Allergic and irritant contact dermatitis
WHAT IS VULVAR CONTACT DERMATITIS ?
This is a general term used to describe inflammation of the skin resulting from an external agent that acts either as an irritant or an allergen to produce a rash that can be acute or chronic.
WHAT IS THE DIFFERENCE BETWEEN ALLERGIC AND IRRITANT CONTACT DERMATITIS ?
Allergic disorders occur when a person’s immune system reacts to normally harmless substances in the environment. Allergic reactions in the vulva most often present with symptoms of itching. They usually occur between 48 hours to days after exposure, sometimes making identification of the causative “allergen” difficult. Allergic reactions in the vulvar area are usually caused by exposure to a perfume, preservative, or a medication that has been applied to the skin…
Acute irritant contact dermatitis occurs very rapidly after exposure to an irritant, resulting in redness, swelling, and sometimes, blistering. The reaction may take place within minutes or up to 24 hours after exposure. Women most often complain of burning, stinging, or pain. The irritants that cause an acute reaction are usually medications applied topically to the vulva to treat warts or yeast, laser treatments, or harsh chemicals in products meant to “cleanse” the vulva and vagina.
Chronic irritant contact dermatitis may be more difficult to diagnose than the acute reactions because symptoms of irritation, pain, soreness, or rawness can develop slowly. Chronic irritant contact dermatitis is usually caused by prolonged exposure to milder forms of irritants such as soap, water, urine, or feces, topical products such as feminine sprays or washes, wet wipes, bases of some gels or creams, or lowgrade yeast infections.
Aphthous Ulcers
WHAT ARE APHTHOUS ULCERS ?
Aphthous ulcers are acute, painful ulcers (loss of the full thickness of the epithelium). They occur suddenly in healthy individuals. When women have ulcers of both the mouth and the vulva that are unrelated to any other disease, this is called complex aphthosis.
WHAT CAUSES APHTHOUS ULCERS ?
The cause of aphthous ulcers is unknown. It is suggested that they are inflammatory disorders triggered in genetically susceptible individuals by factors outside the body.
WHAT ARE THE VULVAR SYMPTOMS OF APHTHOUS ULCERS ?
The main vulvar symptom is pain from the ulcerations.
Bacterial vaginosis
WHAT IS BACTERIAL VAGINOSIS ?
Bacterial vaginosis (BV) is a sign of an imbalance in the vaginal ecosystem. Under normal circumstances, the lactobacilli (known as the “good vaginal bacteria”) outnumber the other bacteria in the vagina and this natural balance makes the vagina slightly acidic. The symptoms of BV occur when the non-lactobacilli bacteria overgrow, causing the vaginal secretions to become more alkaline.
HOW DO WOMEN GET BACTERIAL VAGINOSIS ?
The cause is not fully understood. In many cases, BV is associated with having new, or multiple, sexual partners. However, BV can also occur in women who have never been sexually active. The natural balance of bacteria in the vagina may also be upset by douching and cigarette smoking.
WHAT ARE THE SIGNS AND SYMPTOMS ?
If BV is present, you may notice one, or more, of the following symptoms:
A white or gray discharge that can be mildly irritating
A fishy odor that is more noticeable after intercourse.
Burning during urination, itching around the outside of the vagina, or both.
Although these are the most common symptoms, BV can be present without causing any symptoms.
Behcet’s Disease
WHAT IS BEHCET’S DISEASE ?
Behcet disease is a rare, multi-system chronic inflammatory disorder that is classically marked by recurrent oral ulcers in addition to two of the following: recurrent vulvar ulcers, eye lesions (uveitis or retinovasculitis), skin lesions (erythema nodosum, folliculitis, acneiform nodules) or a positive pathergy tests (intradermal injection of sterile water that results in the formation of a papule or pustule in 48 hours). The disease can cause other forms of inflammation in the body as well. The etiology is unknown.
WHAT ARE THE GENITAL SYMPTOMS ?
In the vulva, the presenting complaint is pain during sexual intercourse with multiple, very tender genital ulcers that may take 2 to 4 weeks to heal.
Chronic vulvovaginal candidiasis / yeast infection
WHAT IS VULVOVAGINAL CANDIDIASIS ?
Commonly known as “yeast infection”, vulvovaginal candidiasis (VVC) is an uncomfortable condition in which normally occurring yeast organisms in the vagina transform and over-grow, causing vulvar irritation, itching, burning, and (sometimes) changes in vaginal discharge. The type of yeast most commonly found on culture is Candida albicans.
WHAT ARE THE SYMPTOMS OF VULVOVAGINAL CANDIDIASIS ?
Vulvar itching is the hallmark of VVC. Other symptoms include irritation, burning, soreness, and pain with urination or intercourse. The vulvar and vaginal skin may become red and swollen. Itching causes scratching and rubbing, which may then cause cracks in the skin. Women often describe a thick, white, clumpy (cottage cheese-like) discharge, but there may be no change in discharge, or it may be thin and watery.
Clitorodynia
WHAT IS CLITORODYNIA ?
Clitorodynia is a subset of vulvodynia. It is defined as a localized chronic vulvar pain or discomfort at the clitoris. The pain can be provoked by contact (vaginal intercourse, bicycle riding, tight clothes,…), unprovoked (occurring spontaneously without touch or pressure) or mixed.
WHAT ARE THE CAUSES OF CLITORODYNIA ?
The most common cause of chronic clitoral pain is an inflammation with or without the presence of keratin pearls (a hard, grain-of-sand like material) secondary to the presence of adhesions between the clitoris and the clitoral hood. Other causes of chronic clitoral pain are hypertonic pelvic floor muscles, skin diseases such as lichen sclerosus, clitoral or para-clitoral cysts or lesions, female genital mutilation/cutting, injury or irritation of the pudendal nerve (the nerve that innervates the clitoris). Sometimes, a herniated disc or a cyst in the sacral or lumbar spine may cause chronic clitoral pain.
