Vulvar and Vaginal Health
Itching, irritation, unusual discharge, or pain ‘down there’? Your vulva and vagina are powerful, sensitive, and often misunderstood. Because what affects one often affects the other, we treat them as a connected system. At WHA, our providers help you find the cause and the right treatment for real relief.
Answers without awkwardness
The word “vagina” is often used to describe the entirety of the female genitalia. But it’s not quite accurate. The external parts—the labia (inner and outer lips), clitoris, vaginal opening and urethral opening—are called the vulva. Vagina refers to the internal parts.
We often refer to this as vulvovaginal health, because the health of the internal vagina and external vulva can be related. And one of the most common questions people have is: does my vulva look normal? Quite simply, there’s no single way a healthy vulva should look; they come in all shapes and sizes. There’s also no one “right” odor, despite what certain products may try to sell, or a “correct” amount of discharge. Vulvas and vaginas can vary in so many wonderful ways:
- Shape, size, and color: Vulvas are as individual as faces. Labia can be short or long, symmetrical or not. Skin color and texture differ from person to person.
- Pubic hair: This is entirely personal—whether it’s thick, sparse, gray or not there at all. (There’s no medical need to remove it, but if you shave, avoid scented products and harsh exfoliants to protect vulvar skin.)
- Discharge: Vaginal discharge changes throughout your menstrual cycle. It may start out clear or white and become more yellow before your period begins. Pregnancy, perimenopause, illness and infection can also cause changes in discharge.
- Scent: A healthy vulva has a mild, unique-to-you scent, which can change from hormones, sweat, sex or even what you eat. A sudden strong odor may be a sign of infection.
- Vulvar bumps: The vulva is covered in hair follicles and sweat glands, so it’s naturally a bit textured, making it perfectly normal to have some bumps. If anything is new, itchy, discolored or painful, visit your provider.
- Vaginal environment: A healthy vagina has its own ecosystem, or microbiome, with a naturally acidic pH. This environment is what creates normal discharge and protects you from infections. It’s not meant to be sterile or scent-free.
When it comes to “normal” vulvas, vaginal discharge or scent, what matters most is knowing what’s normal for you. If whatever that is changes, check in with your provider. There are many types of vulvar and vaginal conditions, and they can happen to anyone at anytime. But they’re largely treatable and definitely nothing to be ashamed of.
At WHA, we take any concern seriously, judgment-free. We’ll listen to figure out what’s going on and make a plan that brings you relief from whatever you may be experiencing.
Vulvar and vaginal conditions can be annoyingly hard to understand or pin down. Especially since “normal” is such a spectrum. But there’s nothing normal—even if common—when it comes to irritation or pain.
Primarily vulvar skin conditions
While highly resilient, vulvar skin can be extra sensitive and just as prone to reactions as the skin on other parts of your body. Many of the most common vulvar skin conditions can be treated (and prevented) at home.
- Contact dermatitis: Presenting as redness and itching, this one’s triggered by soaps, laundry detergents, condoms, lubricants and other irritants and allergens.
- Lichen simplex chronicus: Repeated vulva scratching—often from chronic irritation caused by allergens—can lead to skin that becomes thick, dry or darker in color.
- Folliculitis: After shaving or waxing, you may notice small, irritable bumps courtesy of inflamed hair follicles.
- Sebaceous cysts: These pop up when a hair follicle or skin pore gets blocked from clothing friction, too much moisture or as a reaction to shaving.
- Milia skin bumps: These tiny white or yellowish bumps are caused by protein trapped under the skin surface, usually from irritation or thick creams that block pores.
- Lichen sclerosus: Most common after menopause, this chronic inflammatory skin condition causes thin, white, fragile patches of skin that might be itchy or painful.
Primarily vaginal conditions, sometimes with vulvar symptoms
- Yeast infections: You’ll first notice a yeast infection as a burning and/or itching sensation during urination or simply when walking around. Despite what you may know, they don’t always include a cottage cheese-like discharge.
