Chapter 99: Vulvar disorders

INTRODUCTION

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).