Changes in vulva colour are common and usually normal. Understanding the reasons behind these changes and recognising when medical advice is appropriate can provide reassurance and guide proper evaluation.
Understanding Vulva Pigmentation
The vulva includes the labia majora (outer lips) and labia minora (inner lips). Colour can vary widely between individuals, ranging from pale pink to brown, dark brown, or black.
Natural factors that influence pigmentation include:
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Genetics – skin tone affects vulva colour.
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Friction or minor irritation – clothing or physical activity may temporarily affect colour.
Most changes are normal and not a cause for concern.
Physiological Causes of Vulva Colour Changes
Changes in vulva colour are considered normal under certain physiological conditions:
Hormonal Changes
Hormonal fluctuations during puberty, pregnancy, and menopause can lead to changes in vulva colour:
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Puberty: Increased estrogen levels cause the vulva to darken as part of normal development.
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Pregnancy: Elevated progesterone, estrogen, and melanocyte-stimulating hormone can cause hyperpigmentation.
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Menopause: Decreased estrogen levels result in the vulva appearing paler and thinner.
Aging
As women age, particularly during menopause, the vulva may appear paler and thinner due to decreased estrogen levels. These changes are part of the genitourinary syndrome of menopause.[3]
Normal Variations
There is a wide range of normal pigmentation. Variations in skin tone and colour are common and influenced by genetics. Symmetrical changes that are not associated with symptoms such as itching, pain, or ulceration are generally considered normal.
Important: Any new, changing, or symptomatic lesions should be evaluated by a healthcare professional to rule out underlying pathology.
Pathological Causes of Vulva Colour Changes
Certain conditions can cause changes in vulva colour and may require medical evaluation:
Inflammatory Conditions
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Lichen sclerosus, lichen planus, and lichen simplex chronicus can alter vulva colour and often cause itching or discomfort.
Infections
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Vulvovaginitis or other infections can cause redness or discoloration due to bacterial overgrowth, pinworms, or hygiene-related factors.
Neoplastic Changes
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Pigmented lesions such as vulvar intraepithelial neoplasia (VIN) and vulvar melanoma can change vulva colour.
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Squamous Cell Carcinoma (SCC) may appear as persistent sores, thickened areas, or irregular pigmentation.
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Biopsy is often required for accurate diagnosis and treatment.
When to Seek Medical Advice
Medical assessment is recommended if any of the following occur:
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Sudden or significant changes in vulva colour
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Dark spots or patches with irregular shapes or borders
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Persistent itching, bleeding, or ulceration
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Rapid changes in size or colour
Early evaluation ensures serious conditions are detected promptly while providing reassurance for normal variations.
Medical Evaluation
Assessment may include:
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Detailed medical and gynaecological history
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Physical examination using a vulvoscope for close inspection
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Biopsy of unusual lesions, especially relevant for VIN, SCC, or melanoma
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Development of a management plan, including monitoring, topical treatments, or referral if needed
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Scheduled follow-up to monitor changes over time
Treatment and Management Options
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Topical treatments – for managing conditions such as lichen sclerosus
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Chemical peels or laser therapy – for persistent pigmentation changes
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Management of VIN, SCC, and vulvar melanoma – includes careful monitoring, surgical removal if necessary, and regular follow-up
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Sun protection – to prevent further pigmentation or irritation
Key Takeaways
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Vulva colour varies widely, and most changes are normal.
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Hormones, age, genetics, and minor skin changes are the most common causes.
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Inflammatory conditions, infections, VIN, SCC, and vulvar melanoma can also cause changes and require medical evaluation.
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Symmetrical, non-symptomatic changes are typically benign.
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Sudden, irregular, or symptomatic changes should be assessed promptly.
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Regular self-observation helps identify changes early.
FAQ
Is it normal for the vulva to be darker than surrounding skin?
Yes. Symmetrical pigmentation variations are common and usually harmless.
Can changes in vulva colour indicate cancer?
Most changes are benign. Sudden, irregular, or symptomatic pigmentation should be evaluated, particularly for conditions such as VIN, SCC, or vulvar melanoma.
What should be done if a dark or irregular patch is noticed?
Medical assessment is recommended. Document any changes and symptoms such as itching, bleeding, or discomfort for accurate evaluation.
Dr Sharon Li – Gynaecologist
MBBS FRANZCOG | AHPRA MED0001402739
If you would like more information about vulva pigmentation or to book a consultation in Brisbane or the Gold Coast, please contact our clinic at 07 3219 6868. We welcome you to book a face-to-face appointment with Dr Sharon Li, as every patient’s needs are different.
You will receive a detailed, personalised quote following your consultation, based on your specific treatment plan.
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