Atopic dermatitis/seborrhoeic dermatitis
Chronic vulvovaginal candidiasis
Irritant contact dermatitis (e.g. douches, bubble baths)
Allergic contact dermatitis (e.g. perfumes, topical antimicrobials)
Fissuring from the above dermatoses
Serious disorders not to be missed
Urinary incontinence → ammoniacal vulvitis
Spinal dysfunction (?dysaesthesia)
Is the patient trying to tell me something?
Common: psychosexual problems.
Appropriate history including atopic skin diseases.
Gynae-urological history (e.g. oestrogen status, faecal or urinary incontinence, vaginal discharge, ‘thrush’)
Check allergens and irritants (e.g. panty liners, soap, bubble bath, perfumes, condoms, douches)
Sporting activity (e.g. bike riding and costumes)
Check psychosexual history (e.g. dyspareunia, partnership issues, depression)
The previously named vulvar vestibular syndrome or vestibulitis is now termed provoked vestibulodynia, whereby a vestibule tender to pinpoint pressure and variable erthythema is found, typically, in young nulliparous women.
Always biopsy a focal lesion on the vulva.