Vulvar discomfort and irritation Flashcards
Atopic dermatitis/seborrhoeic dermatitis
Chronic vulvovaginal candidiasis
Irritant contact dermatitis (e.g. douches, bubble baths)
Allergic contact dermatitis (e.g. perfumes, topical antimicrobials)
Fissuring from the above dermatoses
Trauma: ‘dry᾿ coitus
Serious disorders not to be missed
Cancer:
- squamous cell carcinoma
- lymphomas, etc. → pruritus
- melanoma
Infection:
- streptococcal vulvovaginitis
- herpes simplex virus; herpes zoster
Other:
- vulval vestibular syndrome (provoked vestibulodynia)
Pitfalls (often missed)
- Lichen sclerosus
- Urinary incontinence → ammoniacal vulvitis
- Faecal soiling
- Tinea cruris
- Trichomonal vaginitis
- Atrophic vaginitis
- Aphthous ulcers
- Dysaesthetic vulvodynia
- Psoriasis
- Lichen planus
- Infestations:
- threadworms
- pubic lice
- scabies
Masquerades checklist
Depression
Diabetes
Drugs (e.g. antibiotics)
Spinal dysfunction (?dysaesthesia)
UTI
Is the patient trying to tell me something?
Common: psychosexual problems.
Key history
Appropriate history including atopic skin diseases.
Gynae-urological history e.g.
- oestrogen status
- faecal or urinary incontinence
- vaginal discharge, ‘thrush’
Check allergens and irritants e.g.
- panty liners
- soap
- bubble bath
- perfumes
- condoms
- douches
Sporting activity (e.g. bike riding and costumes)
Psychosexual history (e.g. dyspareunia, partnership issues, depression)
Key examination
General health
Inspection of vulva and rest of skin, scalp nails
Vaginal examination
Key investigations
Vaginal swab
Pap smear
Consider need for vulval biopsy and patch testing
Diagnostic tips
The previously named vulvar vestibular syndrome or vestibulitis is now termed provoked vestibulodynia, whereby a vestibule tender to pinpoint pressure and variable erthythema is found, typically, in young nulliparous women.
Always biopsy a focal lesion on the vulva.
