Let's get right down to it, folks. Today, we're here to discuss an under-the-belt problem that many of us vulva-owners deal with but may have trouble talking about publicly due to the still-taboo nature of the topic. We're talking about skin irritation that occurs in this highly intimate region, along with how it can affect one's ability to feel confident and comfortable in sexual scenarios. Now, you should know that this doesn't pertain to the vagina, but rather the vulva, aka the external genital area that surrounds the vagina, which is where a wide range of annoying skin afflictions materialize (not in the muscular canal that babies pass through during childbirth).

"The vulva is an area of our bodies that is often overlooked," says Hilda Hutcherson, a professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons. She adds that it's not uncommon for people to still lump the vulva in with the more general term "vagina" when talking about what's going on downstairs. "To add to that misconception, some gynecologists will skip a detailed inspection of the vulva altogether, even though it should be carefully inspected with each pelvic exam, as the problems one can encounter here range from as benign as folliculitis and irritation from shaving, to skin cancers like melanoma."

Benign or not, when this ultra-sensitive area of the body is irritated, it can cause a whole host of issues, both physical and mental. I personally suffer from vulvar dermatitis as a result of my rare genetic skin condition, Netherton syndrome, and know first-hand how scary and isolating it can feel. Lo and behold, there are actually many different cutaneous disorders — including but not limited to eczema, psoriasis, and hidradenitis suppurativa — that can all affect the vulva, too.

Apart from exceedingly common afflictions (like yeast infections), vulvar skin conditions aren't discussed much at all in mainstream media — or even at the dermatologist's office for that matter. This is a shame when you consider how many folks are quietly struggling with skin disorders that affect the genital region (it's up to two-thirds of people with psoriasis), not to mention the shame and insecurities that come with having one of these conditions, or how it affects one's sexual confidence and satisfaction in romantic relationships.

Take it from New York City-based neuropsychologist Sanam Hafeez, who tells me: "If issues like dermatitis, eczema, and irritation or redness affect the vulvar skin, it is likely to heighten self-consciousness about its appearance, as well as the touch, feel, and smell, which can lead to feelings of reduced attractiveness and inability to enjoy sexual pleasures."

Adam Friedman, a board-certified dermatologist and department chair of dermatology at GW School of Medicine & Health Sciences, based in Washington, D.C., mirrors Hafeez's sentiments almost exactly. "Skin disorders that affect the vulva can have a huge impact on a person's confidence and ability to enjoy sex and intimacy due to the stigma and embarrassment," he says. "It's no question that these conditions can influence mental status and put a person at risk for depression, anxiety, and negative self-image."

Now, for some comforting news. If you're struggling with a vulvar skin condition, you're not alone. On top of that, the majority of these conditions are completely treatable and non-contagious, which should hopefully provide you with some peace of mind.

For more insight, I tapped several experts for their advice on how to navigate everything that comes with having a skin condition that manifests on the vulva — including how to talk to your partner about it, what to do when a doctor gives you bad advice, ways to boost confidence, and more.

How do I know I have a vulvar skin condition and what can I do about it?

When it comes down to it, you should see your dermatologist if you're experiencing any type of skin irritation in the vulva area, whether it be bumps, increased redness, itching, flaking — you name it. This is the only way to get a fully accurate diagnosis, and in turn, a proper treatment plan. Friedman insists that you should never try to diagnosis yourself, as it can be near-impossible for someone who's not a dermatologist to distinguish between the countless conditions and sexually transmitted infections that affect the skin of the genitals. "Do not succumb to Dr. Google," he warns. "It won't do you any good."

On top of that, Friedman notes that certain conditions, such as psoriasis, may present differently from the standard plaques that we see on the rest of the body. "[That's why] it's incredibly important to get a diagnosis from an expert who's trained to look for these things," he says.

Once you receive a diagnosis from your dermatologist, they'll set you up with a treatment plan based on the status of your vulvar condition. "For inflammatory disorders like eczema, we typically use mild topical steroid moisturizers, and for psoriasis, we sometimes prescribe biologic drugs, depending on the severity," says Friedman. He also points out the importance of practicing good hygiene and being ultra-gentle with the sensitive skin in this area. "Stay far away from harsh or fragranced soaps as they can alter the acidity of the skin and disrupt the pH balance, which in itself can cause vulva irritation," he says.

It's worth noting that vulvar skin conditions often go untreated because of the societal stigma surrounding genital disorders, which prevents many people from talking to their doctor about their concerns, even when in extreme discomfort. "I'll have patients come in with eczema and I'll ask them if they have any rashes in their genitals, and they're like, 'Oh yeah, but it's not eczema,' and then I'll take a look and it turns out it is," says Friedman. "There's a general discomfort when it comes to talking about the genitals, but we need to throw that out the window in order to get people the treatment they need."

