Skin care advice for women with vulval skin problems

Many skin conditions cause vulval problems. Although most people think of thrush first, they don't always get better with an antifungal cream. Before you apply one of these products, try the following first. If you have a diagnosed vulval skin disease, these instructions will help you feel better.

Hygiene

Vulval skin conditions are very unlikely to be a hygiene problem, but overuse of soap will aggravate and even cause skin rashes on the vulval skin. Soap, abrasives, washes and wet wipes should be avoided. A soap substitute such as aqueous cream or a proprietary soap-free cleanser should be used for washing.

When having a bath, as well as avoiding soap, do not use bubble bath, perfumed oils and antiseptics. It is safe to use an unperfumed bath oil or salt. Saline made by adding 2 teaspoons of salt to a litre of water is useful if your skin is inflamed. It can be mixed in a bowl and then applied on a wad of cotton wool or a soft flannel.

After washing, dry gently and avoid rubbing with a towel.

Do not have hot baths. Cleanse the area gently with salt water as often as you need to during the day if this is soothing (in a warm bath if this is easiest).

General management

It is very important only to apply what your doctor recommends. Even if you are desperate don't try things from the bathroom cupboard.

Avoid nylon underwear, including pantyhose, G-strings and tight pants. Wear loose fitting cotton underwear and loose fitting trousers or skirts. At night time, sleep in loose pyjamas or nighties with no undies on. Avoid perfumed products, feminine sprays and antiseptics. If possible, use tampons rather than pads. A panty liner without a plastic backing is better than one with. Use hypoallergenic toilet paper and do not rub vigorously with the paper.

There are some substances that you could be allergic to:

• Toilet paper
• Lubricants
• Any medication, either prescribed or over the counter
• Perfumed products
• Antifungal creams and pessaries
• Antiseptics
• Nail polish
• Latex condoms (Hypo-allergenic PVC ones are available from chemists and supermarkets)
• Semen

If you suspect that any of these things make you worse, avoid contact with them. If you think you have a problem with semen, discuss this with your doctor.

Sexual function

Most patients with a vulval problem have found that it has interfered with their sex life in some way. Sexual arousal may be less easy leading to anxiety, dryness and sometimes painful vaginal spasm. It is normal for women to take longer to become aroused than men and it is important not to attempt intercourse until aroused.

Don't attempt penetration if it is causing pain. Wait until your problem has settled completely before having sex again. It is possible to have a sex life without penetration and you need to discuss this with your partner. Your doctor or therapist can give advice too.

It is possible to use a lubricant but avoid gels. They can sting and may contain antiseptics. A proprietary water based lube is best. Sometimes women with sensitive skin find that any lube stings. In this case saliva or vegetable oil (e.g.olive oil) may be an alternative. NOTE: Do not use oil based lubes if you are using condoms, as the oil may cause the condom to rupture. Talk to your doctor about suitable preparations.

Remember that you may need ongoing care for your vulval condition. Forgetting about treatment may lead to a relapse so it is important to make your treatment part of your daily routine.

Ask your doctor for management plans for routine treatment and flares of your condition. Unless you have had thrush before and are quite sure of the diagnosis, see your doctor before obtaining antifungal creams from the chemist and self-medicating!