Chapter 107

### Introduction

Genital skin is very sensitive. This sensitive organ needs protection from chemical and physical damage. The genital area is also affected by the way you feel and symptoms can appear worse at times of stress.

Extract from patient information sheet, ‘The Do’s and Don’ts of Genital Hygiene’, Dermatology/Vulval Diseases Clinic, Mercy Hospital for Women, Melbourne

The dermatoses are the predominant cause of vulvar problems and this chapter focuses mainly on the important female genital skin conditions.

The vulva is that part of the female external genitalia lying posterior to the mons pubis, comprising the labia majora, labia minora, clitoris, vestibule of the vagina, vaginal opening and bulbs of the vestibule.1

The vaginal vestibule is an almond-shaped opening between the lines of attachment of the labia minora. The clitoris marks the superior angle and the fourchette the inferior boundary. It is approximately 4–5 cm long and 2 cm in width.1 The four main structures that open into the vestibule are the urethra, vagina and the two secretory ducts of Bartholin’s glands. The surface is composed of delicate, stratified squamous epithelium.

The genital area is affected by dermatoses found elsewhere on the skin but management is rendered more complex by the sensitivity and thinness of the skin, a tendency to superinfection, in addition to the psychological problems, including the often-resultant dyspareunia.

The vulval area, which is innervated by nerves arising from L1–2 and S2–4 nerve roots, is sensitive to noxious stimuli but the vagina is not sensitive to pain.2 Topical creams, soaps, perfumes and other toilet products irritate the vulva easily—it is an area prone to contact dermatitis.

Clinical manifestations of vulvar disorders include itching, pain, irritation, white mucosal patches, lichenification, erosions and intertrigo3 (see the diagnostic strategy model presented in Table 107.1).

Table 107.1

Vulvar discomfort/irritation: diagnostic strategy model

Key facts ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

## Subscription Options

### Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.