- Bacterial Vaginosis (BV): Though sometimes confused with yeast infections, BV happens when there’s an overgrowth of certain types of bacteria often caused by a disruption in the vaginal balance. This typically leads to vaginal discharge that’s thin, gray and fishy smelling, accompanied by itching or burning.
- Atrophic Vaginitis / Genitourinary Syndrome of Menopause (GSM): When estrogen levels drop (especially during and after menopause), vaginal tissues can become thin, dry, and less flexible. This can cause dryness, burning, and pain with sex (dyspareunia).
- Common sexually transmitted infections (STIs)
- Herpes: This common viral STI can cause painful sores or blisters on the vulva or around the vagina.
- Trichomoniasis: Caused by a parasite, this STI often leads to itching, burning, and a frothy, yellow-green discharge with a strong odor.
- Human Papillomavirus (HPV): Certain low-risk strains of HPV can cause genital warts. These typically appear as painless, skin-colored or whitish bumps on the vulva, in or around the vagina, or on the cervix. They can be flat or raised, single or in groups, and sometimes have a cauliflower-like texture.
- Chlamydia & Gonorrhea: These common bacterial STIs are often asymptomatic, which is why appropriate screening is so important. When they do cause symptoms, they can include an increase in vaginal discharge, a change in its color (often to yellow or green), and burning or pain with urination. Left untreated, they can lead to more serious issues like Pelvic Inflammatory Disease (PID).
Conditions involving pain and other symptoms
Vulvar pain varies by the cause, and may only show up during certain activities (like sex or while urinating). Other times, it’s always there (but doesn’t have to be). Here are some of the common vulvar pain conditions we treat:
- Urinary Tract Infections (UTIs): UTIs usually feel like a burning sensation near the urethra or show up as a constant urge to go.
- Vulvodynia: There isn’t always a clear cause of this chronic vulvar pain issue. It may feel raw or sensitive, and be extra painful with penetration.
It’s normal to question if vulvar discomfort might be a sign of something serious. If you experience swelling, unusual discharge, bleeding, any vulvar pain symptoms or sores that spread or don’t heal, make an appointment with a provider.
Our goals for treating vulvar and vaginal health conditions are pretty simple: relieve symptoms and help you feel comfortable in your body again. So don’t stress about finding the right words to describe what’s going on when you make an appointment. Your provider will simply want to chat through your symptoms, ask about your health history and maybe take a swab, urine test or biopsy depending on what we suspect is happening.
When in doubt, the best way to prevent and treat any vulvar irritation and maintain healthy vulvar and vaginal hygiene is gentle, fragrance-free care. Be mindful of the products you choose (for periods, sex and otherwise), opt for breathable clothing and skip douching or any internal products promising ‘freshness.’ A healthy vaginal microbiome is self-cleaning and essential for preventing infections.
If you develop a vulvar or vaginal condition or infection, your provider might recommend:
- Topical medications: We might use a steroid or estrogen cream to calm inflammation and treat conditions like contact dermatitis or a prescription estrogen cream to restore tissue health.
- Oral medications: Antifungal treatments for a yeast infection, antibiotics for infections like bacterial vaginosis, chlamydia, gonorrhea, or trichomoniasis, and antivirals to manage herpes outbreaks.
- Vaginal moisturizers and lubricants: For symptoms of dryness or pain with sex caused by hormonal changes, these non-hormonal options can provide significant comfort and relief.
- Lifestyle changes: If products are to blame, we’ll suggest avoiding scented soaps, adjusting your shaving routine or even trying new underwear to ease any irritation.
If your symptoms point to it, we may also suggest:
- In-office procedures or prescription creams for genital warts: If you are diagnosed with genital warts from HPV, treatment might include prescription creams you apply at home or simple in-office procedures like cryotherapy (freezing) to remove the warts.
- Pelvic floor physical therapy: This is best for pain tied to nerve sensitivity or tight pelvic floor muscles, like with vulvodynia.
