Vaginal Skin Peeling: Causes, Symptoms, and Effective Treatments

The main reason for vaginal dryness is the decrease in the levels of a female hormone, called estrogen.

Anatomy: The Vaginal and Vulvar Region

Pudendum(vulva) includes:

• Mons pubis
• Labia majora
• Labia minora
• Clitoris
• Vestibule of the vagina
• Bulbs of the vestibule
• Greater vestibular glands

Clitoris

The clitoris is an erectile organ, homologous to the penis. However, it is not traversed by the urethra. It lies in the anterior part of the pudendal cleft. The body of the clitoris is made up of two corpora cavernosal enclosed in a fibrous sheath and partly separated by an incomplete pectiniform septum. A corpus spongiosum is absent. Each corpus cavernosum is attached to the ischiopubic rami.

Vestibule of the Vagina

The vestibule of the vagina is the space between the two labia minora. It presents the following features.

1. The urethra! orifice lies about 2.5 cm behind the clitoris and just in front of the vaginal orifice.
2. The vaginal orifice or introitus lies in the posterior part of the vestibule and is partly closed, in the virgin, by a thin membrane called the hymen.

Vagina

It is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix.

Causes of Vaginal Peeling and Irritation

1. Hormonal Changes:

Vaginal Dryness due to Estrogen Decline

The primary cause of vaginal dryness is the decline in the levels of the female hormone, estrogen. Estrogen, predominantly produced in the ovaries, is responsible for maintaining vaginal lubrication, as well as preserving the thickness and elasticity of the vaginal lining. A decrease in estrogen disrupts these functions, leading to the drying and thinning of the vaginal walls and subsequent symptoms.

 

Vaginal symptoms of low estrogen

The drop in estrogen levels can result in:

• Vaginal dryness
• Vaginal itchiness
• Frequent and painful urination
• Recurrent urinary tract infections
• Pain during intercourse
• Light spotting

 

Conditions causing lower estrogen levels

• Genitourinary Syndrome (Menopause): Estrogen levels drop during menopause, resulting in symptoms such as vaginal dryness and itching.
• Surgical Removal of Ovaries: A significant drop in estrogen occurs when ovaries, the primary source of estrogen production, are removed.
• Chemotherapy or Radiation: Causes damage to ovarian tissue, reducing estrogen levels.
• Postpartum and Breastfeeding: Decreased estrogen levels are observed after childbirth and during breastfeeding, but typically resolve post-breastfeeding.
• Medications: Drugs like danazol, medroxyprogesterone, leuprolide, and others can disrupt estrogen levels.
• Sjögren’s Syndrome: An autoimmune condition affecting moisture-secreting glands, leading to dryness in various body parts, including the vagina.

2. Skin Conditions

a. Vulvar Dermatitis

• Causes itching, irritation, and inflammation of the vulva.
• Triggered by contact with chemicals causing irritation or allergies.
• Treatment may involve avoiding the irritant, proper vulvar care, and corticosteroids prescribed by a healthcare professional.

 

b. Psoriasis

• Psoriasis is a chronic skin condition affecting any body part, including the pubic area.
• Common with up to 63% of affected individuals developing genital psoriasis.
• Causes flaky, inflamed skin and itching. Appearance varies based on skin tone.

 

c. Lichen Sclerosis

• Affects the vulvar skin primarily in women.
• Exact cause is unknown but may involve the immune system.
• Presents as white and glossy skin areas that can sometimes have small cracks and blisters.

3. External Irritants

• The pubic region may be more susceptible to irritation due to factors like sweating, tight clothing, and friction.
• Potential irritating products include:
  • Soaps
  • Bubble baths
  • Shower gels
  • Talcum powder

4. Vaginal Infections (Vaginitis)

Vaginal Infections can cause itchy, flaky skin on the vulva and pubic area. Common types are:

a. Yeast Infection (Candidiasis)

This is an overgrowth of the fungus Candida in the vagina. It can cause itching, burning, and discharge. Factors that may increase the risk include:

• Antibiotic use
• Pregnancy
• Diabetes
• A weakened immune system

 

b. Bacterial Vaginosis

Overgrowth of certain bacteria in the vagina. Symptoms might include a fishy odor, itching, and discharge. Risk factors include:

