Vulval Dermatology

Expert specialist care for vulval skin conditions, from lichen sclerosus to contact dermatitis.

Vulval dermatology encompasses the diagnosis and management of skin conditions affecting the external female genitalia. This is an area of medicine that has historically been underserved; vulval conditions are frequently misdiagnosed or dismissed, causing significant delays between symptom onset and appropriate care.

A specialist dermatologist with expertise in vulval conditions can accurately diagnose and manage a range of presentations:

Lichen sclerosus: a chronic inflammatory condition causing the vulval skin to become thin, fragile, pale, and sometimes scarred. It causes significant itch and discomfort and, without treatment, leads to progressive structural changes. It requires ongoing management and monitoring, including because of a small but significant long-term risk of vulval squamous cell carcinoma.

Lichen planus: an inflammatory condition affecting skin, mouth, nails, and genitalia. Erosive vulvovaginal lichen planus can be painful and cause scarring if inadequately managed.

Contact dermatitis: an inflammatory reaction caused by contact with an irritant or allergen, including soaps, feminine hygiene products, lubricants, topical medications, and laundry products. The vulval skin is particularly sensitive and absorptive.

Vulvodynia: persistent vulval discomfort or pain without a clearly identifiable visible cause, a real, recognised condition that benefits from a multidisciplinary approach.

Vulval intraepithelial neoplasia (VIN): abnormal cellular changes requiring monitoring and treatment.

Chronic vulvovaginal candidiasis: a recurrent fungal condition causing persistent itch, burning, and discharge despite repeated treatment. Many women cycle through over-the-counter antifungals without ever addressing the underlying cause. Accurate diagnosis, including fungal culture and speciation, guides a tailored long-term management plan.

These conditions are manageable, but accurate specialist diagnosis is the foundation of effective care.

Lichen sclerosus has an autoimmune component and is associated with hormonal changes, genetic factors, and prior skin trauma. Contact dermatitis results from sensitisation to specific allergens or repeated irritant exposure; identifying the causative product is central to management. Vulvodynia is thought to involve neural sensitisation, pelvic floor dysfunction, and psychological factors that often interact.

How is it diagnosed?

Thorough history and examination are the basis of diagnosis. Patch testing, a specialised test identifying contact allergens using a panel relevant to vulval exposure, may be recommended. A vulval biopsy (taken under local anaesthetic) is sometimes needed to confirm lichen sclerosus, lichen planus, or vulval intraepithelial neoplasia. Referral to a gynaecologist, pelvic floor physiotherapist, or psychologist may form part of a coordinated management plan.

For lichen sclerosus: potent topical corticosteroids applied according to a structured regimen form the evidence-based standard of care. The goal is to control inflammation, prevent structural progression, and reduce long-term cancer risk. Regular follow-up is important even when symptoms are well controlled.

For contact dermatitis: identifying and eliminating the causative product is the most important step. A simplified, fragrance-free routine is recommended.

For chronic vulvovaginal candidiasis: fungal culture and speciation guides treatment selection, as non-albicans species and antifungal resistance are increasingly common. Management involves a structured suppressive antifungal regimen, identification of predisposing factors, and regular follow-up to ensure long-term disease control.

Vulval conditions are common, manageable, and nothing to be embarrassed about. A specialist consultation provides the accurate diagnosis that is the foundation of effective care.

Use only fragrance-free, soap-free cleansers; avoid douching and all intimate hygiene sprays
Wear loose-fitting, breathable cotton underwear; change out of wet swimwear promptly
Wash new underwear before wearing; use fragrance-free laundry detergent
Do not self-treat with over-the-counter antifungal creams without a confirmed diagnosis, as itching is not always thrush and self-treatment can delay diagnosis and worsen some conditions

You have persistent vulval itch, burning, pain, or discomfort
You have noticed changes in the colour, texture, or appearance of the vulval skin
You have been given repeated antifungal treatment without lasting improvement
Symptoms have not been adequately explained or treated
A previous diagnosis does not feel right, or treatment is not working

Vulval Dermatology

Causes & Diagnosis

Treatment Options

Management & Self-Care

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Discuss Vulval Dermatology with Dr. Nguyen

Sources and further reading