Vulva Conditions
What is the vulva? The external female genital area is called the vulva. The outer folds of skin are called the labia majora and the inner folds are called the labia minora. What conditions affect the vulva? Folliculitis Small, red bumps caused by bacteria that infect a hair follicle, which can occur from hair removal. Folliculitis often goes away by itself. Contact dermatit
What it is
Common vulval conditions include lichen sclerosus, lichen planus, vulvodynia, vulval intraepithelial neoplasia (VIN), chronic candidiasis, contact dermatitis, and (rarely) vulval cancer. Diagnosis is by directed examination and (where indicated) punch biopsy.
When this is relevant
- Persistent vulval itching, soreness or burning.
- Vulval skin colour change - white patches, redness, thickening.
- Painful intercourse with vulval pain (not deep pelvic pain).
- Visible lesion, lump or ulcer - prompt assessment essential.
- Recurrent thrush diagnoses without confirmatory swabs.
How we investigate
Detailed history, vulvoscopic examination, vulval swab (bacterial, fungal, viral), punch biopsy under local where any suspicious area is identified, blood tests for autoimmune screen where lichen planus or lichen sclerosus is suspected.
Options at The Vesey
- Lichen sclerosus - super-potent topical corticosteroid with structured tapering and long-term maintenance.
- Vulvodynia - topical lidocaine, amitriptyline, gabapentin, pelvic floor physiotherapy, psychology where appropriate.
- Confirmed candidiasis - extended fluconazole course; investigate underlying drivers.
- VIN - imiquimod or excision depending on the type and grade.
- Vulval cancer pathway - direct gynae-oncology referral with full workup.
- Emollient and skincare advice - sometimes the most under-used intervention.
What is lichen sclerosus and can it be cured? +
Lichen sclerosus is a chronic autoimmune skin condition causing white, itchy, fragile patches on the vulva. It cannot be cured but is very effectively controlled with a structured super-potent topical steroid regimen. Long-term maintenance treatment reduces the risk of scarring and the small associated risk of vulval cancer.
Is vulvodynia the same as pain on contact only? +
Vulvodynia includes both provoked vulvodynia (pain on touch, tampon use or penetration) and spontaneous vulvodynia (burning or rawness without any trigger). It is a diagnosis of exclusion — made after infection, skin disease and structural causes have been excluded. Management includes topical treatments, low-dose antidepressants, physiotherapy and psychology.
Do I need a biopsy to diagnose a vulval condition? +
Not always. Many common conditions — candidiasis, contact dermatitis, lichen simplex — are diagnosed clinically. A punch biopsy under local anaesthetic is recommended when the diagnosis is uncertain, when the appearance is atypical, when VIN or malignancy needs to be excluded, or when a suspicious lesion is present.
Can vulval intraepithelial neoplasia (VIN) become cancer? +
Usual-type VIN (associated with HPV) carries a 5–10% risk of progression to vulval squamous cell carcinoma if untreated. Differentiated VIN (associated with lichen sclerosus) carries a higher progression risk. Treatment by imiquimod cream or surgical excision is recommended for confirmed VIN, with long-term surveillance.
Pricing at a glance
Initial consultation £260. Vulval biopsy under local from £180. Topical prescription review at follow-up £150. Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
Book an appointment
When to book
Book if you have chronic vulval symptoms, a visible skin change, or have been told "it's just thrush" without an examination and swab.
Cost and pathway
Initial consultation £260. Vulval biopsy under local from £180. Topical prescription review at follow-up £150.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our gynaecology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
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Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
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