Dr Sherene Kalloo

Vul­val itch­ing, burn­ing, dry­ness and ir­ri­ta­tion are among the most com­mon rea­sons women vis­it a gy­nae­col­o­gist. One of the fre­quent—but of­ten over­looked—caus­es is vul­val con­tact der­mati­tis, an in­flam­ma­to­ry skin re­ac­tion trig­gered by ex­po­sure to ir­ri­tants or al­ler­gens.

Al­though the symp­toms can be dis­tress­ing, the con­di­tion is usu­al­ly not dan­ger­ous, not in­fec­tious, and high­ly treat­able once the trig­ger is iden­ti­fied.

Con­tact der­mati­tis of the vul­va oc­curs when the del­i­cate skin of the ex­ter­nal gen­i­tal area re­acts to a sub­stance it finds ir­ri­tat­ing or al­ler­genic. The vul­va is par­tic­u­lar­ly sen­si­tive be­cause its skin is thin, warm, and of­ten ex­posed to mois­ture and fric­tion.

There are two main types:

* Ir­ri­tant con­tact der­mati­tis caused by di­rect chem­i­cal or phys­i­cal ir­ri­ta­tion

* Al­ler­gic con­tact der­mati­tis caused by an im­mune re­ac­tion to a spe­cif­ic sub­stance

Both types can look sim­i­lar and of­ten present with over­lap­ping symp­toms.

In clin­i­cal prac­tice, I of­ten find that women are un­know­ing­ly ex­posed to ir­ri­tants in every­day rou­tines. Some of the most com­mon trig­gers in­clude:

1. Harsh soaps , body wash­es, and heav­i­ly “fem­i­nine hy­giene” prod­ucts are a ma­jor cause of vul­val ir­ri­ta­tion. These prod­ucts can dis­rupt the nat­ur­al skin bar­ri­er and al­ter the nor­mal vagi­nal and vul­val mi­cro­bio­me.

2. Panty lin­ers and san­i­tary pads

Fre­quent or long-term use of panty lin­ers can trap heat and mois­ture, cre­at­ing a hu­mid en­vi­ron­ment that ir­ri­tates the skin. Ad­he­sives, fra­grances, and ab­sorbent gels in some prod­ucts may al­so trig­ger al­ler­gic re­ac­tions.

Women of­ten no­tice symp­toms wors­en dur­ing or af­ter men­stru­a­tion.

3. Tight or syn­thet­ic cloth­ing

Non-breath­able fab­rics such as ny­lon or poly­ester un­der­wear can in­crease sweat­ing and fric­tion. Tight cloth­ing, in­clud­ing leg­gings and skin­ny jeans, may fur­ther wors­en ir­ri­ta­tion by cre­at­ing con­stant me­chan­i­cal rub­bing.

Cot­ton un­der­wear is bet­ter tol­er­at­ed be­cause it al­lows air­flow and re­duces mois­ture build-up.

4. Laun­dry de­ter­gents and fab­ric soft­en­ers

Residue from strong de­ter­gents or scent­ed fab­ric con­di­tion­ers can re­main in un­der­wear and cause ir­ri­ta­tion when in con­tact with vul­val skin.

5. Con­doms and lu­bri­cants

Some women de­vel­op ir­ri­ta­tion or an al­ler­gy to:

* La­tex in con­doms

* Sper­mi­cides

* Flavoured or scent­ed lu­bri­cants

Symp­toms may in­clude burn­ing, red­ness, or swelling short­ly af­ter sex­u­al in­ter­course.

In such cas­es, non-la­tex con­doms or hy­poal­ler­genic prod­ucts may be rec­om­mend­ed.

6. Shav­ing or hair re­moval

Hair re­moval meth­ods such as shav­ing, wax­ing, or de­pila­to­ry creams can ir­ri­tate vul­val skin in sev­er­al ways:

* Mi­cro-cuts from shav­ing

* Fol­lic­u­lar in­flam­ma­tion (ra­zor bumps)

* Chem­i­cal burns from de­pila­to­ry prod­ucts

* In­grown hairs caus­ing in­flam­ma­tion and itch­ing

Re­peat­ed hair re­moval can al­so weak­en the skin bar­ri­er over time.

Symp­toms of Con­tact Der­mati­tis vary but com­mon­ly in­clude:

* Itch­ing (of­ten the main com­plaint)

* Burn­ing or sting­ing sen­sa­tion

* Red­ness and swelling

* Dry, cracked, or flaky skin

* Pain dur­ing in­ter­course

* In­creased sen­si­tiv­i­ty to touch or cloth­ing

Di­ag­no­sis is main­ly clin­i­cal, based on:

* De­tailed his­to­ry of symp­toms and ex­po­sures

* Phys­i­cal ex­am­i­na­tion of the vul­va

* Iden­ti­fi­ca­tion of pos­si­ble ir­ri­tants or al­ler­gens

In per­sis­tent or un­clear cas­es, ad­di­tion­al tests may in­clude:

* Swabs to rule out in­fec­tion

* Patch test­ing for al­ler­gic caus­es

* Oc­ca­sion­al­ly a biop­sy if an­oth­er skin con­di­tion is sus­pect­ed

The most im­por­tant step in man­age­ment is iden­ti­fy­ing and avoid­ing the ir­ri­tant or al­ler­gen.

Gen­er­al treat­ment in­cludes:

1. Skin pro­tec­tion and gen­tle care

* Wash with plain wa­ter or very mild, fra­grance-free cleansers

* Avoid soaps, douch­es, and in­ti­mate wash­es

* Pat dry gen­tly rather than rub­bing

2. Cloth­ing changes

* Wear loose-fit­ting cloth­ing

* Choose cool cot­ton un­der­wear

* Avoid pro­longed use of panty lin­ers where pos­si­ble

3. Med­ical treat­ment

De­pend­ing on sever­i­ty, your doc­tor may pre­scribe:

* Top­i­cal cor­ti­cos­teroid creams to re­duce in­flam­ma­tion

* Bar­ri­er oint­ments to pro­tect the skin

* An­ti­his­t­a­mines if itch­ing is se­vere

In­fec­tion, if present due to scratch­ing, may re­quire ad­di­tion­al treat­ment.

To re­duce re­cur­rence:

* Avoid un­nec­es­sary prod­ucts on the vul­va

* Use un­scent­ed laun­dry de­ter­gents

* Change out of wet or sweaty cloth­ing prompt­ly

* Avoid over-shav­ing or al­low the skin to rest be­tween hair re­moval ses­sions

* Choose sim­ple, fra­grance-free per­son­al care prod­ucts

* Wash up af­ter in­ter­course

See a Gy­nae­col­o­gist if:

* Symp­toms per­sist for more than a few days

* There is se­vere itch­ing or pain

* Skin changes do not im­prove af­ter re­mov­ing sus­pect­ed ir­ri­tants

* There is re­cur­rent ir­ri­ta­tion af­ter sex­u­al in­ter­course

* You are un­sure of the cause

Per­sis­tent symp­toms should nev­er be self-di­ag­nosed, as oth­er con­di­tions such as in­fec­tions or chron­ic vul­val skin dis­or­ders can present sim­i­lar­ly.

Dr Sherene Kalloo

MDW, MBBS, DGO, DM, FACOG

Spe­cial­ist Ob­ste­tri­cian & Gy­nae­col­o­gist