My Vulva Is Itchy and Red. Gynecology or Dermatology?

 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

Dyspareunia

Vulvodynia

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.

38 Comments

  1. JOY June 22, 2013 at 4:30 am - Reply

    Is it OK to continue e-stim and vaginal ball exercise with these symptoms ? Many of the ladies told me they got itchy vulva or have tested to have yeast infection after several times of e-stim. But most of them continue these treatments because doctors told them it doesnot matter. They are more eager to treat the baldder and rectal prolapses.

    • Pelvic Guru June 22, 2013 at 8:46 am - Reply

      Joy – it’s always best to stop estim if there is an increase in itching, particularly if there’s an underlying GYN or dermatological issue that needs to be addressed. It can be resume once that is resolved. It’s not typical to get yeast infections from the estim (or itching). If this happens a lot, it’s important to figure out why.

      • Mohamed January 6, 2014 at 9:34 am - Reply

        Thanks for the post. I agree, it seems strange that ctesimmraoing with other women about reproductive woes is such a taboo subject. I want to live in a world where I can complain to any girlfriend about my yeast infection. Maybe not over the dinner table, but I don’t want to have to “feel out” if she’s that kinda girl. You know, who likes to talk about vaginas.Julianabritto.com

  2. Rosanna Zerafa July 12, 2014 at 7:45 pm - Reply

    I see women with these symptoms and it is often as simple as vaginal atrophy and can be well treated with a product such as Vagifem. Women will often call back astounded with the results! Always do an exam as lichen sclerosus can lead to carcinoma of the vulva and will need ongoing monitoring.

    • Pelvic Guru July 12, 2014 at 7:48 pm - Reply

      Totally agree, Rosanna!!

    • linda February 5, 2016 at 9:43 am - Reply

      I live in Florida and have this problem you ate talking about, where should
      I go to get proper help?

      • Pelvic Guru February 5, 2016 at 2:47 pm - Reply

        Where in Florida? There’s a great vulvar dermatologist in Jacksonville – dr. Kristen Stewart

        • linda February 5, 2016 at 2:52 pm - Reply

          I’m in West Palm Beach, and in so much discomfort

          • Pelvic Guru February 5, 2016 at 2:55 pm

            Sorry to learn that. Definitely seek help. I don’t know anyone right in your area… Dr. Jose Carugno at university of Miami is excellent. Or, if you contact Beth Harris (pelvic PT) at Boca regional hospital, she may know of physicians in west palm.

          • linda February 5, 2016 at 3:00 pm

            Thanks

  3. Anonymous August 28, 2014 at 1:15 am - Reply

    Free treatment for those who qualify for this research project for the treatment of Lichen Sclerosus. Go to this website: http://www.LichenSclerosusTreatment.com

    • Lisa April 1, 2016 at 3:49 pm - Reply

      This site has a very educational webinar about lichen sclerosus. Thank you for posting the link. The professionals that I have seen so far are not very familiar with this disease or treatment. They probably would not have arrived of the diagnosis of LS if I had not already been diagnosed with Lichen Planus in my gums for which two biopsies were taken. Nor was I educated about the problems that could occur if not treated properly. Some of which have unfortunately occurred in the last year. Thanks to this video, I have a better idea of the questions that I should be asking my doctors and the medication that I should be using and how. It was the information on how to use the medication that was the most enlightening of all. Thank you!

  4. samantha March 2, 2016 at 1:25 am - Reply

    has been going on for about 6 months. It started off as a really bad itch around the vulva and then spread to th perineum. skin in that region is now red and dry. it is very itchy at times and painful after scratching or sex due to stretching of the skin. sometimes it is painful and uncomfortable to walk. i have a lot of discharge now which is sometimes clear or yellow. vagina is constantly very wet(panty liners and/or panties get soaked). I’ve seen a doctor but my discharge was tested and came back normal. I have been tested for candida, vaginitis, trichomoniasis, chlamydia and gonorrhoea but all are negative. what do I do? should I see a dermatologist or a gynaecologist

    • Pelvic Guru March 2, 2016 at 1:31 am - Reply

      Have you had a vulvar biopsy for lichens sclerosis?