• Sexual activity
• Use of scented soaps or bath products
• Frequent douching

 

c. Trichomoniasis

Trichomoniasis is a sexually transmitted infection caused by a parasite. Symptoms can range from mild irritation to severe inflammation. Some women may have discharge, itching, and pain during urination. Risk factors primarily include:

• Multiple sexual partners
• A history of other sexually transmitted infections
• Previous trichomoniasis infections

 

5. Sexually Transmitted Infections (STIs)

Certain STIs can lead to symptoms such as dry, flaky skin in the pubic area. Some notable STIs include:

a. Scabies

Caused by the Sarcoptes scabiei mite, which burrows into the skin leading to intense itching, especially at night. The irritation can cause skin to become flaky or scaly over time.

 

b. Pubic Lice (Crabs)

These are tiny insects that infest the coarse hair of the pubic region, though they can also be found in other body hair. They feed on human blood, leading to itching, inflammation, and sometimes secondary bacterial infections if the skin is broken from scratching.

 

c. Genital Herpes

This viral infection, primarily caused by the herpes simplex virus type 2 (HSV-2), leads to painful sores or ulcers in the genital and anal areas. While the sores themselves can cause irritation, the skin around them can become dry or flaky, especially as they start to heal.

 

d. Genital Warts (Human Papillomavirus – HPV)

Caused by certain strains of HPV, these are small, flesh-colored or gray growths in the genital area. They can grow in clusters and might resemble a cauliflower shape. The presence of warts can cause irritation, and the surrounding skin may become dry or inflamed.

Risk Factors for Developing Vaginal Peeling

1. Existing Skin Conditions:

• Individuals with skin disorders like psoriasis or eczema are more likely to experience vaginal skin peeling and other related genital symptoms.
• Additionally, those with psoriasis have an elevated risk of developing lichen sclerosis.

2. Frequent Physical Activities:

• Regular swimming or working out can increase the risk of skin friction and peeling due to the moisture from sweat and wetness.
• Engaging in activities that exert pressure on the genitals, such as cycling, can heighten the risk.
• It’s crucial to change out of damp or sweaty clothing promptly to mitigate this risk.

3. Clothing and Cosmetic Products:

• Wearing non-breathable fabrics, such as nylon, can aggravate the vaginal skin.
• Utilizing cosmetic products containing fragrances or chemicals can irritate the vaginal area, heightening the risk of peeling.

4. Pregnancy-Induced Hormonal Changes:

• During pregnancy, especially in the first and third trimesters, there’s a significant increase in estrogen and progesterone levels.
• The imbalance of estrogen can lead to reduced mucus production in the vaginal epithelium and cervix, causing vaginal dryness and itchiness.

5. Estrogen Decline and Vulvovaginal Atrophy:

• As estrogen levels decrease, particularly during menopause, there can be atrophy of the genitourinary tract, commonly termed as vulvovaginal atrophy.
• This condition presents with symptoms like dryness, pain during intercourse (dyspareunia), discharge, itching, and sometimes bleeding.

6. Sexual Intercourse:

• Vaginal dryness is often most noticeable during sexual activity.
• Insufficient vaginal lubrication can result in discomfort and pain due to friction during intercourse.

Common Symptoms of Vaginal Peeling and Irritation

1. Itching: This can range from mild to intense.
2. Burning or Stinging Sensation: A feeling of discomfort, often likened to a burn or sting.
3. Scaling of the Skin: This can be observed as flaky or peeling skin.
4. Skin Tears: Small, often painful, rips or splits in the skin.
5. Bumpy Rash: Raised patches or lumps on the skin which might be itchy or painful.
6. Vaginal Discharge or Odour: An unusual discharge in consistency, color, or smell, indicating potential infection or imbalance.
7. Skin Patches: These can appear red or white and might indicate inflammation, irritation, or other skin conditions.

