Allergy
Contact eczema is caused by irritation of the vulvar skin. This usually involves redness and/or itching of the vulva. Sometimes the cause is obvious and you can remedy the irritation yourself. Irritation can be caused by, for example, perfumed or coloured toilet paper, underwear or bathing suits, soap, talcum powder, intimate sprays, panty liners, spermicidal paste and condoms. If necessary, cream or ointment can help. Cold compresses may help briefly against itching. With scratching, the symptoms may persist.

Fungal infection
A fungal infection is the most common infection of the vulva. The cause is often the fungus Candida. Usually, the vagina is also infected. You have an increased risk of getting a fungal infection in diabetes, pregnancy and while taking antibiotics. With Candida, the vulva and/or vagina may be red, itchy, and secrete white, granular material. Sometimes there is a burning sensation when urinating. By examining some of the discharge under the microscope, the doctor can usually tell whether a Candida fungus is present. Occasionally, a hypersensitivity also exists, which can worsen the symptoms. Candida can be treated by swallowing tablets or inserting them into the vulva, by a cream, or by a combination of tablets and cream. Sometimes your partner also needs to be treated.

Sexually transmitted diseases (STDs)
The most common sexually transmitted diseases (venereal diseases) of the vulva are caused by viruses. The best way to prevent venereal diseases is to use condoms. There are two common sexually transmitted venereal diseases of the vulva (see also Sexually transmitted diseases and fallopian tube infection). Genital warts (condylomata) Genital warts are caused by the human papillomavirus (HPV). The warts are often white and pointed but sometimes dark brown, and they can be all sizes. They can be present on the entire vulva, near the anus, in the vagina and on the cervix. This may involve pain, itching or discharge. The warts themselves are highly contagious. There are several ways to treat the warts, such as podophylline or Aldara: a liquid that you yourself or the gynaecologist can apply to the warts. Furthermore, the warts can be frozen after an anaesthetic injection. If there are many warts, 'surgical' treatment with laser beams or burning away may be the best solution. After treatment, however, there is a risk of about 50% of the warts coming back (see also Sexually transmitted diseases and fallopian tube infections).

Herpes simplex
Genital herpes is caused by the herpes simplex virus ( HSV ). First, small clear vesicles develop, which break down after a few days and leave small painful sores. During the vesicles phase, the herpes infection is highly contagious. Herpes is an infection that can recur regularly. Especially the first time, the condition is very painful, especially when urinating. There is no treatment that can kill the virus. However, there is a treatment in the form of ointment or tablets (aciclovir) that can inhibit the virus and reduce the symptoms.

Vulvodynia
Vulvodynia literally means: pain in the vulva. It is a collective term for chronic complaints to the vulva with no obvious cause: it involves a burning sensation, itching, irritation and/or pain. Sometimes there are also skin abnormalities. The condition can exist on the entire vulva (as in atrophic vulvitis) or on a small area (as in vulvar vestibulitis syndrome).

Atrophic vulvitis
After menopause, the skin of the vulva becomes thinner (atrophy) and inflammation occurs easily (atrophic vulvitis). Often, the vagina is also inflamed (vaginitis). The main symptoms are burning and itching. The cause is that after menopause, the body makes less oestrogen; oestrogen is needed to build up the lining layer. The symptoms can be easily remedied with tablets, cream or with vaginal suppositories containing oestrogens.

Essential vulvodynia
The vulva may also hurt, constantly or occasionally, without any abnormalities showing. This is rare, really only in older age. Amitriptyline tablets can sometimes give improvement.

Vulvar vestibulitis syndrome, focal vulvitis
A syndrome is a fixed combination of symptoms. In vulvar vestibulitis syndrome, pain is the main complaint. Often, small red spots can be seen at the bottom of the vulva, which are painful when touched. There is often increased tension of the pelvic floor muscles, with the vulva becoming less moist during intercourse. Sometimes this syndrome occurs after a long-term infection of the vulva (such as a fungal infection), sometimes the cause is a less pleasant experience sexually or physically. Especially if this syndrome has existed for a long time, treatment can be difficult. If itching persists, improvement can sometimes be achieved by using a cream or by surgery. If necessary, treatment can be continued with a sexologist (see also the brochure Sexual problems in women), with a psychotherapist or with a physiotherapist specialising in the pelvic floor muscles, in collaboration with the gynaecologist.

Skin abnormalities
Some abnormalities can be a precursor to malignancies. They are called premalignant lesions.

Lichen sclerosus
In lichen sclerosus, the skin of the vulva becomes thinner ( atrophicus ) or thicker ( sclerosus ), white ( lichen ) and shiny. Sometimes parts of the vulva may coalesce, become smaller or even disappear. Lichen can occur on the entire vulva and around the anus; it does not occur in the vulva. Usually, itching is the main complaint. Community may be painful or even impossible. The cause of lichen sclerosus is not known. The condition can occur at all ages. Lichen is not contagious.

For diagnosis, a piece of tissue is taken and examined under the microscope. Lichen sclerosus cannot be cured, but the itching can be treated well with a cream containing adrenal cortex hormones (corticosteroids). You should use this cream in close consultation with the doctor because if used too liberally, the healthy, surrounding skin can sometimes become too thin and therefore fragile. The abnormality can possibly turn into cancer over the long term; this happens in about 6%. So if you develop sores or new thickened areas in the vulva, inform the gynaecologist. If necessary, another piece of tissue will be taken. It is therefore necessary that you remain under observation. Self-examination of the vulva is also useful (see below).

Vulvar intraepithelial neoplasia (VIN)
Intraepithelial neoplasia literally means new tissue forming in the skin, in this case the lining of the vulva. In the condition under discussion, there are many types of skin abnormalities: sometimes warts, sometimes sores or swellings. The colour can vary from white, pinkish-red to brown. VIN is sometimes a preliminary stage of vulvar cancer. There may be itching, sometimes pain, but there may also be no symptoms. Again, tissue is taken for microscopic examination. It is not always necessary to treat VIN. Treatment depends on the symptoms and the extent of the abnormality. There is a distinction between mild, moderate and severe abnormalities. In severe abnormalities that are not treated, the risk of malignant development over time is about 9%. If it is decided to remove the abnormality, it is usually done with laser treatment or by surgery. After treatment, there is an approximate 50% chance of the condition coming back. It is therefore important that you check the vulva regularly yourself, contact the gynaecologist if there are any changes, and remain under observation.

Paget's disease
In Paget's disease (pronounced Peedzjet), there are red and white marbled patches on the vulva, often also on the perineum and around the anus. Usually there is itching and burning. The disease is not contagious. The cause of Paget's disease is unknown. For diagnosis, a piece of tissue is examined microscopically. Treatment is surgery to remove the abnormalities. Discuss with your gynaecologist in more detail exactly what is involved. Paget is a preliminary stage of vulvar cancer. So here too, careful monitoring by yourself and the gynaecologist is important.