious symptoms.
Others don’t.
And this is one of the reasons that knowing what your vulva normally looks and feels like can be helpful.
Lichen sclerosus is not an infection, is not contagious and isn’t caused by poor hygiene. It can usually be managed effectively with treatment, but it is a condition that needs proper diagnosis and ongoing management.
Why does lichen sclerosus matter?
There are two reasons.
The first is that treatment can make a significant difference to symptoms and help protect the vulval skin.
The second is that lichen sclerosus is associated with a small increased risk of vulval cancer.
That sounds frightening, but it is important to put it into perspective.
Having lichen sclerosus does not mean you are going to develop vulval cancer.
It does mean that changes in the vulval skin shouldn’t simply be ignored.
Regular checks, appropriate treatment and speaking to your healthcare professional if something changes are important parts of looking after the condition.
How do you actually check your vulva?
If you’ve never done this before, it might feel a little strange.
You don’t need anything complicated.
A mirror and a good light are enough.
Find somewhere private where you feel comfortable. You could stand with one leg raised, sit down or find another position that gives you a good view.
Have a look at the different areas of your vulva and around the vaginal opening.
You can gently part the folds of skin so you can see areas that aren’t normally visible.
You’re not looking for a textbook-perfect vulva.
You’re getting to know yours.
We recommend regular vulval checks, particularly for people with lichen sclerosus, and suggests looking for changes in colour or texture, lumps, thickened areas, sores, ulcers, cracks or changes to the structure of the vulva.
You might even find yourself thinking:
“Oh. That’s what I actually look like.”
And that’s exactly the point.
What if something looks different?
Don’t panic.
There are lots of reasons why the vulval skin might look different.
Hormonal changes, irritation, eczema, infections and other skin conditions can all cause changes.
But if you notice something new, persistent or unusual for you, get it checked.
That might mean speaking to your GP, practice nurse, sexual health service or another healthcare professional who is familiar with assessing vulval conditions.
Vulval symptoms should be assessed to establish what is causing them, and that if the diagnosis is unclear or the skin doesn’t improve with treatment, further assessment sometimes, including a small biopsy may be needed.
And although it’s easy to say, please don’t feel embarrassed.
Your vulva isn’t shocking, unusual or inappropriate.
It’s a body part.
When should you definitely get it checked?
It’s particularly important to seek medical advice if you notice:
A lump that is new or unexplained.
An ulcer or sore that doesn’t heal.
Unexplained vulval bleeding.
A persistent change in the colour or texture of the skin.
An area that becomes thickened, raised or changes in appearance.
Persistent itching, burning or soreness that isn’t settling.
Symptoms that keep returning despite treatment.
And please don’t keep treating yourself for thrush if it’s not getting better
This is another common situation.
You feel itchy.
You buy a thrush treatment.
It gets a little better.
Then it comes back.
So you treat it again.
And again.
At some point, it is worth stopping and asking:
Is this actually thrush?
Some over-the-counter preparations can themselves irritate sensitive vulval skin, particularly if they are used repeatedly when they aren’t needed. I advise caution with some over-the-counter preparations because they can aggravate allergies or prolong symptoms.
If something isn’t settling, getting the diagnosis right is much more useful than simply adding another cream.
Your vulva doesn’t need lots of products
Another misconception worth clearing up is that the vulva needs to be scrubbed, scented, exfoliated or “freshened”.
It doesn’t.
Vulval skin is sensitive, and products such as perfumed soaps, shower gels, bubble baths, deodorants, wipes and douches can irritate it. I recommend a gentle approach to vulval care.
In other words, when it comes to your vulva:
Clean doesn’t have to mean squeaky.
And you certainly don’t need to make it smell like a tropical shower gel.
The bigger message
There is a bigger reason I want women to feel more comfortable talking about their vulva.
We are generally much better at talking about breast awareness.
We know that breasts come in different shapes and sizes. We know to notice a new lump or change. We know that something unusual should be checked.
We should be just as comfortable knowing our own vulva.
Not because we should be constantly looking for something wrong.
But because you can’t recognise a change if you don’t know what is normal for you.
That might be particularly important if you have a condition such as lichen sclerosus, but it applies more generally too.
Your vulva is part of your body.
It deserves the same attention and care as the rest of you.
So, when was the last time you looked?
If the answer is “I honestly can’t remember”, don’t worry.
You don’t need to turn it into a daily ritual.
But finding a comfortable, private moment to have a look can be a useful way of becoming more familiar with your own body.
And if you notice something that doesn’t look or feel right?
Don’t ignore it.
It doesn’t mean something serious is wrong.
It simply means it is worth finding out what is going on.
Because when it comes to vulval health, knowing your normal can make it much easier to spot when something has changed.
A final reminder
Vulval itching, soreness, skin changes and other symptoms can have many different causes. This article is intended to help you recognise changes and understand when to seek advice; it is not a substitute for an examination or diagnosis.
If you have a new or persistent vulval symptom, or a change that concerns you, speak to your GP or another appropriate healthcare professional.
Useful resources
The Labia Library – The models in this gallery span a wide range of ages and genders it can be helpful to view what the spectrum of normal looks like.
The LS Guide – A fantastic website covering a wealth of helpful information about Lichen Sclerosus.