6 vulvar skin issues and what to do about them!
By Sara Twogood, MD
First, please please please – remember anatomy!
The vulva (and therefore the vulvar skin) is the external, visible part of female genitalia. It where pubic hair grows and if you look in the mirror (highly recommended!), you can see it.
The vagina? That’s NOT THE SAME THING. The vaginal opening is visible from the vulva, but the vagina itself is an internal organ. Please don’t confuse them.
Words matter. Anatomy matters.
Now the vulvar skin can be delicate but it’s not smooth as a baby’s bum.
Things can grow on it. It can get irritated. It can get a rash, or bumps, and lumps.
Today’s post: the top 6 vulvar skin issues that people ask me about in the office … and what to do about them!
RAZOR BURN
Razor burn can happen anywhere razors are used – face, armpits, legs, pubic hair.
This is such a common vulvar skin issue!
They look like red little bumps and show up minutes to hours after shaving. They can sting and look angry but usually go away by themselves with time!
Razor burn is usually caused by friction from the razor on the skin – either from using an old razor, or having preexisting bumpy or irritated skin, or not using a lubricating shaving cream.
Tips to reduce razor burn may seem obvious:
Use a sharp, fresh razor
Shaving cream helps the razor glide easier
Avoid shaving over irritated skin
If razor burn couldn’t be prevented, how to treat it?
Avoid adding insult to injury. Don’t put on acne creams or medications, or essential oils, or really anything. This is exactly the reason why it’s so important to know that it’s razor burn and not pimples or some other skin disorder!
A cool damp washcloth may help
INGROWN HAIRS
Ingrown hairs can occur anywhere hair grows. Since I’m a gynecologist, I am specifically talking about pubic hair as a common vulvar skin issue.
Ingrown hairs look like small red, irritated bumps on the skin. Sometimes it looks like a little pustule.
What causes them? The regrowth of hair.
When hair is removed, it is often removed below the surface of the skin. As it regrows, if the hair doesn’t come out of the skin in a fresh, straight opening, it can get trapped under the skin. The hair keeps growing and pushes the skin up to an irritated bump.
Ways to reduce ingrown hair focus – this focuses on not letting it get trapped in the first place!
Exfoliate the skin! This helps keep that fresh, straight opening open instead of accumulating dead skin cells or debris that block the opening
If you are very prone to ingrown hairs, consider changing your form of hair removal. Plucking, waxing, and depilatory creams all remove hair beneath the surface of the skin so are more likely to result in ingrown hairs. Try shaving or trimming instead.
How can you get rid of it?
Apply a warm compress to the area. This can help dilate the skin pores
Then gently exfoliate the area to remove any superficial dead skin cells or debris
Repeat. You’ll likely see a little hair poke through eventually
Try not to pick too much, as tempting as it is. Picking can cause scarring If the instruments aren’t clean, it may even cause an infection!
PIMPLES
Occasional pimples in the genital area – specially the vulvar and buttock skin – are normal and common.
Sweat, heat, humidity, and hormones can lead to small outbreaks.
These pimples are typically temporary, small, and go away.
Tips to reduce and treat:
Using a salicylic acid body wash and topical ointment. This can be irritating and never get it near the labia minora (the inner vulvar skin folds), which are especially sensitive (and don’t get pimples anyway!).
Warm compresses can help
I am NOT talking about big, deep, bursting, cystic acne in the groin area. These types of “pimples” may be a skin disorder called hidradenitis suppurativa (also called “HS”). HS can be mild or severe but is treated different than superficial pimples. We often treat HS in conjunction with a dermatologist and with prescription topical creams. Often prescription antibiotics are required too. If you’re not sure – see your gynecologist and we’ll help you figure it out!
EPIDERMOID CYST
These small cysts are also called epidermal inclusion cysts. They are flesh colored with one specific defining feature – a little “punctum” in the middle – a darker, centrally located dot. They of course occur on the vulvar skin but can be seen anywhere else on the body as well.
