Treatment for Vaginal Chafing
For vaginal chafing, start with skin protectants/sealants applied to the external vulvar folds, combined with lubricants for any sexual activity or touch, and vaginal moisturizers to improve tissue quality. 1
Initial Conservative Management
The first-line approach focuses on barrier protection and tissue restoration:
- Apply skin protectants or sealants to the external vulvar folds, particularly if you're using pads for leakage or discharge, as these can worsen chafing 1
- Use lubricants for all sexual activity or touch to reduce friction-related trauma 1
- Apply vaginal moisturizers regularly (not just during sexual activity) to improve vulvovaginal tissue quality and restore the protective barrier 1
When Conservative Measures Fail
If symptoms persist or are severe at presentation, escalate treatment:
- Consider low-dose vaginal estrogen for women with more severe symptoms or those not responding to conservative measures 1
- Apply topical lidocaine for persistent introital pain, which can accompany chronic chafing and dyspareunia 1
Addressing Underlying Contributing Factors
If Pelvic Floor Dysfunction is Present:
- Refer for pelvic floor physiotherapy if there are signs of pelvic floor issues, pain with examinations, or sexual activity 1
- Recommend cognitive behavioral therapy and pelvic floor (Kegel) exercises to decrease anxiety, discomfort, and lower urinary tract symptoms that may contribute to protective guarding and worsening chafing 1
If Vaginal Stenosis or Vaginismus is Contributing:
- Offer vaginal dilators for anyone experiencing pain with examinations or sexual activity, as these conditions can lead to compensatory behaviors that worsen chafing 1
- Start dilator therapy early rather than waiting for symptoms to worsen 1
Important Caveats
Do not confuse chafing with infectious vaginitis. If there is pruritus, abnormal discharge, or erythema suggesting infection rather than mechanical irritation, proper diagnostic evaluation is needed before treatment 1. Vaginal chafing presents with irritation and soreness from friction, not the classic signs of infection (abnormal pH, discharge with odor, or microscopic findings of pathogens).
Avoid potential irritants that can worsen chafing, including harsh soaps, douches, tight synthetic clothing, and prolonged pad use without barrier protection 1.