- Long-term condition management: If symptoms are related to perimenopause or low estrogen, we can talk about vaginal estrogen or other hormone-based therapy to support your comfort.
No matter what it is, we’ll help treat it and, hopefully, prevent it in the future, too. The vulva and vagina are mighty workers, so they’re bound to go through some ups and downs. When you need care, seek it. You should never feel embarrassed by looking out for your body.
Care for You
Let’s talk about it
Related Providers
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Nurse Practitioner/Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Women's Health | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | External Hospital-Only Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | External Hospital-Only Nurse-Midwife
Midwifery | External Hospital-Only Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Gynecology | Minimally Invasive Surgery | Physician and Surgeon
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Gynecology | Physician and Surgeon
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Gynecology | Physician and Surgeon
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Midwifery | Certified Nurse-Midwife
Gynecology | Physician and Surgeon
Midwifery | Certified Nurse-Midwife
Gynecology | Physician and Surgeon
Midwifery | Certified Nurse-Midwife
Additional Resources
Accepted Insurance
WHA takes Medicaid, Medicare and most commercial insurance plans. Check the list of insurance companies WHA is contracted with here.
ACOG Disorders of the Vulva
From the American College of Obstetricians and Gynecologists, answers to frequently asked questions about vulvar health and care options.
ACOG Patient Resources
From the American College of Obstetricians and Gynecologists, find links to frequently asked questions on a wide range of women's health, pregnancy and childbirth and gynecology questions.
Advocates for Youth
Online resources for parents.
Anemia in Pregnancy
Michael P. Smrtka, MD. Perinatal Progress, Volume 9, Number 1. April, 2016.
Antenatal Surveillance Guidelines
July 2021
Approach for Determining Gestational Age
August 2013
Baby Center
A comprehensive online resource for pregnancy and parenting, offering expert articles, week-by-week guides, community forums and tools.
Bedsider
A website about birth control and STDs.
Billing and Collection Practices
What you need to know--before you need to know it.
Billing and Payments During Pregnancy
Expecting parents often have questions about how much care may cost, how much they may be responsible for and when payments will be due. Here's a handy summary of how it all works!
Breastfeeding Articles
It's International Breastfeeding Week and we've collected all of our past blog articles here.
CDC.gov
The website of the Centers for Disease Control and Prevention – this is a great resource for vaccination and disease screening and prevention recommendations.
CDC.gov – Pregnancy
Particularly useful for steps you can take to reduce your risk of problems.
Cell-free Fetal DNA in Maternal Blood
Thomas Lee, MD and Wendy Busch, MS, CGC. Perinatal Progress, Volume 5, Number 1. September 2012.
Checking Your Insurance Benefits for Genetic Testing
Information to help you check your insurance coverage and benefits for genetic screening.
Comfort Measures and Over-the-Counter Medications During Pregnancy
From allergies and backaches to constipation, gas and heartburn (fun!), here are safe strategies for coping with or treating what ails you during pregnancy--straight from our providers!
Contemporary Management of Sonographic Aneuploidy Markers
2018-09-20; Thomas Lee, MD, MBA, 16:17
COVID-19, Pregnancy, and Breastfeeding (ACOG)
The latest information from the American College of Obstetricians and Gynecologists on COVID-19.
Delivery of Twins
2018-09-20; Lisa Farkhouh, MD, 14:12
Diabetes Mellitus
Barbra M. Fisher, MD, PhD
Perinatal Progress Volume 11, Number 1
April 2018
Diabetes Mellitus Quick Reference Guide
April 2018
Endometriosis Foundation of America
A nonprofit focused on endometriosis awareness, education, advocacy and research that also offers opportunities to get involved with events and community support related to this chronic reproductive health condition.
Enfermedad por coronavirus (COVID-19), embarazo y lactancia (ACOG)
La información más reciente del Colegio Americano de Obstetras y Ginecólogos sobre COVID-19.