Epidermoid cysts rarely become painful or swollen. Most of the time they are simply noticed as a small lump and people ask about them when they’re in the office for something else. They don’t need to be treated or removed! But if the cyst is bothersome, it can be removed in the office with a little local lidocaine and a small incision.
Epidermoid cysts often form because of other trauma to the skin – like cuts and abrasions, scratching and itching, or pimples. So trying to minimize these risk factors may help avoid epidermoid cysts from forming!
GENITAL WARTS
A patient of mine – in a long term monogamous relationship – was exploring her body and noticed a few little growths on her vulvar skin. She came to me to ask about them. You guessed it – she had genital warts.
Now she wasn’t sure how long they had been there. Her partner didn’t have any.
She was distraught – a completely normal and expected response to this new diagnosis.
Genital warts are a sexually transmitted infection caused by the virus HPV. Remember – different HPV strains cause different problems. Some strains of HPV can lead to abnormal pap smears and cervical cancer. The strains that cause genital warts are DIFFERENT STRAINS. If you have genital warts does not mean you need an updated pap smear. An abnormal pap smear does not mean you will get genital warts.
Anyway – back to genital warts.
They look like both / either skin tags or tiny cauliflowers. They can be minor and barely noticeable or, in some cases, so severe that they need to be cut off surgically. They cause irritation (especially in that last scenario) but more often there are no associated symptoms except seeing an actual wart.
Want to know what does cause irritation? Treatment of genital warts!
Here are treatment options :
DO NOTHING. 60% of genital warts will go away from our immune system fighting it! This is always an option
TCA (trichloroacetic acid). This acid is applied by a health care provider in the office directly to the wart itself. It usually takes weekly treatments for a month or so with the majority of warts cleared by the end.
Freezing (liquid nitrogen). This one hurts but can be very effective. It’s applied in the office setting with local anesthesia. Again, this is usually weekly treatments until the warts are gone. Its use is limited to offices with this available since it takes storage and planning to have it ready for patients.
Topicals: the 2 most common prescription topicals are Podofilox and Imiquimod. These can be applied at home and used for several month. While the medications are doing their job, the area can become irritated and raw – both normal and expected side effects but not worth it to everyone (especially if the warts weren’t causing symptoms to begin with). I usually ask my patients to return within 6 weeks of starting the treatment for quick exam to make sure the area isn’t getting too inflamed.
BARTHOLIN GLAND CYST
I go into a lot more detail about Bartholin gland cysts and abscesses in this article.
But as a reminder – Bartholin glands sit right next to the vaginal opening. There’s two of them – if your vaginal opening is a clock, your Bartholin glands are the 4 and the 8. They’re very small (less than 0.5 cm) and have the glamorous job of secreting mucus for vaginal lubrication.
A little bump can form in that area called a Bartholin gland cyst. People often do not even notice it’s there because most are asymptomatic. The most common symptom is a bulge on one side of the vagina. It may be felt during sexual activity, or exercise, or even just sitting in a certain position.
Usually only 1 side is affected at a time, so if you see or feel a lump on one side of your vulvar area, that may clue you in (and of course you see your gynecologist if you notice a lump on the vulva that doesn’t go away on its own). If this cyst becomes infected, it’s called an abscess. And it can be very painful often initiates an urgent visit.
Both problems – the cyst or the abscess – can be treated with a procedure that drains the cyst or abscess. A little catheter or stitches are placed to hold the drainage site open for a few weeks.
With a cyst that’s asymptomatic, small, and not infected, your doctor may recommend just watching it and seeing if it increases or decreases in size.
Sitz baths may help decrease the size of a Bartholin gland cyst and certainly won’t hurt. Here’s details about sitz baths if you’re looking for something proactive to do while you’re waiting for your appointment!
As with many things gynecology – it’s super easy to misdiagnose yourself from reading something on the internet (EVEN THIS ARTICLE!). If you’re not sure – come see one of us trusty gynecologists!