Sexual health is an important part of general wellbeing, yet symptoms affecting the genital area are often ignored because of embarrassment or the assumption that they will resolve without treatment.
Some symptoms are caused by relatively minor conditions, while others can indicate a sexually transmitted infection, commonly known as an STI. Importantly, several STIs can also be present without obvious symptoms.
Knowing which changes require attention can help ensure that infections are identified and treated appropriately while reducing the risk of complications or transmission to sexual partners.
Unusual genital discharge
A change in vaginal or penile discharge can be associated with several infections and should be assessed when it is unusual for the individual.
Chlamydia and gonorrhoea can both cause abnormal discharge, although either infection may also occur without symptoms.
Other signs can include discomfort or burning during urination, pelvic discomfort and testicular pain or swelling.
Symptoms alone cannot reliably identify the infection responsible. Testing is therefore important rather than attempting to select treatment based on appearance or symptoms.
Sexual health clinics can perform appropriate tests using urine samples, swabs or blood tests depending on the infection being investigated.
Pain or burning when urinating
Pain during urination has several possible causes.
A urinary tract infection is one possibility, but burning or discomfort can also occur with STIs including chlamydia, gonorrhoea and genital herpes.
The surrounding symptoms can provide useful information, but they are not sufficient for diagnosis.
For example, discomfort accompanied by genital discharge may suggest a different cause from pain associated with visible blisters or sores. Persistent symptoms should therefore be assessed by a healthcare professional.
Genital blisters or sores
Blisters and sores around the genitals or anus require particular attention because they can be associated with genital herpes and other infections.
Genital herpes is caused by the herpes simplex virus. Symptoms can include small blisters that rupture to form sores as well as itching, tingling or burning around the affected area. Some people also experience pain when urinating.
Testing for genital herpes is usually performed by taking a swab from a visible blister or sore. This means it is advisable to attend a sexual health clinic while lesions are still present if herpes has not previously been diagnosed.
There is currently no treatment that removes the herpes simplex virus permanently from the body. Once acquired, the virus remains within nearby nerves and may reactivate periodically.
However, antiviral medicines can help manage outbreaks.
For people who have been appropriately diagnosed, oral aciclovir can be used to treat genital herpes by reducing viral replication. Treatment is most effective when started promptly after symptoms develop.
Recurrent outbreaks are often less severe than the first episode and may become less frequent over time. People experiencing frequent outbreaks may require a different treatment strategy and should discuss this with a healthcare professional.
Sex should be avoided while blisters, sores or the early tingling and itching associated with an outbreak are present. Condoms can reduce the risk of transmission at other times, although they cannot provide complete protection because herpes can affect skin outside the area covered by a condom.
Lumps or swelling
Any new lump around the genital area deserves attention.
There are many possible causes and most are not cancerous. Nevertheless, a new testicular lump, swelling or change in the size or shape of a testicle should be assessed by a GP.
Men should become familiar with what is normal for their testicles so that changes are easier to recognise.
Lumps elsewhere around the genital area can have different causes, including cysts, infections and genital warts. Trying to diagnose them through photographs online is unreliable because several conditions can have a similar appearance.
A clinical examination provides a more reliable way to establish the cause.
Persistent itching or irritation
Occasional genital irritation may result from friction, sweating or sensitivity to products such as soaps and detergents.
Persistent itching requires more consideration.
Possible causes include fungal infections, skin conditions, irritation and certain STIs. Genital herpes can also produce itching or tingling, particularly shortly before blisters develop.
Avoid repeatedly applying treatments without knowing what is causing the symptoms. A cream designed for a fungal infection, for example, will not treat a viral or bacterial STI.
If irritation persists, becomes painful or is accompanied by discharge, sores or other symptoms, professional assessment is appropriate.
Pain during sex
Pain during sexual activity should not automatically be considered normal.
There are numerous possible causes, including inadequate lubrication, infections, skin conditions and underlying gynaecological or urological problems.
If pain occurs repeatedly, identifying the cause is more important than simply trying to tolerate it.
Pain associated with other symptoms such as unusual bleeding, discharge, sores, pelvic pain or urinary changes should be discussed with a healthcare professional.
When there are no symptoms
One of the most important facts about sexual health is that the absence of symptoms does not necessarily mean the absence of infection.
Chlamydia and gonorrhoea can both occur without noticeable symptoms. Other infections can also remain undetected for extended periods.
Testing should therefore be considered following potential exposure even when someone feels completely well.
This may be particularly relevant following sex without a condom, when a condom has broken or when a current or previous sexual partner has been diagnosed with an STI.
The tests required will depend on the type of sexual contact and potential exposure. A sexual health clinic can advise which tests are appropriate and when they should be performed.
Protecting your sexual health
Reducing sexual health risks relies on several measures rather than one precaution.
Condoms can substantially reduce the risk of many sexually transmitted infections when used correctly. However, infections transmitted through contact with uncovered skin, including genital herpes, can still sometimes be passed between partners.
Regular testing is also valuable for people who have new or multiple sexual partners.
Communication matters as well. Discussing STI testing, contraception and existing infections with a partner can allow both people to make informed decisions about their health.
Vaccination can provide additional protection against certain sexually transmitted infections, including human papillomavirus and hepatitis B, for people who are eligible.
When to seek medical advice
A sexual health clinic or GP should be contacted when symptoms such as genital sores, unusual discharge, persistent pain, burning during urination or unexplained lumps develop.
Assessment is also appropriate following potential STI exposure even when symptoms are absent.
Sexual health clinics provide confidential testing, advice and treatment. The type of assessment required will depend on symptoms, sexual history and the infections that may have been encountered.
Seeking advice early can make treatment more effective in some conditions. With genital herpes, for example, antiviral treatment is most useful when started early during an outbreak.
Most importantly, sexual health symptoms should be treated in the same way as changes affecting any other part of the body.
Recognising a problem and obtaining an appropriate diagnosis is considerably safer than ignoring symptoms or attempting to identify the cause without testing.
