The urethra in women lies just beneath the clitoris, and above the vaginal opening. Urinary incontinence, the involuntary loss of urine, can occur with activities such as exercise, sex, coughing, sneezing, and laughing, and can also occur with uncontrolled urge to urinate/overactive bladder. Sometimes it can be just a drop or two, requiring no more than a change of underwear, but in some women, it can be significant, leading to use of liners or pads. The pads, whether dry or wet with urine, can themselves irritate sensitive vaginal and perineal (the area between the vagina and anus) skin. Simple urine contact with vaginal and perineal skin, when chronic, can lead to dermatitis, skin irritation and infection.
How does this happen?
The opening of the vagina, the labia majora, and perineum can become red and inflamed. Women will complain of a “burning sensation down there”. I encounter this complaint frequently in my female patient population. This non-specific description can often be misunderstood for burning with urination (or a urinary tract infection), leading to a reflexive prescription of antibiotics. If vaginal dermatitis exists, direct urine contact on these areas will lead to a burning sensation, that is, a burning sensation after urination. The physician should be careful to elicit the correct problem here: is there burning with urination/dysuria (which may be a UTI), or is there vaginal skin burning? The treatments of course are much different.
Think of a baby’s red bottom which after prolonged contact with a wet diaper, becomes irritated and very painful. This is how I describe this problem to my patients, as it’s a common scenario all mothers have dealt with. Balmex and Desitin to the rescue, usually. However, in adults, the treatment goal is not only to soothe and heal the skin, but to stop the incontinence and urine contact in the first place.
Constant moisture to the skin alters the skin’s pH and natural protective barrier, allowing this barrier to break down, becoming more permeable to bacteria.