Excellent PDF link:
Guidelines for the Diagnosis and Management of Vulval Carcinoma – PDF. Screening vs Dermatologic Conditions.
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”.
Many women assume that they only need to see their local GYN and they should have all of the answers. We now see that without specialized training, the various dermatologic conditions can get missed. Consider seeing a dermatologist or gynecologist who has specialized training in vulvar or genital dermatology. This takes some investigation and patient advocacy.
“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 conditions that can be seen in isolation OR together:
Contact dermatitis and other eczema
Dermatitis due to substances taken internally
Unspecified symptom associated with female genital organs (chronic vulvar pain)
Lichen planus (lichen planopilaris, ruber planus)
Pruritus of genital organs
Lichenification and lichen simplex chronicus (Hyde’s disease, neurodermatitis [circumscripta] [local], prurigo nodularis)
Circumscribed scleroderma (lichen sclerosus et atrophicus)
The use of the colposcope or punch biopsies can be very helpful for making these diagnoses.
**Warning- the pictures in the first 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.