Where even is the vulva?!

The vulva is the name of a woman’s external genitalia: bordered by the pubic bone at the front, the buttocks at the back, and the tops of your inner thighs on either side. (It’s basically the area covered by the gusset part of your undies.)

What body parts make up the vulva?

There are several distinct parts that are contained within the vulva, including the:

• Labia majora: the ‘outer lips’ around the vagina. They are two folds of hair-bearing skin (with underlying fat pads), which extend from the pubic area at the front, to the perineum at the back, on either side of the vagina
• Labia minora: the ‘inner lips’ around the vagina. They are two folds of hair-free skin, which join at the front at the clitoral hood, and at the back in the perineum
• Clitoral gland: the hairless, visible tip of the much larger and deeper clitoris organ, which is made up of erectile tissue and nerves
• Hymen: a ring of soft stretchy tissue just inside the vagina (a bit like a scrunchie!)
• Perineum: the area between the vaginal opening and the anus

Vulval care

Vulval skin is similar to your mouth’s lips: prone to becoming dry or chapped, and often (unfortunately) exposed to irritating surfaces and substances.

Like your mouth’s lips, your vulva shouldn’t be scrubbed hard or cleaned with soap: treat it kindly! If needed, use an oil- or paraffin-based ointment to soothe and protect your vulval skin.

Does it matter how I care for my hair down there?

It is healthy and natural to have pubic hair! If you wish to shorten your pubic hair, the healthier options include:

• Trimming your pubic hair with electric clippers
• Waxing
• Laser hair removal is an option for some people

Shaving pubic hair with a razor increases the risk of folliculitis (when the hair follicles become infected), and ingrown hairs (which can be very painful!). Hair removal creams often contain irritating chemicals, so should not be used on delicate vulval skin.

How should I clean my vulva?

The vagina is a self-cleaning organ! There is no need to ever flush the vagina with water, wash it out with any cleaning product, use any perfume etc. If you are concerned about abnormally smelly vaginal discharge, please read this blog, and consider seeing your women’s health GP, who may think that a swab is needed (to check that there isn’t an infection brewing).

When cleaning your vulva:

• Wash it gently using plain warm water on your hand: don’t use any soap or shampoo, nor any exfoliating scrubbers
• Gently pat your vulva dry with a soft towel
• +/- use a hair-dryer on a cool setting (which can be good for hard-to-reach areas!)

Over-cleaning your vulva (particularly using harsh chemicals or scrubbing brushes) can make your symptoms much worse! Less is more…

Do I need to moisturise my vulva?

Most women don’t need to apply any moisturising creams to their vulval skin: by and large, the vulva mostly maintains the perfect balance of dryness versus moistness, all of its own accord!

If your vulval skin is prone to dryness or irritation, you may want to apply an emollient once a day (eg. before bed, or after your shower / bath). Healthy emollients include:

• Vegetable, coconut or olive oil
• An emulsifying ointment (which contains paraffin oils, such as ‘Dermeze’ or vaseline)

When you try an oil or ointment for the first time, try it on only a small patch of vulval skin, to check that it’s not going to worsen your irritation. You may need to try a few different ones, until you find one that feels soothing.

What clothing and underwear are recommended?

While everyone’s vulva is different, the below is general guidance from specialised vulval clinics and specialists:

• Cotton-rich underwear with a full backside (ie. not G-strings) are best; the elastic around the leg holes shouldn’t be too tight.
• Period underwear, menstrual cups or tampons are preferable to pads or panty liners, which can cause vulval irritation and even allergies. If you must use pads, seek out and use 100% cotton, unscented pads.
• If your vulva is irritated or painful, wear loose-fitting pants, or (even better) a skirt / dress. Tight-fitting pants, leggings, and hosiery (especially when made of synthetic fibres) can worsen vulval friction and irritation.
• Remove wet bathers or wetsuits as soon as practicable
• Consider not wearing underwear at night, to let the area get some air.

Do I need to launder my clothes differently?

If you’re experiencing vulval irritation, some laundry tips include:

• Use hypoallergenic laundry powder / liquid, and only use half the recommended amount of detergent
• Avoid: fabric softeners; and products that claim to have any anti-bacterial, -viral and / or -yeast ingredients

How to manage vulval irritation

If your vulva is feeling irritated and sore, there’s a number of things you can try at home before seeing your doctor:

• Follow the general guidance provided above
• Use an emollient (such as sorbolene cream) or an emulsifying ointment (which contains paraffin oil). These create a protective barrier on the skin, by helping to retain moisture

If your symptoms persist, please see your women’s health GP for further guidance. Many over-the-counter products can actually worsen vulval irritation, so please try to resist the urge to self-diagnose and treat yourself!

Topic area frequently asked questions (FAQs)

I found a lump on my vulva. What should I do?

There are a number of different things that can cause lumps or bumps on the vulva. These include a:

• Bartholin’s abscess
• Sebaceous cyst
• Lipoma
• Sexually transmitted disease, such as herpes or syphilis
• Varicosity (the vulval equivalent of varicose veins)

If you are in a lot of pain, please see your GP or local women’s health Emergency Department urgently (eg. the Royal Women’s Hospital, Sunshine Hospital, or the Northern Hospital).

If you don’t need an urgent review, it’s best to book in an appointment to see your women’s health GP (such as Maven Centre’s Dr Amy Sinclair-Thomson or Dr Phillippa Wootton) or a sexual health clinician. They will be able to provide guidance as to whether any investigations or management are needed.

I can feel a strange bump on my vulva. Could it be cancer?

Vulval cancer is very rare. If you have noticed an abnormal lump on your vulva, please see your women’s health GP as a first port-of-call. GPs with vulval dermatology expertise (such as Dr Amy Sinclair-Thomson) can perform a biopsy of the area if needed, to rule out any cancerous changes.

Does it matter whether I wear underwear while I’m sleeping?

Most women prefer to wear underwear during their period, for peace of mind. When you’re not bleeding, it’s actually better to go commando when you’re sleeping: this allows your vulval skin to get some air, thereby maintaining the delicate balance between too dry and too moist.

My vulva burns after sex. Help!

After sex, rinse the vulval skin with lukewarm / cool water, then pat it dry. Apply a barrier ointment (such as an emulsifying ointment, described above), then a cool pack. If the problem persists, see your women’s health GP.

Sometimes, lubricants can cause vulval irritation. The best lubricants are:

• Adequate foreplay, by a gentle and knowledgeable partner
• Water-based
• Having a pH of approximately 4.5
• Having an osmolality less than 1,200 mOsm/kg. Many commercial lubricants have a much higher osmolality, which can damage and dry the vaginal lining and vulval skin

This link provides the pH and osmolality of many commonly-available lubricants.

What activities can irritate the vulval skin?

For some women, the activities below can worsen vulval irritation or pain:

• Sitting for long periods: consider buying a soft pillow or foam donut to sit on
• Chlorinated pools or spa baths; salt water may be better. Change out of wet bathers as soon as you can
• Bike-riding and horse riding. Consider trying a different bike-seat or saddle, or clothes that provide additional bum padding

Conclusion

Ideally, your vulval skin should require no (or minimal) maintenance. Treat it gently, and when in doubt go au naturale: wash with warm water in the palm of your hand, pat dry, wear cotton undies during the day, and none at night.

If you’re experiencing vulval irritation, pain, a rash, or find an abnormal lump or bump, please see a women’s health GP for some expert advice and guidance! Because it’s important to care for the area down there both appropriately, and expertly…