DEFINITION

Vulval Dermatitis (also known as eczema) is an inflammatory condition causing irritation of the skin on or around the vulva.

DESCRIPTION

Vulval Dermatitis is characterised by intense vulval itching and swelling, burning on urination and painful intercourse.
The local conditions of heat, wetness and friction modify the ‘text-book' signs of skin disease when it occurs on the vulva. These conditions also make these skin signs much subtler. This is why many Doctors may think your vulval skin looks ‘normal', when in fact there may be a subtle (but still significant) rash on it.
Vulval Dermatitis is frequently mistaken for candidiasis (thrush), resulting in women often self-treating repeatedly with anti-fungals, which are ineffective against dermatitis. Vulval Dermatitis is usually associated with a thin but offensive discharge and not the thick "cottage cheese" discharge associated with thrush. It is possible for dermatitis and thrush to occur at the same time. Often the anti-fungal creams used to treat thrush cause dermatitis on the vulva. Medical examination and vaginal swabs can determine the diagnosis.

CAUSE

There are two types of Vulval Dermatitis: irritative and allergic.
IRRITATIVE: The most common causes of irritative contact dermatitis are tight synthetic clothing, especially jeans, G-strings, pantihose, sanitary pads and liners. Sitting for long periods of time, such as prolonged car or air travel and office work are factors, along with shaving and bikini waxing. Sweating and skin rubbing due to obesity may also affect some women.
Sexual lubricants, particularly those containing the antiseptic chlorhexidine, are highly irritating, which is a further concern when the dermatitis begins to cause painful intercourse. The rubbing involved in intercourse is merely the last straw in a long line of irritants. If your vulval skin is healthy, and your partner understands how to arouse you properly, then sex does not cause pain or discomfort. The problem is the inflammation of your vulval skin from all the other irritants.
ALLERGIC: Allergic dermatitis tends to occur in women who are also prone to asthma, hay fever and sensitive skin. There are many potential allergens, including perfumed shower gels and bath additives, latex condoms, talcum powder and deodorants, toilet papers and some antibiotics.

TREATMENT OPTIONS

As with all conditions your Doctor should be consulted to diagnose and treat this condition.

Treatment must cover both environmental factors and medicinal factors.
ENVIRONMENTAL TREATMENT
Cease any activities or routines, however "harmless" they may appear, that may be irritating your vulva. Try the following:
- No soap, bubble bath or essential oils. Instead, use a soap substitute from your Pharmacist, which must be 100% free of soap and perfume. Plain water is also a perfectly satisfactory cleanser.
- Try not to rub and scratch. Pat dry or even air dry after showering.
- Use toilet paper without perfume or colouring.
- Wear 100% cotton underwear and ensure it is not too tight.
- No pantihose, G-strings or tight trousers.
- Use tampons instead of sanitary pads and no panty-liners in between periods.
- No talcum powder, vaginal deodorants or perfume.
- Don't douche - it will ruin the natural balance of your vagina and vulva.
- Before commencing sex, protect your vulval skin with a thin coating of petroleum jelly, vegetable oil or glycerine. (But don't use petroleum jelly or oil if you use condoms as they can cause breakage.)
- If you are overweight, see the Obesity topic for further advice.
MEDICATIONS
Medications will only be effective if used in conjunction with the 'environmental' recommendations. However, most women require a moisturiser and a steroid preparation to achieve adequate control of their dermatitis symptoms.
- Moisturisers: The safest moisturiser is petroleum jelly. Use a thin smear any time your vulval skin feels uncomfortable.
- Steroid ointments: most steroids can be obtained only on prescription. However, most patients only need a very low-dose type called 1% hydrocortisone ointment. This is available without a prescription (1% hydrocortisone also comes as a cream, but the cream form may give some people allergies.) Put a thin film of this ointment onto every area that feels inflamed. Do this 2 or 3 times a day. Don't be afraid to apply it all the way into the entrance of the vagina, as this is actually still part of the vulval skin, and is almost always involved in Vulval Dermatitis.

Treatment must continue daily for at least one month. Some serious cases may take several months to resolve. The wetness and warmth of vulval skin means that it is very hard to reduce any inflammation. It takes much longer to treat dermatitis in this area than it would on, for example, your hand. One 'day off' from the treatment may cancel out the gains you have previously made.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) Avoid using soap or detergents where possible and wear non-constrictive cotton underwear.
2) A salt water bath (1 tablespoon of salt for every litre of water) may help to relieve irritated skin.
3) Consider using a 1% cortisone cream on the affected area. Ask your Pharmacist for advice.
4) Do not use anti-fungal creams for dermatitis. Ask your Pharmacist or Doctor if you are unsure of your condition.
5) Apply a thin coating of petroleum jelly before intercourse. (But don't use petroleum jelly or oil if you use condoms as they can cause breakage.)
6) Use tampons instead of sanitary napkins.

VITAMINS/MINERALS/HERBS

- Gamolenic acid, as found in evening primrose oil is a mild anti-inflammatory used for dermatitis.
- Essential fatty acids are vital to skin health and are found in many oils such as olive and linseed oils.
- Vitamins A, C and E provide antioxidant protection in the blood and body fluids.
- Zinc is used for cell repair and strengthening of the immune system.
- All B group vitamins are essential for healthy skin.

NOTES

It is estimated that at least 7 out of 10 women with vulval symptoms have dermatitis as their fundamental problem.
However, some patients have other causes for their vulval discomfort. Other common diagnoses are candidiasis (thrush), psoriasis and lichen sclerosis. See your Doctor or Pharmacist if you are uncertain of your condition.

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