Causes of vulval pain and discomfort — vaginal infections
Vaginal infections often affect not only the vagina but also the vaginal opening and the skin around it causing itching and pain. Getting a prompt diagnosis and treatment will alleviate symptoms and may reduce the amount of treatment you need. It is important to remember that not all women get all the symptoms associated with an infection. Also, symptoms may vary between different bouts of the same infection.
The most common infections with symptoms of vulval discomfort are thrush, bacterial vaginosis, trichomonas vaginalis and herpes simplex.
This is usually caused by a fungal organism called candida albicans which lives in our bodies but can grow out of control in our genital area causing symptoms of thrush. These include a white, thick, yeasty smelling vaginal discharge, and a very itchy, sore and red vulval area. Sometimes the anal opening can become itchy and sore, too.
Thrush is treated with a range of antifungal drugs available as vaginal creams, vaginal pessaries and tablets to be swallowed. The creams and pessaries, which you put inside your vagina, may sometimes cause burning and skin irritation similar to the thrush infection itself. This may make it hard to tell the difference between the side effects of the treatment and the symptoms of the infection. You can also get cream to put on the vulval skin to ease the soreness and itching. Many women prefer to take tablets by mouth either as a single dose or two doses on the same day. These may cause more side effects compared to vaginal creams or pessaries and should not be taken if you are pregnant, breastfeeding or taking certain other medicines.
Treatment for thrush can be bought over the counter or prescribed by your doctor. Because you can buy these medications over the counter, it is possible to mis-use the treatment for itching and soreness that is not actually thrush. If the treatment you are using is not working, if you have any doubts about the cause of your symptoms, or if you are pregnant, see your doctor or attend a clinic to get an accurate diagnosis. Inappropriate use of thrush treatments may lead to long-standing vulval problems or make other infections worse.
Thrush is not a sexually transmitted infection, but if women suffer repeated attacks, especially after penetrative sex, it is possible they are being re-infected by their partners. Michele Goldsmith, author of the book Painful Sex, suggests using condoms for a few months to see if the attacks stop. If they do, it may be a good idea for your partner to be examined or tested, and if necessary, treated for thrush before you stop using condoms. Thrush infection does not always cause symptoms in men and may present as balanitis or a non-specific urethritis (NSU).