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Itch, irritation and confusion: What’s actually normal when it comes to sexual health?
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From unexpected discharge to persistent itching, many women experience symptoms they don’t fully understand – and often don’t feel comfortable talking about. Here, a doctor explains why these concerns are far more common than we think, and why understanding what’s normal (and what’s not) is key to getting the right care.
When it comes to sexual health, many of the issues women experience are far more common, and far more treatable, than they realise. But as Dr Aisling Loy explains to Ellie Balfe, a lack of awareness, combined with embarrassment or confusion around symptoms, often delays women from seeking help.
“It’s all about access to care… removing those barriers is really key,” she says, in this episode of IMAGE The Check-in, noting that even within the healthcare system, awareness of specialist services can be limited.
Sexual health, she adds, doesn’t necessarily mean just STI care. “It can be anything to do with the genitals, the sexual anatomy… the entire genital tract. So it could be anything from looking after the skin in that area, people with lichen sclerosus, people with chronic Candida, bacterial vaginosis. It can be STIs. That is a large bulk of what I look after.”
“There’s lots of different infections that people can present with, from herpes infections, genital warts, Chlamydia, gonorrhoea, syphilis. And we see a lot of anxiety, especially in the younger people now around their sexual health,” she says.
Lichen sclerosus: The condition many women haven’t heard of
One of the most common conditions Dr Loy sees in clinic is lichen sclerosus – a chronic inflammatory skin condition that primarily affects the vulval area.
“So that tends to be something which mostly affects middle-aged to older women… but it can start in your 20s, 30s, and it does affect men too,” she explains.
The main symptom is persistent itching. “The main symptom is vulval itch… it’s a skin condition in the genital area.”
While the cause isn’t fully understood, irritation, including prolonged contact with urine or the use of pads, may play a role. Left untreated, the condition can progress significantly. “It’s a progressive thing where, over time, they lose the architecture of their vulva… the clitoris can go, the labia can go, and it all gets… flattened out.”
In more severe cases, scarring can lead to the skin adhering together, affecting both comfort and function.
While lichen sclerosus is treatable, Dr Loy notes it also carries a small but important increase in vulval cancer risk (around 1%), which is why proper diagnosis and regular follow-up are so crucial. Early intervention can make a significant difference.
“It can be treated and it can be reversed… but by the time they come to see you, sometimes it’s irreversible. It’s all about managing the progression.”
Recurrent thrush or something more complex?
Another issue Dr Loy frequently treats is chronic or cyclical Candida infections.
“I’ll see another very common thing… women with chronic Candida… and there’s a thing called cyclical Candida… where it happens every month.”
Symptoms can include itching, abnormal discharge, discomfort and even skin splitting, often flaring at specific points in the menstrual cycle. Treatment can include antibiotics, but taken regularly, this can have its own implications, shifting women’s PH balance.
“They’re just sick to their back teeth of taking a fluconazole… they’re like, ‘I can’t deal with it’ because it can take several days out. They’re uncomfortable. They’re unable to be intimate with their partners. It affects relationships.”
And, she continues, what many women don’t realise is how vulnerable the vulval area is to disruption. “If you think about the vulval skin, it’s some of the most delicate skin in our body… it’s occluded most of the time… there’s moisture, hair, discharge… it’s a sitting duck for all of these sorts of issues.”
This means that factors like friction, tight clothing, and even everyday hygiene habits can contribute to ongoing irritation and imbalance.
The importance of intimate skincare
Despite the rise of multi-step skincare routines for the face, Dr Loy sees a stark contrast when it comes to intimate care.
“I see these women come into me with the most beautiful skin on their face… and then they’re getting a bar of soap and cleaning down below, and I’m like, goodness, you know, think about why you’re having issues down there.”
Many common habits – from harsh products to hair removal – can disrupt the natural protective barrier of the vulva.
“Mother Nature’s protection… has shifted,” she explains. “Mother Nature’s protection of your skin down there to protect against infections and friction and all of that, and it keeps a particular level of moisture in there. Nowadays, culturally, most women have taken it away, or taken a good portion of it away, and so that protective barrier has shifted.”
“So you’ll have people coming in with folliculitis, [because] the skin is more exposed to infection. So where before you had that barrier and that barrier can even help herpes, for example… because, again, the men are also doing hair removal, so you have this sort of cheese grater effect on delicate skin,” she continues.
There are a lot of symptoms that women just put up with in the past and thought, sure, look at it, it’s part of being a woman… But there's a lot of things that can indicate that there's something wrong and that can be treated.
What’s normal and what’s not?
A major source of confusion for many women is understanding what “normal” actually looks like, particularly when it comes to discharge. Dr Loy agrees that many women don’t know what’s normal or abnormal, particularly around discharge.
In general, normal discharge should be:
- Not odorous
- Not uncomfortable
- Not associated with itching
“It’s normal to have discharge, and different women will have different amounts… based on hormones or just individual chemistry.”
Changes in colour, smell, or associated symptoms can signal an issue. “It shouldn’t be green… it shouldn’t be very bloody… if it smells or it’s uncomfortable or itchy, they’re all signs that there could be an infection there.”
She also highlights the importance of noting bleeding outside of expected times. “You shouldn’t have post-coital bleeding… that can be a sign of infection or something abnormal.”
What matters more than a test
While tests and swabs can be helpful, Dr Loy emphasises that they are only one piece of the puzzle. “It’s their story that tells you more than the result of a swab.”
Because many conditions fluctuate, a single test may not capture the full picture. “That just gives you a snapshot of that moment in time… it doesn’t give you the overall picture.” Instead, understanding patterns – when symptoms occur, what triggers them, and how they evolve – is key.
“Why it happens, when it happens, what triggers it… that is more important than a swab.”
She also emphasises the importance of stigma and removing any shame, especially if women see it as a barrier to getting treatment.
“There are a lot of symptoms that women just put up with in the past and thought, sure, look at it, it’s part of being a woman… But there’s a lot of things that can indicate that there’s something wrong and that can be treated.”
At the heart of it, Dr Loy’s says it is about normalisation.
“To me [the vulva/vagina], it’s just another body part,” she says. “You can go in and talk to your doctor about your sore throat… It’s the same. It’s a mucosal opening in the body.”
Removing shame, understanding your baseline, and seeking help early can make all the difference, not just in managing symptoms, but in preventing more serious complications down the line.
“Just because it performs a sexual act… doesn’t mean that you can’t come and talk to a doctor about it.”
We’re lifting the lid on women’s health: the real, the raw, the rarely spoken aloud. Our new podcast ‘IMAGE The Check-in’, hosted by Ellie Balfe, gets straight to the heart of what’s truly on women’s minds right now. We dive into monthly health themes with expert guests and honest voices.
Listen to IMAGE The Check-in HERE or wherever you get your podcasts.
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