      • Anne April 8, 2016 at 12:01 pm - Reply

        I have been having the same problems mentioned in this post, without the discharge, for over a year. No yeast infection but lots of redness and itching and at times inflammation. Is there a vulvar dermatologist in the Northern Virgina/Washington DC area that you would recommend? Thanks much.

  5. Scott Pratt March 12, 2016 at 1:42 pm - Reply

    Reblogged this on Medical Aesthetic Journal and commented:
    Thank You About Pelvic Guru Founder, Tracy Sher for such an informative and wonderful blog. Information is true power. Another way to Empower women everywhere.

  6. Diane lessard April 9, 2016 at 7:31 pm - Reply

    Dear pelvic guru

    I have such pain, burning, raw, redness in my vagina. I haven’t had sex in over 9 yrs, now divorced. I can’t tolerate pelvic exam w out huge flare. Pain doc is doing perineal nerve block and pelvic floor Botox. But vagina is so bad I can’t walk or stand. She gave me Estrace and then vagifem which both killed me and had flare for over 8 days. Please let me know if you have any further suggestions. Thank you so much!
    Diane

  7. goldcoastdermatologycenter April 13, 2016 at 12:08 am - Reply

    Thanks for your sharing, it’s a good post, keep going and support you. And maybe you intersted in

  8. Anonymous May 8, 2016 at 11:36 pm - Reply

    I want to know who can solve the ceginal infection dermatologist or gynecologist

  9. Sheila June 17, 2016 at 8:32 pm - Reply

    I’ve been diagnosed with Lichen, by an OBGYN, but am in search of a dermatologist in the Omaha area. Any recommendations?

    • Pelvic Guru June 18, 2016 at 8:07 am - Reply

      It is difficult to find the right match. I’d call some derm offices ask to see who specializes in it or possibly Google it for your area.

  10. Bonnie July 3, 2016 at 12:51 am - Reply

    Wow! I have been living with this “burning itch” for years! I have seen both GYN’s and dermatologists. I have been given tons of cream that only irritated my condition or increased the pain and discomfort. I have stopped seeking help and was guessing at what might help (medicated powder) until it seemed to spread this past year. The flare ups have increased also. The doctors act as if they know, but in reality, they are just guessing. A dermatologist told me it was psoriasis and gave me a cream. (Bad reaction. The psoriasis on my elbows have gone way down, almost non existent. So maybe it’s not psoriasis at all!). Now, I want to find someone who actually is on top of the research in this area and NOT a doctor who pretends to know everything. Do you have any suggestions in the Cleveland, Ohio area?

  11. Ro October 26, 2017 at 6:58 am - Reply

    Know anyone in the Chicagoland area

  12. Janey November 15, 2017 at 1:41 am - Reply

    Dr. Christy Beyer at University of Chicago. She is part of ISSVD. She is oby/gyn who specializes in this and much better than vulvar dermatologists in Chicago.

  13. Elle January 3, 2018 at 12:25 am - Reply

    Know of anybody near Asheville, NC area? Really desperate for some remedy and answers for a 2+ yr itch in my vulva that has now spread to my anus as well. Thanks I’m advance.

  14. anonymous January 24, 2018 at 4:12 pm - Reply

    So, which doctor should we call first??

    • Tracy January 31, 2018 at 10:38 pm - Reply

      Can you clarify your question? Which doctor to call first – do you mean a GYN or a Dermatologist? It is either one who – depends on who has experience with vulvar skin conditions.

  15. Mo January 27, 2018 at 12:33 am - Reply

    I was recently diagnosed with LS by my GYN. I’d like to find a genital dermatologist in Northern California. Thanks in advance!

    • Tracy January 31, 2018 at 10:37 pm - Reply

      See if you can reach out to the Pelvic Health Rehab Center in San Francisco. They may have a list of vulvar dermatologists or GYNs who specialize in Lichens Sclerosis in that area.