Especially for Teens
A resource from the American College of Obstetricians and Gynecologists.
Fundamentals of Obstetric Ultrasound
Thomas Lee, MD, MBA
Perinatal Progress Volume 11, Number 2
August 2018
Genetic Carrier Screening
2018-03-21; Karen Hansen, MS, CGC; 15:11
Genetic Testing
2018-01-24; Karen Hansen, MS, CGC, 16:24
Genetic Testing Specifications
August 2014
Gestational Diabetes – Insulin Made Simple
2018-01-24; Michael Smrtka, MD, 14:49
Getting Disability, FMLA and Other Forms Completed
Oh those pesky forms...from how long they take to how much it costs, here's everything you need to know.
GoodRx
A website to compare the cost of prescription medications.
Healthy Weight Gain in Pregnancy
Wondering how much weight you should be gaining during pregnancy? We've got you covered.
Hemoglobinopathies
2018-03-15; Barbra Fisher, MD, PhD and Jeri Milanovich, MS, CGC, 8:15
Hypertensive Disorders in Pregnancy: An Update
Mark W. Tomlinson, MD, MBA and Lisa J. Farkouh, MD
Perinatal Progress Volume 8, Number 1
April 2015
Hystersisters
On online resource and forum for women having bleeding issues, fibroids, pelvic pain, etc.
Incidence of Significant Chromosomal Abnormalities
Hook EB, Cross PK, Schreinemochers DM
Information on Genetic Screening in Pregnancy
An overview of different genetic and chromosomal conditions for which screening is available, who they are most likely to affect and how often they occur.
Insurance and Billing Information
Does it sometimes feel like you need a degree in insurance to even understand your statement? Think of this as a crash course to help you understand how we bill for services and what questions to ask your insurance provider.
International Urogynecological Association | YourPelvicFloor.org
YourPelvicFloor.org is the patient-centered website of International Urogynecological Association where you can find patient information leaflets, videos, FAQs and more.
La Leche League
Information and support related to breastfeeding—including local support groups.
Language Access & Non-Discrimination Policies
Learn more about WHA’s free translation services and our commitment to non-discrimination.
Late Preterm Steroids: An Update
2018-03-15; Meredith Williams, MD, 13:22
Magnesium Sulfate Uses and Abuses
2018-03-15; Sophia Lannon, MD, MPH, 12:08
Management of Intrauterine Growth Restriction/Fetal Growth Restriction
July 2021
Management of Migraine Headaches in Pregnancy
2018-09-20; Ashlie Tronnes, MD, 16:34
Managing Women at Risk for Preterm Birth
Barbra M. Fisher, MD, PhD and Meredith Williams, MD
Perinatal Progress Volume 6, Number 1
August 2013
Marijuana Use in Pregnancy
2019-05-29; Thomas Lee, MD, MBA; 17:28
Medical Record Amendment Request
If you think the information in your medical or billing record is incorrect, you can request a change, or amendment, to your record using this form.
Medical Records Release Form
If you would like to transfer your records to provider outside of WHA, download and complete this form. If you have a MyHealth account, you can also request your records there.
Menopause Preparedness Toolkit
A downloadable educational guide from the Society for Women’s Health Research designed to support individuals through the menopause transition with information on symptoms, midlife health, care planning, wellness and preparing for conversations with health care providers and loved ones.
MiddlesexMD Blog
A good resource for articles on sex after 40. Also includes various products, but this is not a specific endorsement of those.
National Association for Continence
Fecal and urinary incontinence information for patients, caregivers and healthcare professionals.
National Friendship Day Giveaway
Enter to win a manicure for two on our Facebook page in honor of #NationalFriendshipDay.
National Vulvodynia Association
An educational resource from Oregon Health & Science University about vulvar conditions, with guidance for patients experiencing vulvar discomfort or concerns.
New Patient Checklist
Remember when mom made sure you had everything you needed? Think of this as mom’s checklist—only shorter.
