Vulvar complaints

The vulva is the skin around the sheath and consists of big, outer and small, inner labia plus the clitoris.

The Kunlun (mons veneris) lies directly on the pubic bone. Underneath the mons veneris lie the hairy big labia (labia majora). Between these outer labia are the small labia (labia minora); these do not have any hair on them.

Problems with the vulva can occur on any age, both with younger girls as with older women. Some problems with the vulva are easy to solve, but some problems take longer and require more attention. Common problems are itching, a burning or lean feeling or irritation. Most problems are caused by infections. Other irritations are caused by a change of the skin of the vulva. Skin disorders, for instance: eczema or psoriasis, can appear on the vulva too.

Problems with the vulva can have a negative effect on your sexual life. It can also be the other way around; sexual problems can be the cause of the general problems with the vulva. An STD may play a role. When you have problems or had problems during sexual activities, do not hesitate to talk about it with a gynaecologist. If you do not feel good about the examination, try to talk about that too.

Treatment

Allery:

Contact eczema is caused by irritations of the vulva skin. Most of the time the eczema is expressed in redness and/or itching of the vulva. Sometimes there is a very clear cause of the eczema and you can easily redress it. Some causes can be the use of perfumed or coloured toilet paper, underwear or bathing clothes, soap, talcum powder, intimate sprays, panty liners, spermicidal pasta or condoms. Crème or ointment might help. Cold compresses can reduce the itching. Due to scratching the problems might not fade.

Fungal infection:

The fungal infection is the most common infection of the vulva. The cause is often caused by the fungus Candida. Most of the time the vagina if infected too. You have an increased change of a fungal infection when you are pregnant, use antibiotics or have diabetes. With a Candida infection the vulva and/or vagina can be red, itchy and give off white, grainy discharge. Sometimes there can be a burning feeling while peeing. Sometimes, hypersensitivity can be a system too. this worsens the other symptoms. By looking at the discharge under a microscope, the Gynaecologist can (most of the times) recognize the presence or absence of the Candida fungus. Candida can be treated by taking pills (via the mouth or sheath), with a crème or with a combination. Sometimes your partner needs treatment too.

Sexually Transmitted Diseases (STD’s):

The most common sexually transmitted diseases (venereal diseases) of the vulva, are caused by viruses. The best way to prevent STD’s is by using condoms. There are two common STD’s of the vulva (look at ‘Sexually Transmitted Diseases’ and ‘fallopian tube inflammation’): Genital Warts (condylomata). Genital Warts are by the human papillomavirus (HPV). The warts are often white and pointed, but they can also be dark brown, and they can be all sizes. They can be located on the vulva, at the anus, in the vagina and on the cervix. This can create pain, itching, or discharge. The warts self are very contagious. There are different ways to treat the warts: like podophyllum or Aldara: a liquid that can be applied by you or by your Gynaecologist. The warts can also be frozen after applying an anaesthetic. If there are many warts, an ´operative´ treatment might be a better solution; this means that the warts will be burned away with a laser. However, after the treatment there is a 50% change that the warts come back.

Herpes simplex:

Genital herpes is caused by the herpes simplex virus (HSV). First, there will be small, clear blisters. After a few days, these blisters ill break and leave painful sores. The virus is most contagious in the blister phase. Herpes is an infection that can come back regularly, but the first time is often the most painful (especially peeing hurts a lot). There is no treatment that can kill the virus. But there are treatments that can be used) as a virus inhibitor: you can take pills (acyclovir) or use crèmes. They will reduce the complaints.

Vulvodynia:

The meaning of Vulvodynia is: pain of the vulva. It is a collective name for chronic problems ait the vulva without a clear cause; a burning feeling, itching, irritations and/or pain are meant by problems at the vulva. Sometimes a skin disorder is involved too. The disease can be on all parts of the vulva (as with atrophic vulvitis) or only occur on a small part of the vulva (as with the vulvar vestibulite syndrome).

