Genital Skin Lightening

Why does the genital area get darker?

Skin colour depends on the amount of melanin (the pigment that gives skin its colour). The pigment cells in the skin of the outer genital area, groin, inner thighs and around the anus are more sensitive to hormones and friction. For this reason it is normal for genital skin to be darker than the surrounding skin; in most women this is not a sign of disease. Further darkening over time is called hyperpigmentation (darkening of the skin) in medicine. The main causes are:

• Friction and tight clothing: constant use of tight trousers, synthetic fabrics and narrow-strap underwear causes long-term irritation of the skin. The skin produces more pigment to protect itself and the area gradually darkens.
• Hair removal methods: waxing, shaving, hair-removal creams or laser hair removal with unsuitable settings can cause heat and small injuries to the skin. Darkening that develops afterwards is called post-inflammatory hyperpigmentation (darkening that remains after irritation or injury).
• Hormonal changes: pregnancy, breastfeeding, menopause, use of the contraceptive pill and Polycystic Ovary Syndrome (PCOS, a condition with many small cysts in the ovaries and a hormone imbalance) can darken the genital area. Darkening that appears in pregnancy often partly fades after birth.
• Insulin resistance and excess weight: insulin resistance (a reduced response of the body to insulin) and excess weight can be accompanied by acanthosis nigricans (velvety darkening in skin folds), which shows as dark, thickened, velvety skin in the groin, armpits and neck folds. It can be a sign of an increased risk of diabetes.
• Age and genetics: skin structure changes with age. In people with naturally olive or darker skin, a darker genital area is expected.

Is genital lightening applied inside the vagina?

No, these procedures are not applied inside the vagina. The vagina is the internal canal; lightening procedures are applied to the skin of the vulva (the outer genital area), especially the outer lips, the groin folds, the area between the vaginal entrance and the anus (the perineum) and the skin around the anus. In medical texts these procedures are described as genital skin lightening or treatment of genital hyperpigmentation. Genital lightening is not a medical necessity; it is a cosmetic procedure chosen by the person herself.

Medical evaluation first: which kinds of darkening need an examination?

Lightening is a cosmetic procedure and is not done before the cause of the darkening has been assessed. Some colour changes are not cosmetic but a sign of a medical problem. An examination is needed first in the following situations:

• Darkening that appears over a short time or on one side only.
• A spot or mole that is raised, has irregular edges, contains several colours, is growing or bleeds. Such skin changes on the vulva can, although rarely, be a sign of a serious disease such as skin cancer; if needed a biopsy (removal of a small tissue sample) is done.
• Darkening together with itching, burning, thickening of the skin, whitening or cracks. These may be due to skin diseases of the vulva or long-standing infections.
• Velvety darkening seen together in the groin, armpits and neck. Because acanthosis nigricans can be a sign of insulin resistance, it needs blood sugar and hormone testing. In this case the main approach is treating the underlying cause; with weight loss and improvement of insulin resistance the darkening may also lessen.
• Darkening accompanied by irregular periods, acne and increased hair growth (assessment for PCOS).

Methods of genital skin lightening

If no medical problem is found at the examination, the following methods may be planned alone or in combination, depending on skin type and the cause of the darkening. Which method is suitable varies from person to person.

Laser lightening

A fractional (applied to tiny dot-like areas) carbon dioxide (CO2) laser or a Q-switched laser (a laser that targets pigment with very short pulses) is usually used. The laser aims to remove dark pigmented cells in the epidermis (the top layer of the skin) and to renew the skin. A numbing cream is applied to the area beforehand; depending on the person there may be a mild pricking or warm sensation. The number of sessions is set according to skin type; most plans include a few sessions at intervals (usually 1 to 3). For general information on laser use in the genital area, see the Genital Laser page.

Chemical peeling

Chemical peeling (peeling off the top layer of the skin with an acid solution) aims to shed the darkest top layer of skin so that a lighter layer comes up from beneath. Substances such as lactic acid, mandelic acid or trichloroacetic acid may be used. Because genital skin is thin and sensitive, the substance and the application time are chosen by the doctor according to skin type.

Supportive treatments

In addition to laser or peeling, Mesotherapy (giving substances into the skin with fine needles), in which vitamins and similar substances are injected into the skin, may be used as a supportive treatment. Studies showing its contribution to lightening are very limited; it should not be seen as a lightening method on its own.

Daily habits

Whatever method is chosen, the colour will darken again if the factors causing the darkening continue. Choosing loose cotton clothing, reconsidering hair removal methods that irritate the area, and having excess weight and insulin resistance treated if present are important for keeping the result.

Who should not have it, or should postpone it?

• Anyone with an unexplained spot, mole or skin change, until the assessment is complete.
• During pregnancy and breastfeeding. Darkening in this period may lessen on its own after birth.
• If there is an active infection, an open wound, irritation, or recent waxing or laser hair removal in the area, until the skin has healed.
• Anyone with a history of genital herpes (cold sores in the genital area) must tell the doctor; herpes can flare up after the procedure.
• In people whose skin scars or darkens easily, the method and settings are chosen more cautiously.

After the procedure

After laser or peeling, daily life can usually be resumed straight away. In the first days there may be mild redness, a burning feeling, temporary darkening and then flaking and peeling; this is an expected process. During this period it is advised to keep the area moist with the care product recommended by the doctor, to avoid tight clothing and friction, and to take a short break from sexual intercourse and from swimming pools and the sea. Sunbathing in swimwear, sunbeds and friction can increase darkening again.

Risks and level of scientific evidence

Scientific studies on genital skin lightening are limited. Current data come mostly from small studies with few participants and from expert experience; long-term results are not well known. The main reported risks are:

• Burning, stinging and temporary redness lasting a few days.
• Paradoxical darkening: the irritation caused by the procedure can result in post-inflammatory hyperpigmentation instead of lightening. This risk is higher in people with darker skin.
• Permanent lighter patches, scarring or infection (uncommon).
• The colour darkening again over time, especially with friction and hormonal changes.

A word of caution about over-the-counter lightening creams: some lightening creams sold online and among cosmetics may contain hydroquinone (a skin-lightening substance that should be used only on prescription), mercury or corticosteroids (anti-inflammatory hormone medicines). The World Health Organization and the U.S. Food and Drug Administration (FDA) warn about the harms of such products, including thinning of the skin, irritation, paradoxical darkening and mercury poisoning. Because genital skin is thin, these products should not be used without medical advice.