While there's no denying most doctors have your best interests at heart, I've learned the hard way that this isn't always the case. For example, a few years ago I saw someone who I believed to be a reputable dermatologist for my vulvar irritation, and her brilliant suggestion was to — wait for it, folks — try using green makeup down there to disguise the redness from my partner. I left the office with tears streaming down my face, feeling absolutely stunned, mortified, and shook to my core that a health-care provider would offer up such insensitive and unsafe advice so flippantly. I knew in my gut it wasn't right.

In the event that you experience a similar situation, first and foremost, trust yourself and what you know. "If a doctor tells you something that sounds that bizarre, don't just blindly believe it," says Lynette J. Margesson, a board-certified dermatologist in Lebanon, New Hampshire, whose work has largely focused on vulvar skin diseases. "There are some great educational resources out there that teach about vulvar care, like the International Society for the Study of Vulvovaginal Disease (ISSVD), which has helpful leaflets for patients, as well as the British Association of Dermatologists. They have many handouts that are well-written and easy to understand." In this case, as long as you're looking to reputable resources for your information, the Internet can be a helpful tool, albeit you should always try to get a second opinion from an expert.

In addition, Friedman suggests trying to track down a dermatologist in your area who focuses on vulvar disorders, as this will give you a better shot of seeing someone who's well-trained in this particular specialty and thereby can help get you the care you need. Finally, it's worth mentioning that even when you're in the hands of a trained professional, it can't hurt to go into appointments with a list of questions ready and some basic knowledge of your condition, so feel free to do some of your own research ahead of time. This way, it'll hopefully be easier to advocate for yourself.

OK, but how do I talk to a partner about my vulvar skin condition?

When it comes to our relationships with our bodies, it's true that there can already be a level of anxiety, and it can daunting to talk to our partners about such personal, seemingly taboo topics. Believe it or not, it can actually be incredibly beneficial for your relationship — as well as your own mental health. As Hafeez explains: "Having a candid conversation about any skin conditions, or how you treat them, is helpful to both you and your partner because it sets up a place of transparency, which in turn opens you up to sexual intimacy without feeling embarrassed or ashamed."

In a similar vein, she adds that communicating with your significant other about your condition can serve as a catalyst for even more "vulnerability, closeness, and sexual freedom" within the relationship. "Intimacy comes from being able to be raw and fearful in relationships with people who matter most," she says. "So often, the easiest and smallest steps can achieve that."

Rachel Needle, a psychologist and sex therapist based in West Palm Beach, Florida, advises getting up to snuff on the facts of your condition prior to talking to your partner, as this way you can hopefully feel more comfortable and in control of the conversation. "People rarely talk about conditions that impact their vulva, even to their doctors, but it's first important for you to become more comfortable and knowledgeable about the condition before sharing it with your partner," she says. "Once you do, the best way to communicate with your partner about your vulvar skin condition is to do so honestly — be direct and share information regarding the condition and how it has impacted you."

She recommends approaching your partner by saying something like, "Hey, I want to share something with you about my body." From there, give them the lowdown on whatever condition it is that you have and how it's impacted you. Needle offers an example: "About one year ago, I was diagnosed with lichen sclerosus. It's a skin condition that is not contagious and affects 1 in 80 women. For me, this has been difficult in that… And then you can continue to share whatever you are comfortable with."

Lastly, ask your partner if they have any questions or concerns. "If they do, you can give them what you know or even do some research together," says Needle.

Bottom line: If they're a loving, compassionate partner who values your feelings and overall well-being, then they'll show up for you during this tough conversation and not make it any harder for you than it is.

How do I navigate the insecurity that sometimes comes with this?

"There is pressure for women to have these small, tight, and symmetrical vulvas that are totally unrealistic," Laura Miano, a sex therapist and sexologist based in Australia, tells me. "This trend originated with porn, where women had undergone labiaplasties to change the shape of their vulvas, but has proliferated with the normalization of pornified culture, leading to an overly sexualized aesthetic that's being reflected in society today."

As a result, many folks struggle with some form of insecurity when it comes to their vulva — including those without skin conditions. That being said, this widespread belief that vulvas need to meet certain criteria in order to be accepted or worthy of desire can prove especially difficult for those suffering from skin conditions. For instance, as Friedman and Hafeez both noted earlier, these conditions can have a hugely negative impact on one's self-esteem, as well as their own sexuality, when the genitals are affected.

According to Miano, a great first step in addressing these insecurities head-on is to find a reputable educational outlet that provides you with factual and inclusive information about the vulva, sex, and our bodies. "I direct clients to The Labia Library, which features a gallery section with over 20 images of real-world vulvas, demonstrating the gorgeous variety that exists in the world of vulvas," says Miano. "I'd recommend spending some time educating yourself through these resources, and then spend some time getting to know your own vulva." While The Labia Library doesn't showcase any photos of skin conditions in this area, it still offers a more factual representation of the wide variety of vulvas out there.

Needle backs up Miano's advice. "Look at pictures of different vulvas so you that you can get a realistic view of the vast variety of appearances of them," she says. "Then start to look at your own vulva so you can begin to embrace and accept what you have. Vulvas do not have to look a particular way to be beautiful."

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