No Surprise Billing
Learn more about your rights and protections against surprise medical bills.
Notice of Privacy Practices
Read WHA's Notice of Privacy Practices
NWP Antenatal Late Preterm Steroids Protocol
April 2017
NWP Referral Form
Updated 2017
NWP Ultrasound and Financial Disclosure
Updated 2017
NWP Ultrasound Patient Instructions
Updated 2017
Obesity in Pregnancy
2019-09-19; Ashlie Tronnes, MD; 16:55
Office of Women's Health – Pregnancy
Good basic content on pregnancy and women's health.
Oligohydramnios Measurement and Management
Michael P. Smrtka, MD
Perinatal Progress Volume 7, Number 1
June 2014
Opioid Use Disorder in Pregnancy
Meredith K. Williams, MD
Perinatal Progress Volume 12, Number 2
October 2019
Our Bodies, Ourselves
A book (and now an organization) that's been around for decades, revised often.
Our Moment of Truth
Learn more about midwifery care and women's health during pregnancy and beyond on this site from the American College of Nurse-Midwives.
Patient Rights and Responsibilities
Every good relationship has clear expectations—and we want this to be a very good relationship! Learn more about what you can expect from us and vice versa.
Patient Survey Program
If you have a visit in one of our offices, you could be asked to provide feedback through an online survey. Learn more about what we do with the information here.
PCOS Awareness Association
A nonprofit dedicated to increasing understanding of Polycystic Ovarian Syndrome (PCOS) and supporting those affected with educational materials, information on symptoms and treatment options, and links to community support and specialist directories.
Placenta Accreta Spectrum Diagnosis, Myths and Management
2019-03-21; Mark Tomlinson, MD, MBA; 15:29
Placenta Previa Diagnosis and Management
2019-05-29; Barbra Fisher, MD, PhD; 16:41
Planned Parenthood
Great information about all aspects of reproductive health.
Pre-pregnancy Care (ACOG)
From the American College of Obstetricians and Gynecologists, this FAQ includes ideas for optimizing your health before pregnancy, including preventive care, lifestyle guidance and preparation for conception.
Preconception Considerations for Patients Considering IVF
2019-09-19; Meredith Williams, MD; 22:20
Prenatal Education for New Pregnancies
By WHA providers, for WHA patients: here's the educational information we recommend to all our pregnant patients.
Prenatal Education Video
WHA's prenatal educational information, explained in 25 minutes!
Prenatal Patient Information
Here's all the information we covered with you at the beginning of your pregnancy and other helpful resources, including information from the CDC and American College of Obstetricians and Gynecologists on pregnancy and COVID-19.
Preparing for Your Office Visit
Masks are no longer required—but still greatly appreciated.
Preparing for Your Video Visit
Your clinician wants to be able to see and speak with you during your upcoming appointment, so please take a moment to make sure you're prepared.
Privacy & Security
Learn more about how we’re protecting you—and your health information.
Protocol for Managing Asymptomatic Patients at Risk for Preterm Birth
February 2024
Protocol for Managing Oligohydramnios and Borderline AFI
August 2014
Queer / LGBTQIA+ Menopause
A community-centered resource and support space focused on menopause experiences in LGBTQ+ communities, providing education, stories and connections related to aging and midlife health.
Recommendations for Genetic Screening in Pregnancy
Ashlie A. Tronnes, MD and Karen E. Hansen, MS, CGC
Perinatal Progress Volume 12, Number 1
May 2019
Recurrent Pregnancy Loss
Sophia M.R. Lannon, MD, MPH
Perinatal Progress Volume 10, Number 1
May 2017
Recurrent Pregnancy Loss Protocol for Targeted and Sequential Evaluation
March 2017
Routine Cervical Length Surveillance
2017-09-21; Thomas Lee, MD, MBA, 15:27
Scarleteen
A blog about lots of topics for teens.
