Even though they can have a huge impact on your sexual health and wellness, it wasn’t until quite recently that vulval and vaginal problems received much attention from wellness experts. In the past 10 years, many doctors have tried to develop theories and treatments for these distressing conditions, but many chronic vulvo-vaginal symptoms remain misunderstood, leading to a number of confliction opinions as to their causes and remedies.
According to specialist dermatologist Dr Gayle Fischer and specialist gynaecologist Dr Jennifer Bradford, who conduct a joint private clinic where they see women with complex vulval conditions, ‘Many women suffer in silence from annoying and distressing vulval symptoms, either because of embarrassment or because they believe (or have been told) that nothing can be done to help. We have known patients whose stories went back 25 years or more.’ There is a variety of forms that vulval discomfort can take, including itching, burning, pain, soreness, cutting, ripping, swelling, lumps, ulcers and vaginal discharge. Fischer and Bradford point out, ‘It is important to understand that a particular symptom does not necessarily mean a particular diagnosis. For example, many women believe that an itch always means that they have thrush (candidiasis, monilia). This is just not true. In fact, we have found that any vulval symptom may be due to just about any vulval diagnosis.’
Fischer and Bradford note, ‘A particular feature of vulval problems is that discomfort can often remain unnoticed until it becomes severe. This is why a patient will often state that her primary concern is painful sexual intercourse, and is surprised when we show her (using a mirror) how badly inflamed her vulval skin is. Some women with badly inflamed vulval skin do not even notice discomfort on entry to their vaginas, but will seek help from their doctors only when they have deep dyspareunia (abdominal pain during sex because of pelvic muscle spasm). These women are not ‘neurotic’: the natural lack of pain sensation in their vulval and vaginal regions has allowed the inflammation to become severe without their realising it.’
You might find that your vulval discomfort may be worse at a particular time of the month, especially if you’re on your period. ‘We think that this ‘cycling’ discomfort is usually due either to thrush or to an allergy to the body’s natural oestrogen production,’ Fischer and Bradford detail. ‘Oestrogen allergy is something that you may not have heard of. It has been suspected for some time, and recently proven to exist by research done by Dr Fischer and her colleagues. It should be stressed, however, that the oral contraceptive pill does not cause or exacerbate an oestrogen allergy, which is caused by a woman’s own natural oestrogens.’
Even though you may be experiencing a lot of discomfort in your vulval area, it’s common to be told by your doctor that he or she cannot see any visible abnormality. Fischer and Bradford explain, ‘We believe that almost all vulval problems are due to various types of skin disorders: the problem with recognising these skin problems is that they do not look the same as when they occur on “outside” skin, for example, the hand. 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 more subtle. This is why many doctors may think that your vulval skin looks “normal”, when in fact there may be a subtle (but still significant) rash on it.’ Nonetheless, Fischer and Bradford recommend that if you do have discomfort in this area, you should consult your GP or, failing that, a specialist dermatologist or gynaecologist.
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