Patrick Hudson MD, FACS

Perineal pigment, dark skin around the anus, vulva and perineum

It is often normal to have some pigment around the anus, vulva and perineum. In normal children under age 11 studies show pigmentation occurs in  one in five white children, 53% of black and 58% of hispanics. It can occur in both men and women and all races but is more common in those with darker skins such as Hispanics, Native Americans, Blacks and Asians, including both Chinese and Indians. 

Excessive darkening of the skin around the anus has  several causes. First, It may be caused by an increase in pigment in the skin.  Often this is genetic and simply reflects your distribution of skin pigment. It is often more noticeable as we grow older. Although more common in those with a darker complexion it can become noticeable even in women with very light skin color, like redhead and  blondes. In these cases it produces a more diffuse sandy coloring to the skin.  

Sometimes it is related to pigment changes associated with pregnancy and may persist after the baby is born, rather like areolar or nipple pigment, linea nigra, inner thigh and facial masking or chloasma. In some women this may only last a year or so but in others is permanent. Sometimes it can extend on to the pink area of the internal labia and vagina.It is common for the labia to be larger, more loose and darker than before you were pregnant.

Another cause is increased pigmentation due to existing or previous skin irritation. Examples include chronic itching around the anus, pin worms or allergies. Chronic infections, such as yeast infections, can also cause changes in pigment.  Repeated anal sex may also be a factor. Simply rubbing the area too much, as in a nervous habit may cause irritation and pigment change. Irritation from repeated pubic hair removal with shaving and waxing may also be a factor.

Localized pigmentation, like moles, of the anal verge or vulva may have medical significance. Any change or new mole should be checked by a physician to rule out malignant change. Melanoma accounts for 5% of vulvar cancer. A pigmented, well defined plaque on the perineum that looks like a flattish wart may be a pigmented type of Bowen’s disease, seborrheic keratosis or psoriasis. Asymmetrically pigmented patches on the vulva and perineum have even been associated with Paget's disease. This is usually seen on the nipple and areola of the breast and is often associated with underlying breast cancer.When they occur in the labial area some skin diseases like lichen simplex can cause thickening and enlargement of the labia as well as pigment change.

Finally poor hygiene and a failure to clean the anal area after bowel movement may stain this area.

Because most people do not examine their perineum regularly they are unfamiliar with their own normal appearance. Sometimes patients think they have darker areas when in fact part of the perineum or labia has lost pigment. Such discoloration or hypopigmentation may be harmless depigmentation related to age but can be an early sign of skin disease. It should be checked by a physician.

Whatever the cause, whether after pregnancy, genetic or irritation, peri-anal pigment may become severe enough to embarrass some people.  In the past only models, celebrities and those involved in the porn industry opted for anal bleaching but today it is more widely accepted.  In this case a medical opinion may help. A strong local bleaching cream such as hydroquinone, 2% or 4%. may help but this should only be used externally and under medical supervision after a consultation with a physician. Significant rashes may occur. In resistant cases a light chemical peel may be used. This should only be done by a doctor who is expert in peeling techniques and a risk of damage to the anal sphincter does exist.

Alternative names: anal pigment, vulvar pigment, labial pigment, perianal pigment, perineal pigment, anal staining, vulvo-vaginal pigment

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