My Vulva Is Itchy and Red. Gynecology or Dermatology?
Here’s the scenario we see often: A patient comes in to a gynecologist or pelvic physical therapist with complaints of burning at the vulva (or itching) and painful intercourse. It’s quite possible that the patient has a typical type of presentation such as yeast or fungal infection OR vulvodynia with subsequent spasm of the pelvic floor muscles. However, admittedly anectodally, I have seen far too often in my practice, that the patient actually also has a vulvar dermatological condition, such as Lichens Sclorosus, that is not diagnosed or addressed; or is occurring concomitantly with the aforementioned diagnoses. It’s a very confusing situation so awareness is key here- for patients and treating healthcare professionals. I recently had a patient who was treated for 10+ years for yeast infections, but she actually had an underlying significant case of Lichens Sclerosus that was never addressed. When asked if she was testing positive for yeast infections, she said “no, but the doctor didn’t know what else it could be so they just kept treating me for yeast”.
“Vulvar pain and dyspareunia [painful intercourse] are common presenting complaints in the office setting. Vulvar dermatoses must be considered as a part of the differential diagnosis for any woman with sexual dysfunction or pain. A detailed history and physical examination, backed by a confident knowledge of the vulvar dermatoses, will aid in diagnosis and treatment”
Here’s a list of some of the diagnosis codes/conditions that can be seen in isolation OR together:
Contact dermatitis and other eczema (692.0 – 692.9)
693 Dermatitis due to substances taken internally (693.0 – 693.9)
625.9 Unspecified symptom associated with female genital organs (chronic vulvar pain)
697.0 Lichen planus (lichen planopilaris, ruber planus) 698.1 Pruritus of genital organs
698.3 Lichenification and lichen simplex chronicus (Hyde’s disease, neurodermatitis [circumscripta] [local], prurigo nodularis)
701.0 Circumscribed scleroderma (lichen sclerosus et atrophicus)
As mentioned in the article, the use of the colposcope
can be very helpful. The CPT codes for its use in examining the vulva are:
56820 Colposcopy of the vulva 56821
**Warning- the pictures in this pdf link are quite graphic and show some of the dermatological conditions at the vulvar area. They are helpful to provide a better perspective on different types of vulvar issues.