Vulvar Contact Dermatitis and Its Preventive Care

Introduction

Vulvar contact dermatitis is a common condition in dermatology and women’s health, where irritation of the vulva is a frequent complaint among women. It is characterized by a painful rash wherever an irritant contacts the vulnerable skin. The vulva is the external part of the female genitalia, which includes the labia minora, labia majora, and clitoris. Exposure to irritants such as sweat, urine, and vaginal secretions may cause itching and rashes in the genitalia. This article discusses the symptoms and causes of vulvar contact dermatitis and its preventive care.

What Is Vulvar Contact Dermatitis?

Vulvar dermatitis is characterized by irritated, inflamed, and itchy skin around the vagina. It occurs when the vulvar skin becomes sensitive to contact irritants. In comparison to other areas, the vulvar skin is exposed to many physiologic irritants such as vaginal secretions, sweat, urine, occlusion by sanitary pads, underwear, skin-to-skin contact, and mechanical trauma from scrubbing and sexual activity. It can occur suddenly or get worse with repeated exposures to irritants, such as body soaps, laundry detergents, or feminine products, such as vaginal creams, douches, and wipes. Vaginal contact dermatitis is a frequently diagnosed condition, but its incidence is unknown.

What Are the Signs and Symptoms of Vulvar Contact Dermatitis?

The signs and symptoms may differ based on the cause of the vulvar contact dermatitis. The common symptoms include:

• Pain.

• Moderate to severe itching.

• Tenderness or burning of the vulva.

• Irritation.

• Discomfort or pain during intercourse.

• Swelling of the vulva.

• Weeping (wet feeling in the vulva from damaged skin with fluid seeping out).

The symptoms can get worse when menstruating, sweating at night, and during sexual intercourse.

What Is the Cause of Vulvar Contact Dermatitis?

Vulvar contact dermatitis is caused by contact with irritants to the vulvar skin. It occurs when the person’s skin becomes sensitive to moisture, heat, or other irritants. There are two types of vulvar contact dermatitis:

• Irritant Vulvar Contact Dermatitis - It is the most common cause of vulvar contact dermatitis in prepubertal girls. It occurs when a substance or product irritates the vulvar skin. The irritants include body fluids (vaginal discharge), laundry detergents, feminine hygiene products, excessive washing, washcloths, friction soap, and tight-fitting clothes.

• Allergic Vulvar Contact Dermatitis - It occurs when a person is exposed to a substance he or she is allergic to. According to AAD (American Academy of Dermatology), there are more than 15000 known allergens that can cause dermatitis. The potential cause of allergic vulvar contact dermatitis include perfumes, sanitary pads, lubricants, spermicides, rubber products such as condoms and menstrual cups, and clothing containing azo dyes.

How to Diagnose Vulvar Contact Dermatitis?

Vulvar contact dermatitis has symptoms similar to other conditions, such as psoriasis, lichen planus (a condition causing inflammation of the skin), vulvar cancer, vaginitis (inflammation of the vagina causing itching, discharge, and pain), vulvodynia (pain in the vagina), and vaginal atrophy (drying, thinning, and inflammation of vaginal walls due to low estrogen levels). So it is important to rule out other conditions to make an accurate diagnosis and provide the correct treatment.

The doctor will ask about the symptoms and medical history to diagnose vulvar contact dermatitis. The doctor will inspect the vulva and vagina to look for signs of inflammation and skin damage. An itchy vulva is often a sign of infection. The doctor may test vaginal discharge to rule out bacterial or yeast infections.

The doctor may perform a patch test by exposing the skin to certain allergens. Patch testing is done to identify whether an allergen is causing the symptoms. The doctor may also request a biopsy if the symptoms are getting worse or have no effect of treatment to rule out vulvar cancer or other conditions with similar symptoms.

How to Treat Vulvar Contact Dermatitis?

Vulvar contact dermatitis treatment can be quite challenging. It may involve different doctors from different specialties such as dermatology, gynecology, and physical therapy. The treatment plan may include:

• Elimination of potential offending exposures and irritants that trigger the symptoms. This may involve making drastic changes in a person’s daily routine, sexual practices, and shopping habits but the anxiety produced by these changes can serve as a barrier to patient compliance. Such a response should be anticipated and addressed accordingly by the healthcare provider and ensure the best chance of improvement.

• Symptoms such as itching and burning should be addressed immediately as they are the main reasons for the patient's distress. Over-the-counter antihistamines can be helpful for some patients. For pain, patients can be prescribed Acetaminophen. Topical application of zinc oxide or petrolatum may provide a soothing effect to patients.

• Cold compresses and sitz baths twice a day can help alleviate the pain and itch. Patients should avoid placing the cold compress in the freezer to avoid frostbite.

• Topical corticosteroids can be prescribed to reduce inflammation in the vulvar area. Ointments are preferred over creams because they are less irritating and better absorbed.

• In severe cases of vulvar contact dermatitis, systemic steroids such as Prednisone are administered. Although corticosteroids help in treating the condition, they also cause some side effects. The healthcare provider will have to plan ways to counteract them.

What Are Preventive Measures for Vulvar Contact Dermatitis?

Some of the at-home preventive measures include:

• Refrain from scratching the area.

• Avoid allergens or irritants that trigger symptoms.

• Use a cold compress on the vulvar area.

• Wash new clothes before wearing them.

• Take anti-itch medications.

There are some self-care and hygiene practices for preventing and reducing the risk of vulvar dermatitis including:

Do’s:

• Use sanitary pads that have a cotton liner.

• Pat dry or use a hairdryer to dry the vulva in a cool setting.

• Be cautious of feminine hygiene products.

• Use unscented toilet paper.

• Change the underwear when they are damp.

Don’t:

• Scrub the vulva with the washcloth.

• Douche.

• Use menstrual products containing deodorants or plastic layers.

• Put perfumed oils or lotions on the vulva.

• Use gels, lotions, or gels that are scented.

• Shave the vulva or use hair removal products.

• Sleep in underwear at night.

Which Irritants Should Be Avoided?

Women should avoid some irritants to prevent the development of vulvar contact dermatitis. These include:

• Fabric softeners and dryer sheets.

• Perfumed gels, bath soaps, and lotions.

• Feminine hygiene sprays, powders, and perfumes.

• Laundry detergents with brighteners, enzymes, and whiteners.

• Deodorant pads and tampons.

• Douches (a method of washing inside parts of the body parts such as the vagina).

• Adult wipes.

• Condoms that are prepacked with spermicides or lubricants.

• Nylon underwear or pantyhose.

• Contraceptive jellies, foams, creams, and sponges.

• Bubble baths, gels, soaps, and skin softeners.

• Adults and baby wipes.

• Perfumed or colored toilet paper.

Conclusion

Vulvar dermatitis has multiple causes, but contact dermatitis is the most common cause of it. Along with physiologic symptoms, vulvar contact dermatitis also affects the patient's quality of life. It can be prevented if proper hygiene is maintained and certain self-care measures are taken. While there are many options to address the pain and itch associated with the condition, the only cure for vulvar contact dermatitis is to avoid responsible irritants and environmental exposures.