Underarm lightening and intimate lightening are general names for treatments that aim to reduce darker skin in the underarms, the bikini line and the external genital area. You may also see them called intimate whitening or genital skin lightening. The treatments are applied to the outer skin only, not inside the vagina.

It is common for these areas to be darker than the rest of the body. This is usually normal, is not a disease in itself and does not need treatment; choosing a treatment is a personal decision.

The aim is to help reduce the color difference. The natural color cannot be completely changed, and the response varies from person to person. The right method depends on your skin type and the cause and depth of the darkening, and it is decided at your consultation. For other pigmentation concerns on the face and body, see skin spot treatments.

In the genital area, the hormone estrogen plays an important role: it stimulates melanocytes, the cells that give skin its color, which can make the area look darker.

Other factors that may contribute include:

• Hormonal changes: Pregnancy, birth control pills and some hormone medicines used over a long time.
• Friction and irritation: Tight clothing, shaving, waxing and other hair removal methods.
• Inflammation: Color changes left after irritation, infection or surgery in the area.
• Products: Irritating creams and deodorants.
• Genetics: In some people, these areas are naturally darker.

Velvety, dark skin in the underarms, on the back of the neck or in the groin may be linked to metabolic conditions such as insulin resistance. That is why the cause is assessed before treatment, and blood tests may be requested. If an underlying cause is found, it should first be managed by the relevant doctor.

The area is examined first. If there is active irritation or infection, it is treated before anything else. Depending on your skin, the following methods may be used:

• Pink Intimate System: A peel system designed for sensitive areas such as the genital area, bikini line, underarms and nipples. It aims to renew the top layer of skin and help reduce the color difference. For general information on peels, see chemical peeling.
• Mesotherapy: Cocktails prepared with ingredients suited to the area are applied to the skin over a series of sessions.
• Energy-based methods: CO2 fractional laser, plasma energy and golden needle treatments, which are also used for facial pigmentation, may be considered in this area for suitable people.

Methods may be used alone or combined. At the clinic in Nişantaşı, Istanbul, procedures are carried out by a doctor, with care for your privacy. Session length depends on the method.

For a few days beforehand, avoid hair removal and irritating products on the area. Tell your doctor about earlier treatments and the creams you use; this helps reduce the risk of irritation and color change.

Redness, mild burning, dryness or flaking may appear and usually ease within a few days. You will usually be advised as follows:

• Clothing: Wear loose cotton clothing rather than tight synthetic fabrics.
• Hair removal: Avoid shaving, waxing and other hair removal for a while.
• Products: Apply nothing to the area except the care products your doctor recommends.
• Heat and water: Stay away from Turkish baths, saunas, pools and the sea for the first days.
• Sun: Protect the underarms and bikini line from direct sun.

Irritation from treatment may temporarily cause more darkening in some people, especially those with darker skin tones. With energy-based methods, burns, crusting and scarring may rarely occur. If you notice marked burning, discharge or a wound, contact your doctor.

The number of sessions depends on how dark the area is, your skin type and the method. Several sessions are usually planned at set intervals, and the plan is adjusted at follow-up visits if needed.

Lightening may not last. If the factors behind the darkening continue, the color may gradually darken again. Comfortable clothing, gentler hair removal and continued treatment of any hormonal or metabolic cause may help maintain the result.

Maintenance sessions may be planned if needed, as decided at a follow-up visit. Because pregnancy or hormonal medicines can darken the area again, the plan is updated when such changes occur.