Screening for Fetal Chromosomal Abnormalities
Wendy Busch, MS, CGC and Jeri Milanovich, MS, CGC
Perinatal Progress Volume 3, Number 3
October 2010
Sex, Etc.
A website for teens, by teens.
SMFM – Evaluation and Management of Polyhydramnios
Consult Series #46 - October, 2018
SMFM: Five Things Physicians and Patients Should Question
Choosing Wisely, An Initiative of the ABIM Foundation
SMFM: The Role of Ultrasound in Women Who Undergo Cell-free DNA Screening
Consult Series #42 - March, 2017
The Menopause Society
Find trusted information on menopause and midlife women’s health, including symptoms, treatment options and evidence-based guidance for patients and clinicians from a professional medical society.
Thromboembolism and Inherited Thrombophilia
Mark W. Tomlinson, MD, MBA
Perinatal Progress Volume 3, Number 2
June 2010
Thyroid Disease in Pregnancy
2017-09-21; Lisa Farkouh, MD, 12:35
Thyroid Disease in Pregnancy: An Update
Lisa J. Farkouh, MD
Perinatal Progress Volume 9, Number 2
August 2016
Twin-to-Twin Transfusion Syndrome: An Update
Juan Martinez-Poyer, MD
Perinatal Progress Volume 4, Number 2
September, 2011
Twins, the First Trimester
2017-09-21; Ashlie Tronnes, MD, 15:24
Ultrasound – Think Value!
2018-01-24; Mark Tomlinson, MD, MBA, 15:10
Up to Date
A searchable database of current medical information for both patients and providers.
Urgent Visits and After-hours Help
Life happens and we’re here when it does. Learn more about what to do when you think you need to be seen urgently or need help after hours.
Vaccines in Pregnancy
Santosh Pandipati, MD, FACOG
Perinatal Progress Volume 3, Number 1
February, 2010
Venous Thromboembolism in Pregnancy
2019-03-21; Michael P. Smrtka; 15:08
Vitamin D in Pregnancy: Should We Be Testing?
2018-05-29; Sophia M.R. Lannon, MD, MPH; 17:20
Voices for PFD
A great resource from the American Urogynecologic Society for women experiencing pelvic floor disorders, including bladder and bowel control issues and pelvic organ prolapse.
Voiding Diary
If you’re seeing one of our urogynecologists to talk about urinary incontinence, we may ask you to keep track of things for a while before your visit. Download a copy of the voiding diary here.
WebMD Baby
Good information on all things pregnancy.
Wellbeing Assessment and Other Online Forms
Help us get to know you before your visit or get reacquainted if it’s been a while. If you need to complete a wellbeing assessment, a urogynecology intake form—or any other online forms, you’ll have a notification in your MyHealth account.
What to Expect During a Physical Exam
This resource from the Oregon Medical Board provides more information on what to expect from various types of physical exams at the doctor's office, including how to advocate for your rights and what to know about medical chaperones.
Women's Healthcare Associates – Bridgeview
Women's Healthcare Associates – Gateway
Women's Healthcare Associates – Hillsboro
Women's Healthcare Associates – Newberg
1003 Providence Drive, Suite 340, Newberg, OR, 97132, (503) 538-2698
Women's Healthcare Associates – Oregon City
1508 Division Street, Suite 205, Oregon City, OR, 97045
Phone: (503) 657-1071 | Fax: (503) 657-3321
Women's Healthcare Associates – Peterkort North
9701 SW Barnes Road, Suite 200, Portland, OR, 97225. (503) 734-3700
Women's Healthcare Associates – Tabor
5050 NE Hoyt Street, Suite 230, Portland, 97213
Phone: (503) 249-5454 | Hours: M-F 8:30AM-5:00PM
Your Electronic Health Record
WHA is part of the Legacy Epic computer system for scheduling, medical records and billing. Learn more about what that means for you.
Your Test Results
Learn more about when--and how--you'll hear about your test results and how we'll work with you to adjust your treatment plan, if necessary.