Diagnosis Process for Vaginal Peeling and Irritation

1. History Taking:
   • Medical and Family History: The healthcare provider will inquire about a history of skin conditions, asthma, autoimmune diseases, and other related medical conditions within the family.
   • Symptoms Inquiry: Information regarding the onset, duration, severity, and patterns of the symptoms will be collected.
   • Medication and Lifestyle: The provider will ask about any medications currently being taken and lifestyle habits, especially those related to vulvar care.
2.  Physical Examination:
   • The provider will visually inspect the vulva and vagina for signs of skin damage, inflammation, or other visible abnormalities.
   • A test may be conducted on the vaginal discharge to identify or rule out potential infections like yeast or bacterial infections.
3.  Patch Testing:
   • In this test, the skin is exposed to specific allergens to check for reactions. It helps in determining if an external allergen is the cause of the dermatitis.
4.  Biopsy:
   • In cases where the symptoms worsen, change rapidly, or don’t respond to treatment, a biopsy might be recommended.
   • This involves taking a small tissue sample from the affected area to be examined under a microscope. It helps rule out conditions like vulvar cancer, cervical dysplasia, and other diseases with similar presentations.

Treatment for Vaginal Dryness and Associated Symptoms

1. Over-the-counter Treatments

For mild symptoms, over-the-counter options can offer relief. These are hormone-free and generally safe to use:

• Vaginal Moisturizers: These often contain hyaluronic acid, designed to retain moisture in vaginal tissues. They come in two forms:
  • For the vaginal canal: Usually applied around 3 times a week.
  • For the vulva: External application.
• Lubricants: Specifically for sexually active women to reduce friction during intercourse. They can be:
  • Water-based: Compatible with latex condoms.
  • Oil-based: Not safe with latex condoms. Always consult a healthcare provider before using any non-standard lubricants.

2. Prescribed Treatments

When OTC options aren’t sufficient, doctors might recommend treatments often involving hormones:

• Vaginal Estrogen: A potent remedy for vaginal dryness, it helps restore the vaginal walls’ lining. Forms include creams, capsules, or rings. Rings are replaced every 3 months, while creams and capsules are applied/inserted regularly.
• Dehydroepiandrosterone (DHEA): A hormone that converts into estrogen and testosterone. It’s available as a suppository inserted into the vagina daily. Though less researched than vaginal estrogen, it’s a suitable alternative for those who can’t take estrogen.
• Ospemifene: A Selective Estrogen Receptor Modulator (SERM) treating genitourinary syndrome. It acts similarly to estrogen on vaginal tissues. Taken as a daily pill, it’s often chosen by those who prefer not to use vaginal medications. However, it’s not advised for those with high breast cancer risk.

 

3. Other Treatment Options:

• Laser Therapy: Vaginal carbon dioxide laser therapy is emerging as a promising treatment. It improves cell renewal, circulation, and vascularization of vaginal tissues. Although research is ongoing, it shows potential, especially for post-menopausal women with genitourinary syndrome.
• PRP (Platelet-Rich Plasma): PRP injections aim to treat vaginal dryness by promoting tissue regeneration. While some positive results have been observed, more comprehensive research is required.

Prevention and Maintenance

• Use an ice pack or a cold compress to ease irritation and itching
• Avoid staying in wet clothing for long periods, change out of them quickly
• Choose breathable, cotton clothing and underwear
• Using cleaning products such as soaps and detergents that are gentle and fragrance-free.

Outlook for People with Vaginal Peeling

Recovery Duration

• The duration of recovery from dermatitis largely depends on its root cause.
• For example, contact dermatitis may take anywhere from a few weeks to a month to heal once the causative irritant is eliminated.
• If dermatitis is accompanied by an infection, the healing process might extend further.

Warning Signs

Immediate medical attention is advised if one experiences any of the following symptoms:

• High fever
• Rapidly expanding redness or swelling
• Excessive vaginal bleeding
• Intense pain, particularly if it spreads to the abdomen or back.

Treatment Approaches

The type of treatment prescribed primarily depends on the underlying cause of the condition:

• Infections: Depending on the nature of the infection, doctors may recommend antifungal, antibacterial, or antiviral medications.
• Menopause-Related Issues: Hormone Replacement Therapy (HRT) might be advised to address symptoms stemming from menopause.