Atrophic vulvitis:

After the menopause the skin of the vulva becomes thinner (Atrophic) and inflammation occur easier and therefor more often (Atrophic vulvitis). Oftentimes, the vagina in inflamed too (vaginitis). The main complains are a burning feeling and itching. The cause of the disease: after the menopause your body creates less oestrogen; oestrogen is key to the making of the covering layer. The problems can be solved very easily with a crème, pills or vaginal suppositories containing oestrogen.

Essential vulvodynia:

The vulva can also hurt (constantly or occasionally) without any visible abnormality. This is rare. It occurs almost always on an older age. Amitriptyline tablets can help get rid of the pain.

Vulvary vestibulite syndrome, focal vulvitis:

A syndrome is a fixed combination of symptoms. With the vulvary vestibulite syndrome pain is the main symptom. Often, there are small red stains visible at the bottom of the sheath. Many times, there is an increased tightening of the pelvic floor muscles, whereby the sheath becomes less wet during sexual intercourse. The syndrome sometimes arises after a long infection of the sheath (like a fungal infection) and sometimes it originates from a less pleasant sexual or physical experience. Especially when the condition has been present for a longer time, it is difficult to treat the condition. A persistent itching can sometimes be cured with a crème or an operation. A treatment can, eventual, be continued with a sexologist (also look at the brochure about sexual problems with women)., with a psychotherapist or a physiotherapist that is specialized in the pelvic floor muscles, in collaboration with the gynaecologist.

Skin disorder:

Some skin disorders can be a harbinger of malignant diseases. They are then called ‘premalignant disorders’.

Lichen sclerosis:

Lichen sclerosis causes the skin of the vulva to become thinner (atrophicus) or thicker (sclerosis), whiter (lichen) and shiny. Sometimes, pars of the vulva can grow together become smaller or even disappear. Lichen can appear on all parts on of the vulva and around the anus; it does not appear in the sheath. Most of the time the itching is the main problem. Sexual activities can be painful or even impossible. The cause of lichen sclerosis is unknown. The condition can occur on all ages. Lichen is not contagious.

To diagnose the disease, a small piece of tissue is removed and examined under a microscope. Lichen sclerosis is not curable, but the itching can be treated with a crème that contains adrenal cortex hormones (corticosteroids). You must use this crème with good consultation with your gynaecologist, because to wide use of the crème can cause the healthy, surrounding skin to become too thin and therefor vulnerable. The condition can, after a long period of time, cause cancer, this happens with 6% of the cases. So, when sores and new swelling son the vulva occur, tell the gynaecologist. New tissue samples can be taken. It is therefore necessary to have frequent check-ups. Self-examination is useful too (see more).

Vulvar intraepithelial neoplasia (VIN):

Intraepithelial neoplasia literally means that new tissue forms within the skin; is this case, the covering skin of the vulva. The disorder that is mentioned here, contains many different skin abnormalities: sometimes warts, sometimes sores or swellings. The colour can vary from white, rose red to brown. VIN can sometimes be an early stage of vulva cancer. There can be itching or pain, but it is also possible that there are no problems. Here too, a small piece of tissue is taken for a microscopic examination. It is not always necessary to treat VIN. The treatment is dependent on the present symptoms and the extensiveness of the disease. There is a difference between a light, medium or heavy deviations. With severe deviations, there is a 9% change that they develop into malignant diseases. If the decision is made to remove the disorder, it often happens with a laser treatment or operation. After the treatment, there is a 50% change that the treatment returns. It is therefor important that you keep track of any changes that occur on your vulva. When changes occur, you should contact your gynaecologist.

The disease of Paget:

With the disease of Paget (pronounced like paadzjet) there are white and red marbled spots on the vulva, often also on the perineum and around the anus. There is itching and a burning feeling. The disease is not contagious. The cause of the disease of Paget is unknown. To diagnose the disease, a piece of tissue is examined microscopic. The treatment is an operation whereby the disease is removed. Discuss more details of the operation with your gynaecologist. Paget is an early stage of vulva cancer. So, check-ups by your gynaecologist and yourself are very important.