  16. Melissa Dermody February 16, 2018 at 2:43 am - Reply

    I have been to a handful of GYNs and most recently a gyn who specializes in dermatology. I cant count all of the yeast infection tests I’ve taken. The all come back negative including some test that looked for about 8 hard to test years. Did a biopsy and it came back negative Lichen Sclerosis. But positive for lichen simplex chronicus. Also possible to be viulvodynia. The lidocaine is helping. Next up PT and possible oral and yet another topical ointment. I am so furious at this. I can’t get any relief. It it he’s so bad and I scratch so much that I’m rare, bleeding and can close my legs or walk it hurts or is inflamed. I just dont feel like it’s the right answer. Also I’ve been told the mosquito bite looking bumps are normal and just happen to be near the it hung but aren’t the cause of the itching. But what is causing the itching and how can I make It stop?

  17. Lyndsey March 3, 2018 at 8:50 am - Reply

    I have these symptoms and I am in a lot of pain. Are there any specialists in the San Antonio, TX area?

  18. dori March 5, 2018 at 12:41 pm - Reply

    is there a gynecologic dermatolgy, in the chicago area, can’t find one, I need help now

  19. Sandy Pafundi April 3, 2018 at 2:00 pm - Reply

    4/3/18

    I am 63 years old, post menopausal, currently using 1 ml of Estrace every 5 days. I was diagnosed with a UTI on 3/2/18 and was given a 7 day antibiotic (by Urgent Care).I felt better immediately. After taking all of the antibiotic prescription, my entire genital area felt inflamed and irritated including perianal area. I was told by my Primary the prescription I was given for the UTI was very strong, wiped out my system and created a yeast problem. I was given a 2 pill prescription for yeast infection (take 1st pill, wait 2 days take 2nd pill). After completing this prescription I still felt the same inflammation and burning of the genital area. Was advised to use Vaseline or Calmoseptine for irritation, but both of those products irritated the area even more. Went back to primary, and was told to increase my Estrace regimen to 2 ml every day for two weeks, then decrease to 1 ml daily for 2 weeks, then 1 ml every 3 days. I am just starting the 2nd week at 2 ml daily and do not feel any different. Very bothersome to have clothing touch the genital area. I am an active senior who rides horses, so you can only imagine how riding impacts the irritation!!

    Any vulvar dermatologists or gynecologists specializing in menopausal women in the Saratoga, NY area?

  20. Ghe April 25, 2018 at 12:45 am - Reply

    Hi. I’ve been having this irritation for 10years on and off. Usually on- i can’t sleep at night it’s so itchy. I can’t stop scratching because it’s the only way i get relieved. Dr sys it’s contact dermatitis I tried everything but still no good. I’m im north york, ontario area. Any doctor you can recommend me?

  21. Melissa May 13, 2018 at 5:37 am - Reply

    Hi! The last couple years, I have been having this reoccuring feminine itch. Anything sets it off! I am very careful which laundry soaps, feminine wash, etc that I use, but it doesn’t matter. I DON’T have an infection (my gynecologist confirmed this). I am 45 years old and was thinking it must be related to my hormones and the lack of moisture and thinning of my vagina wall. Do you know a Vulva specialist preferably in the Albany, NY area? or if necessary, in the Syracuse or Rochester, NY area? Would greatly appreciate any help!! This itch is horrible!

  22. carolyn bobsin May 13, 2018 at 3:51 pm - Reply

    I am 65. I experienced serious itching, my GYN tested and diagnosed Group B strep. I was prescribed Clotrimazole and Betamethasone Dipropionate cream 1%/0.05%. This worked well for awhile but I returned to the GYN because I still had a terrible itch. Upon examination she exclaimed that there were shiny white patches. The way in which she said this alarmed me because she seemed alarmed. I was prescribed Clobasol, a steroid cream and to take sitz baths. I was cautioned to not use too much of the steroid because it could be harmful to my skin. She also suggested Aquaphor and Cocoanut oil for dryness. I did get some relief but within a weeks time the itching returned. I have not scratched much only when I could not help it. But for the most part I have resisted the urge. The sits baths burned and also urination burns. The tops of inside my thighs turns bright red and has a milder itch. I have decided to see a dermatologist. I have become very depressed. Walking is very difficult as is wearing normal jeans. At home I wear no underwear and loose sweat pants or a long skirt. Does this condition ever go away ?

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