REMAINING VULVAL DISORDERS

For the last few posts we have been focusing on various skin and mucous membrane problems that cause vulval pain ,discharge , discomfort and dyspareunia, most of these have already been elaborated on and I will discuss the remaining few today. It is very difficult to discuss all of them as many of them such as psoriasis, tinea, and lichen planus effect almost all parts of the body covered by skin and mucous membrane and they often come under the domain of a dermatologist.
One of the common group of inflammatory conditions of the vulva  are called; 1-Lichen Planus, 2-Lichen Simplex Chronicus, 3- Lichen Sclerosis.

Lichen Planus is an erosive condition of the vulva which can affect both the vagina and the vulva, besides the genital area it can affect the scalp, hair and legs.
It has a reticulated purplish appearance which is very painful and uncomfortable. The diagnosis is confirmed by a biopsy and has a malignant potential, there is no definitive treatment, the patient needs reassurance, local emollients and steroids. Some people have tried testosterones. Recently cyclosporine are being tried.

 The above picture is Lichen Simplex Chronicus.

This also causes itching and leads to chronic rubbing and scratching , this usually affects the labia Majora, Labia Minora, and Labia Crural Folds. The vagina is not involved, this can result from chronic infection , anxiety conditions such as Psoriasis, Eczema. The skin becomes thick and leathery as you can see in the above picture and brownish. So the treatment is again reassurance, tranquillisers, antihistamines, anti pruritic agents and corticosteroids. The cause of chronic anxiety or infection causing the itch also needs to be treated.

Lichen Sclerosis is a chronic inflammatory disorder of the skin affecting both genital and extra genital skin such as the armpit, neck and shoulder and sub memory fold below the breast.
It can occur at any age including children, usually if it occurs in young girls it goes away as they mature. Most often it occurs in post menopausal women. Again like other vulval skin problems it causes itching and pain. The skin gets thickened and causes adhesions. The local tissues are destroyed. We are not sure what causes this, but like Lichen Planus it is thought to be auto immune.
Autoimmunity is a process in which the body fails to recognize itself and therefore attacks its own cell and tissues.
The treatment consists of avoiding commercial body washes and antiseptic solutions. Washing with a freshly made saline solution of two teaspoons full of salt with one litre of water is very soothing.
You need to do this twice daily for several weeks, then repeat the wash as required.
Daily strong tropical steroids are required on your doctors advice.

Lichen Planus and Lichen Sclerosis both have a five percent cancer potential , therefore it is very important to have six monthly regular appointments with your gynaecologist.



The vulval conditions described above need patient education, psychological  counselling, avoidance of commercial gimmicks, symptomatic treatment, saline washes, emollient's, corticosteroids, treatment for any inter current infections, ie: Thrush, (Candiasis) and above all regular check ups, and never treat yourself without correct diagnosis by a professional.

Bartholin's Cyst and Abscess

Bartholin gland is a small gland that lies in the entrance to the vagina and basically a small amount of fluid keeps the vagina moist which is useful during sexual intercourse. It has a small gland which carries the fluid to the vagina. If there is any infection the area, this little duct gets blocked and can cause a Bartolin's Cyst or Abcess. The important thing to know is that if it keeps happening it needs attention to exclude STI and often it requires drainage.

The above picture show the location of a swollen Bartholin Cyst and it's drainage.

Genital Herpes

Genital Herpes is caused by type one and type two herpes virus, initially not much attention was paid to this, but nowadays it is the most commonly transmitted disease. To prevent from yourself from getting herpes is to always use condoms, use suppressive viral therapy to protect your partner and avoid skin trauma by using silicone based lubricants.
The diagnosis is made by a swab test from the lesion, the blood tests are not so accurate. The initial attack of herpes is very painful. The treatment is anti viral drugs called Valtrex, Famvir and Zovirax.
The frequent occurrence can be treated by taking one tablet daily, this also protects transmission to the partner. It is very important to avoid herpes in the last few months of pregnancy as it can be dangerous to the newborn baby, and if the mother has an active rash on the vulva, the baby should be delivered by caesarean section.


Human Papilloma Virus is another virus which affects the female genital organs, particularly the cervix and the vagina and the vulva. The visible disease that is causes is the warts, otherwise it causes changes in the cervix which in the long term can lead to cervical cancer. To avoid cervical cancer that the smear test is implemented around the western world.
Please ensure that you have regular smear tests.

Another cause of vaginal discharge in post menopausal women is due to lack of oestrogens and it can be easily relieved by local oestrogen. However any women who suffers from irregular bleeding in the older age group must be investigated to exclude malignancy.

Often the vaginal discharge is due a foreign body and often this is a forgotten tampon.
The four tests which are useful for all these diagnoses  is a cervical smear, swabs, biopsy and ultrasound.

You may have to read or research more to increase your knowledge on vulval vaginal infections.
And this is all from me on this topic.

In future posts we will continue our journey on Womens Health problems.