The Vulva

Question 1

Pruritus vulcae:

What is it?

4 ways it can be caused

What is important to remember?

What may make it worse?

Investigating

Treatment

Answer 1

Vaginal itch which is distressing and embarrassing

General pruritus or skin disease

Local - infection and vaginal discharge (candida)
Allergy - washing powder, fabric dyes
Infestation - pubic lice, threadworms
Vulval dystrophy - lichen sclerosis, leukoplakia carcinoma

Self-treatment and scratching could have changed the appearance
Postmenopausal atrophy DOESN’T cause itch

Obesity and incontinence

Patch testing

Vulval care advice

Question 2

Lichen sclerosis:

What is it?

Appearance

Main symptom

Why is it monitored long term?

Topical clobetasol propionate is used. Why?

Answer 2

Elastic tissue turns to collagen

Vulva gradually becomes white, flat and shiny

Intensely itchy

It is pre-malignant

Treats swelling, itching and irritation.

Question 3

Leukoplakia:

What is it?

Why should it be biopsied?

Rx - just read

Answer 3

White vulval patches due to skin thickening and hypertrophy

Can become cancerous

Topical corticosteroids
UV phototherapy
Methotrexate
Ciclosporin

Question 4

Lichen planus:

What is this more likely to present with other than itching?

Answer 4

Pain

Look up

Question 5

Lichen simplex:

What is it?

What other issues do patients tend to also have?

Answer 5

Chronic intractable itching, especially at night

In those with sensitive skin or eczema

Question 6

Vulval Care

Answer 6

• Use warm water to wash the vulva.
• Dry thoroughly with a clean towel. (If the vulva is very irritated, you can try drying it with a blow dryer set on cool.)
• The vagina cleanses itself naturally in the form of normal, vaginal discharge. Avoid using douches unless prescribed by your physician. These products can upset the natural balance of organisms.
• Wear only white, 100 per cent cotton underwear. Avoid wearing nylon, acetate, or other manmade fibres if you have delicate skin or are prone to vulvar irritation.
• Avoid wearing thongs.
• Rinse underclothes carefully after washing or double-rinse.
• Avoid using too much laundry detergent.
• Wash new underclothes before wearing.
• Use a mild soap (such as Woolite®) for washing underclothes.
• Avoid fabric softeners (including dryer sheets) and detergents with enzymes (amylase, lipase, protease and cellulose).
• Use soft toilet tissue (white only).
• Use tampons instead of sanitary napkins to control menstrual bleeding. (Do not use deodorant tampons.) Do not leave tampons in for a long period, due to toxic shock syndrome. Do not leave tampons in all night.
• Take sitz baths daily, if prescribed by your healthcare provider.
• Don’t scratch.
• Avoid wearing nylon pantyhose or panty girdles. They trap heat and moisture, providing an ideal breeding environment for organisms. When nylons or leggings are required, wear cotton or nylons with a cotton panty.
• Avoid these feminine hygiene products, which can irritate the vulva: sanitary pads, feminine spray and deodorants, scented oils, bubble baths, bath oils, talc or powder.