Skip to Main Content

++

Probability diagnosis

++

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

++

Trauma: ‘dry’ coitus

++

Serious disorders not to be missed

++

Cancer:

++

  • squamous cell carcinoma

  • lymphomas, etc. → pruritus

  • melanoma

++

Infection:

++

  • streptococcal vulvovaginitis

  • herpes simplex virus; herpes zoster

++

Other:

++

  • vulval vestibular syndrome (provoked vestibulodynia)

++

Pitfalls (often missed)

++

Lichen sclerosus

++

Urinary incontinence → ammoniacal vulvitis

++

Faecal soiling

++

Tinea cruris

++

Trichomonal vaginitis

++

Atrophic vaginitis

++

Aphthous ulcers

++

Dysaesthetic vulvodynia

++

Psoriasis

++

Lichen planus

++

Infestations:

++

  • threadworms

  • pubic lice

  • scabies

++

Masquerades checklist

++

Depression

++

Diabetes

++

Drugs (e.g. antibiotics)

++

Spinal dysfunction (?dysaesthesia)

++

UTI

++

Is the patient trying to tell me something?

++

Common: psychosexual problems.

++

Key history

++

  • 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)

++

Key examination

++

  • General health

  • Inspection of vulva and rest of skin, scalp nails

  • Vaginal examination

++

Key investigations

++

  • Vaginal swab

  • Pap smear

  • Consider need for vulval biopsy and patch testing

++

Diagnostic tips

++

  • 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.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.