Vulval disorders

Question 1

List 4 symptoms of vulval dermatitis

Answer 1

dermatitis - DIE Pain

D - discharge
I - itch
E - erythema
Pain

Question 2

List 4 signs of vulval dermatitis

Answer 2

Dermatitis - DEE DIES

Dry skin
Erosions
Erythema

Dry skin
Itch
Erythema
Symmetrical

DEE = signs
DIES = symptoms

Question 3

List 3 symptoms of vulval psoriasis

Answer 3

Itchy ASS

I - itch
A - arthritis
S - Scaly Skin

Question 4

list 2 signs of vulval psoriasis

Answer 4

• red, scaly, well demarcated patches

- asymmetrical patches

Question 5

List 4 symptoms of lichen sclerosis

Answer 5

Itch
Dry skin
Dyspaerunia
pain
May be asymptomatic

Question 6

List 6 signs of lichen sclerosis

Answer 6

• loss of vulval architecture
• pale vulva/anogenital area
• figure of 8 sign - pale skin around Introits and anus
• hair loss
• spares vagina
• fusion of labia

Question 7

List 4 signs of lichen planus

Answer 7

The vagina P’s

May involve vagina
Purple
Papules or plaques
Appears inflamed or sore

Question 8

List 6 contributing factors to vulval dermatitis

Answer 8

• sweat
• recurrent candidiasis
• synthetic underwear
• douching
• use of chemical on vulva
• laundry detergents
• spermacides

Question 9

List 4 macroscopic features that are consistent with lichen sclerosis

Answer 9

PAVLOva

P - pale skin around anus/introitus
A - asymmetry
V - vaginal stenosis
L - labial fusion/Loss of architecture
O - obliteration of clitoral hood

Question 10

What advice would you give someone about lichen sclerosis as a condition?

Answer 10

• autoimmune condition
• causes chronic inflammation of the vulva
• associated with an increased risk of vulval cancer

Question 11

What management options are available for lichen sclerosis?

Answer 11

• conservative - cotton underwear, sleep without underwear, avoid vulval irritants/douching
• medical - treat with potent steroids lifelong
• surgical - occasionally labioplasty is required for restoration of anatomy and for sexual/urinary function

Question 12

List 5 conditions that present with vulval itch and rash?

Answer 12

Vulval dermatitis
Lichen sclerosis
Lichen planus
VIN
lichen simplex chronicus

Question 13

Describe the medical management of vulval dermatitis

Answer 13

• avoiding causative agents is first line
• cream/emollient
• Anti-histamine
• consider course of low potency steroid

Question 14

What is the differential diagnosis for vulval itch?

Answer 14

THIINN
Trauma 
hormonal
infection
inflammatory
Neoplastic 
neurological

Question 15

What can cause traumatic vaginal itch

Answer 15

• obstetric trauma

- FGM

Question 16

What are the causes of infective vaginal itch?

Answer 16

• candidiasis

- HSV

Question 17

What are the causes of inflammatory vaginal itch?

Answer 17

• eczema
• contact dermatitis
• psoriasis
• lichen simplex chronicus
• lichen planus
• lichen scelorosis
• desquamative inflammatory vaginitis

Question 18

What are the causes of neoplastic vaginal itch?

Answer 18

VIN/VAIN

Extra-mammary pagets disease

Question 19

What are the causes of neurological vaginal itch?

Answer 19

post-herpetic neuralgia

nerve injury

Question 20

What are the hormonal causes of vaginal itch?

Answer 20

atrophy

Question 21

What are 3 characteristics that can help you differentiate Lichen sclerosis from lichen planus?

Answer 21

• Lichen sclerosis occurs on the vulva only, whereas LP affects vagina also
• LS is white and is not primarily erosive, whereas LP is red/erythematous and primary erosive
• LS occurs in children while LP rarely occurs in childhood
• LS is associated with malignancy while LP only rarely associated with malignancy