We often shy away from talking about caring for the skin in our nether regions yet it’s a very important part of our regular routines.  Many women think any little itch or irritation is a yeast infection and turn to over the counter treatments quickly.  However, many times it is not a yeast infection and these treatments could actually make the condition worse.

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There is a lot to cover on this topic so I’ve broken it down into three parts.

Part 1 – Common Complaints – the top 7

Part 2 – Gentle care down there

Part 3 – The male Version

In Part 1 of this series I’m covering the top 7 complaints ‘down there’.  Before we get into the specific list I think it is important to point out that many of these conditions have similar symptoms so if the condition persists after at-home treatment or is severe from the start, only a trained doctor can make a correct diagnosis and prescribe treatment.  Symptoms will usually fade quickly once treatment begins, bringing much relief.

1.  Yeast Infection – Medically termed candidiasis, this is an infection caused by yeast on the skin and/or mucous membranes.Yeast is completely normal in the digestive system and vaginal area but can lead to an infection in certain conditions (especially when skin is damaged, in warm and humid conditions, and when the immune system is compromised). Antibiotics lead to a growth of yeast because they kill normal bacteria so that yeast can grow.  The symptoms of a yeast infection vary based on the person and the area of the infection.In women suffering from a yeast infection in the vaginal area, there will be white or yellow discharge from the vagina along with itching, redness and burning on the vaginal skin.

There are a number of over the counter treatments that can effectively treat a yeast infection.  However, the symptoms of a yeast infection can resemble many other skin conditions so consulting a doctor for a diagnosis is important.  A doctor will complete a medical history and physical exam and may scrape off a skin sample to confirm the diagnosis.  Most yeast infections will be treated effectively with a medicated ointment like Monistat but in severe cases an oral anti-yeast medication may be prescribed.   

Candida Intertrigo is a yeast infection of skin folds that is caused by a specific type of yeast.  Areas of the body that have skin touching create a skin fold (groin area, under heavy breasts, fat folds) and provide a warm and moist area (breeding ground for yeast).  Hot and humid weather can contribute to this condition.  Wearing loose, comfortable underclothing and proper hygiene is usually enough to help prevent this condition.  If you find yourself with redness and irritation in fold of your skin, a dermatologist can help to diagnose, treat and offer tips to manage the area to prevent the condition in the future.

2.  Folliculitis – This is a very common skin condition which occurs when hair follicles become inflamed.Typically caused by bacteria or by significant irritation of the follicles (i.e after waxing), it usually appears as small red bumps or white-headed pimples around hair follicles (which are the pockets from which hairs grow). A mild case of folliculitis will usually clear on its own if you follow basic self-care measures.Sometimes the infection will spread and result in crusty sores that don’t heal on their own.

If you have a mild case of folliculitis, gentle care of the area should result in quick improvements.  Self-care of the area includes gently washing the infected skin twice a day with an antibacterial soap, and soothing lotion or hydrocortisone cream to help relive itchy skin. If you have folliculitis it is best to avoid shaving if possible but if you must shave try an electric razor and moisturize well afterwards.

More severe cases of folliculitis will require an antibiotic. I usually start by giving my patients a topical antibiotic, but sometimes oral antibiotics are needed.   There are many different types of folliculitis, which range from superficial (limited to the skin) to deep infections that involve the entire hair follicle.  A doctor can examine the infected area and prescribe treatment based on the symptoms.

3.  Allergies – Allergic contact dermatitis that affects the genital area is commonly caused by fragrances, preservatives or rubber.These allergies aren’t always easy to diagnose but the patient will usually notice a pattern of irritation after exposure to the allergen.

Although rare, it is possible for women to be allergic to male semen.  If you notice redness, swelling, itching and burning when semen contact skin then an allergy is likely the cause.  Minimizing contact with semen is suggested to minimize reactions but doctors can also help to desensitize you to the allergen.  It is also possible to have a latex allergy and because most condoms are made of latex you may notice irritation following condom use.

A lot of people also have allergies to certain fragrances that are used in laundry detergent, body wash and lotions.  These are more difficult to identify but sticking to fragrance free products will help to limit any reactions.

4.  Vaginal Eczema – Often mis-diagnosed as a yeast infection, vaginal eczema can cause intense itching and burning in the vaginal area.Your history of eczema, allergies, and cleaning habits will help to diagnose vaginal eczema.Typically vaginal eczema will present with redness, scaling, cracking and thickening of the skin.There are two important elements when treating vaginal eczema.First, you need to avoid scratching the area so that irritation can heal.A mild topical steroid can be used to can help to relieve itching. In severe cases a stronger corticosteroid ointment can be very effective. The second element of treatment addresses caring for the skin.Gentle skin care is a must. Baby wipes should absolutely be avoided, as they can worsen eczema and cause contact allergies as should harsh soaps. Great care should be made to avoid excessive cleansing of the area (which people are more inclined to do when they feel like they have a problem down there).Given the sensitive nature of the area and the intensity of vaginal eczema it is important to consult with a doctor for the proper diagnosis and treatment.

5.  STDs – Sexually Transmitted Diseases.There are a number of STDs that could be causing vaginal irritation and a doctor is the only one that can make the official diagnosis.The STD’s that most often cause vaginal irritation (itching, redness, bumps) are Chlamydia, Gonorrhea, Herpes Simplex, HPV (genital warts), Syphillis, and Trichomoniasis. If you suspect that you have an STD, stop all sexual activity and see your doctor immediately for treatment. Be sure to check out Part 2 of this series where I delve into STDs in more detail. 

6.  Molluscum Contagiosum is a skin infection caused by a virus.The virus is spread through skin-to-skin contact as well as through contact with infected surfaces so can be spread during sexual activity, towels, washcloths etc.The bumps associated with Molluscum will usually appear within 2 to 6 weeks of coming into contact with the virus and will appear as small, smooth, round pearly bumps (with a noticeable dimple in the middle).When these bumps appear in the genital area, treatment is often necessary to prevent spreading the virus through sexual contact.Treatment options include freezing, scraping, or a prescription cream.If you suspect that you have molluscum, avoid sexual contact until you have had a chance to discuss with your doctor.

7.  Lichen Simplex Chronicus – Caused by persistent itching and scratching of the vulvar skin, lichen simplex chronicus results in thick, leathery, brownish skin.This condition can be the result of minor irritations or sometimes may be a result of psychological stress or environmental factors.Breaking the itch-scratch cycle is key to the treatment of this condition. Vulvar lesions can be treated with a mild topical corticosteroid which will help to manage the condition.

If you struggle with dry, itchy skin in the winter be sure to check out this blog post. I’ve got tips to ease the itch and a GREAT Giveaway.

Stay tuned for the next part of this blog that will take you through a gentle care routine for ‘down there’.

Part 2 – A deep dive into Sexually Transmitted Diseases