Vulvar Skin Care

Why do we care about vulvovaginal health in urology?

Urological conditions often coexist with vulvovaginal conditions.

For example, reduced estrogen levels associated with menopause, some birth control pills, and during breastfeeding can result not only in vulvovaginal dryness but can also contribute to urinary urgency / frequency and increase the risk of urinary tract infections. Another example is women with urinary incontinence who may experience vulvovaginal irritation from urine, pad materials, frequent wiping and washing, as well as chemicals in cleansers / soaps.

So, treatment of these urological conditions must also take into account vulvovaginal health.

The following is general advice. A diagnosis requires evaluation by your health care provider.

Related topics include Vaginal Estrogen & Lower Urinary Tract Function and Urinary Tract Infections Urinary Tract Infection Fact Sheet

General Care

Keeping the vulvar skin healthy involves:

(1) Identifying and avoiding irritants
(2) Avoidance of over-washing
(3) Protection from unavoidable irritants
(4) Treating underlying conditions.

It is important to treat the vulvar skin gently…as you would your face!

What to Avoid

  • In general, avoid products with multiple ingredients, even those that are designed for vulvar care as many contain chemicals that could irritate or cause contact dermatitis.
  • Common vulvar irritants
    • Over-washing
    • Soaps, bubble baths, vaginal douches (commercially available products and yogurt)
    • Wetness (urine, feces, menstruation, sweat)
    • Panty liners, pads including the adhesives
    • Nylon underwear, chemically treated fabrics
    • Perfumes
    • Talcum powder, deodorants
    • Alcohol, astringents
    • Creams with drying bases, lanolin
    • Nail polish
    • Spermacides
  • Common vulvar allergens
    • Benzocaine (in Vagisil)
    • Chlorhexidine (in KY Jelly)
    • Neomycin (Neosporin antibiotic ointment)
    • Imidazole antifungal
    • Latex (condoms, diaphragms)
    • Preservatives: e.g. propylene glycol, some wipes and paper products contain methylchloroisothiazolinone / methylisothiazolinone
    • Trichloroacetic acid
    • 5FU
    • Tea tree oil
  • Treat existing skin conditions
    • Genitourinary Syndrome of Menopause / “vaginal atrophy” (see Estrogen & Lower Urinary Tract Function)
    • Dermatologic conditions: lichen sclerosis, lichen planus, eczema, lichen simplex, psoriasis, vulvar pain syndromes
    • Vulvovaginal infection
    • Vulvar malignancy

How to Wash

  • Frequency: Once per day should be sufficient. Avoid excessive rubbing / scrubbing (do not use an abrasive wash cloth or sponge)
  • Cleanser products:
    • Warm (not hot) water alone is often sufficient
    • Conventional soaps and body washes can produce irritation
    • A “non-soap” unscented, non-alkaline cleanser (may be labeled as a facial cleanser) such a CeraVe Foaming Facial Cleanser, Hydrating Daily Face Wash or Baby Wash and Shampoo, Cetaphil Gentle Skin Cleanser or Facial Cleanser, Cliniderm Gentle Cleanser, Aveeno products, are readily available at most drug stores or on-line
    • If soap is preferred, it should be unscented and labeled “hypoallergenic”
    • A simple emollient can be used as a soap substitute
    • Avoid: Fragrance, essential oils, most wipes, vaginal douches and hygiene sprays. Instead of a wipe consider using a spray bottle with plain water, and then pat dry.

How to Protect

  • Using a moisturizer on the vulvar skin daily can help heal and protect irritated skin. After washing, when the skin is warm and slightly moist, apply the moisturizer using your fingers to the labia (inner and outer lips) , entrance to the vagina, and the perineum (area between the vagina and anus).
  • Moisturizer products:
    • Any unscented general emollient such as CeraVe Daily Moisturizing Lotion and Baby Moisturizing Lotion, Cetaphil Moisturizing Lotion, Cliniderm Soothing Cream and Lotion, Glaxal Base Moisturizing Cream, Aveeno products, Lubriderm products.
  • Barrier creams.
    • When the skin is more severely affected and in cases of contact with urine and pads, a barrier cream is useful. Options: Vaseline, CeraVe Baby Healing Ointment, Cetaphil Barrier Cream, zinc oxide based products for (often for baby diaper rash) such as Desitin, Penaten, Ilhe’s paste, Sudocrem.

Sanitary Products and Underwear

  • Cotton underwear that breathes is best. Avoid synthetic and chemically treated fabrics. Loose clothing will minimize abrasion and maximize air-flow.
  • Cotton pads and tampons are best (e.g. Natracare, Organyc, Seventh Generation).
  • Reusable cotton pads (e.g. Gladrags, Lunapads) and “period underwear”/”incontinence underwear” are more readily available these days (e.g. Knix, Thinx).
  • Menstrual cups eliminate the need for pads/tampons: Diva Cup (silicone), Moon cup (silicone), Keeper cup (contains latex).

Sexual Activity

  • Lubrication is important for reducing friction from penetrative intercourse. Apply to the external vulvar skin as well as to the entrance to the vagina just before sex.
  • Look for products that are free of alcohol, glycerin, parabens, petroleum, fragrance, and avoid those with “cooling” or “warming” sensations.
  • Water based options: Astroglide for Sensitive Skin, Good Clean Love, Slippery Stuff, Sliquid, Yes
    • Water based lubes can dry out quickly and some contain more preservative which can cause skin irritation.
  • Silicone based options: Uberlube, ID Millennium, Wet Platinum.
  • Oil based option: Yes
    • It is important to note that oil based lubes can break down condoms.
  • Non-hormonal vaginal moisturizers: Gynetrof, Replens, Repagyn, Mae, Zestica.

References
Haefner, H. The Latest in Vulvar Dermatoses. University of Michigan Center for Vulvar Diseases. December 2016.
The V Book, by Elizabeth G. Stewart, M.D., and Paula Spencer (Bantam Books, 2002).
2014 UK National Guideline on the Management of Vulval Conditions. British Association for Sexual Health and HIV.