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 the Bartholin 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, and 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 99.1).
Table 99.1Vulvar discomfort/irritation: diagnostic strategy model ||Download (.pdf) Table 99.1 Vulvar discomfort/irritation: diagnostic strategy model
Chronic vulvovaginal candidiasis
Irritant contact dermatitis (e.g. moisture with urinary incontinence or faecal soiling, panty liners, douches, bubble baths)
Allergic contact dermatitis (e.g. latex, topical antimicrobials)
Trauma—tears from vaginal intercourse, vaginal delivery
Serious disorders not to be missed
Pitfalls (often missed)
Provoked vestibulodynia Psoriasis
Lichen simplex chronicus
Herpes simplex virus
Seven masquerades list
Spinal dysfunction (dysaesthesia)
Is the patient trying to tell me something?
Common: psychosexual problems.
Key facts and checkpoints
If a dermatosis is suspected, check the skin on the body.
Provoked vestibulodynia (vulvar vestibular syndrome) is a distressing, reasonably common ...