Desquamative inflammatory vaginitis (DIV)
WHAT IS DIV?
Desquamative inflammatory vaginitis (DIV) is a cause of persistent vaginitis. DIV can occur at any age, before or after menopause.
WHAT CAUSES DIV?
The cause of DIV remains unknown. To date, no bacterial agent has been identified. It is not cancerous or contagious, and it is not sexually transmitted.
WHAT ARE THE SIGNS AND SYMPTOMS OF DIV?
Women with DIV often complain of an excessive, pus-like, yellow-green discharge that may have been present for years. The discharge may be blood-stained. The discharge may be associated with vulvar burning, irritation, and itching. Intercourse is often uncomfortable or painful.
Female genital mutilation/cutting (FGM/C)
WHAT IS FEMALE GENITAL MUTILATION / CUTTING ?
Female genital mutilation / cutting involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons.
Four types of FGM/C are described:
Type 1: partial or total removal of the clitoral glans (the external and visible part of the clitoris), and/or the prepuce or clitoral hood (the fold of skin surrounding the clitoral glans).
Type 2: partial or total removal of the clitoral glans and the labia minora, with or without removal of the labia majora.
Type 3 (also known as infibulation): narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce/clitoral hood and glans.
Type 4: all other procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping, cauterizing the genital area, …
WHAT MAY BE THE MEDICAL CONSEQUENCES OF FEMALE GENITAL MUTILATION / CUTTING ?
Potential long-term gynecological and obstetrical complications include urinary problems (e.g., painful urination, voiding difficulties, recurrent urinary tract infections), vaginal problems (e.g., recurrent vaginal infections), menstrual problems (e.g., painful menstruations or dysmenorrhea, difficulty in passing menstrual blood), pain during sexual intercourse, chronic vulvar pain, scar tissue and keloid, vulvar cysts and abscesses, infertility, and difficulty with pelvic examinations, coitus, and vaginal delivery. In addition, some women experience psychological problems such as depression, anxiety, post-traumatic stress disorder, etc that may negatively influence their overall quality of life.
Genital warts or Condylomata
WHAT IS THE CAUSE OF GENITAL WARTS OR CONDYLOMATA ?
Genital warts (also called « condylomata acuminata ») are caused by the human papillomavirus (HPV). They are among the most common sexually transmitted infectious diseases. There are many different types of HPV. Some are associated with cervical changes presenting abnormalities on the pap test, while others cause genital warts.
WHAT ARE THE SIGNS AND SYMPTOMS OF GENITAL WARTS OR CONDYLOMATA ?
The lesions are usually asymptomatic. Sometimes they cause itching. If the lesions are large they can be traumatized, fissured, and sore.
Graft versus host disease (GVHD)
WHAT IS GVHD?
Graft versus host disease (GVHD), a systemic immune disorder, is a complication of allogeneic hematopoietic stem cell transplantation. Many areas of the body can be affected, including the vulva and the vagina.
WHAT ARE THE SIGNS AND SYMPTOMS OF GVHD?
The lesions may be asymptomatic. Sometimes the lesions cause itching. Most women report vulvar irritation, vulvovaginal pain, pain during vaginal intercourse, bleeding after sexual intercourse and/or pain during urination. There may be vulvar fissures, clitoral agglutination, vaginal synechiae and vaginal stenosis.
Herpes and post-herpetic neuralgia
WHAT IS HERPES AND POST-HERPETIC NEURALGIA ?
Genital herpes is a common sexually-transmitted infection caused by the Herpes Simplex Virus (HSV). There are two types of HSV. Both HSV 1 and 2 can produce painful blisters and sores in and around the vaginal area and around the anal opening.
WHAT ARE THE SIGNALS AND SYMPTOMS OF HERPES AND POST-HERPETIC NEURALGIA?
Symptoms can be different in each person. The first outbreak may be associated with flu-like symptoms and may last 2 to 4 weeks. Early symptoms of genital herpes are often marked by burning, itching, or tingling on the vulva before the sores appear. Lesions can also occur inside the vagina and on the cervix, or in the urinary passage. Recurrent outbreaks are typically less painful and heal more quickly.
Herpes zoster
WHAT IS HERPES ZOSTER ?
Herpes zoster (synonym « shingles ») is an acute infection caused by the varicella-zoster virus (VZV). It usually involves the skin of a single dermatome.
WHAT ARE THE SIGNS AND SYMPTOMS OF HERPES ZOSTER AND POST-HERPETIC NEURALGIA?
The first symptom of herpes zoster is unilateral pain, itching, burning, or tingling in a certain dermatome. This may last for several days before the appearance of red swollen plaques and vesicles. The vesicels go on to form pustules and crusts with increasing pain in the area. Around ten percent will of women will develop post-herpetic neuralgia, that is continued pain which can last for weeks, months or even years after the rash goes away. It is caused by damage to the nerves from the HZ virus.
Hidradenitis suppurativa (HS)
WHAT IS HIDRADENITIS SUPPURATIVA AND WHAT ARE THE SIGNS ?
Hydradenitis suppurative (also called « acne inversa », or in French « maladie de Vernueil ») is a chronic recurrent disease that manifest with blackheads, scars of acne and painful brownish-red cystic nodules that appear suddenly, increase in size rapidly, and can then rupture under the surface of the skin or drain to the surface. At the vulva the lesions are most commonly seen on the mons pubis, the labia majora and the area around the anus. However, they are also seen in the axilla (armpits), under and around the breast, in the creases of the groin and on the buttocks.
Lichen sclerosus
WHAT IS LICHEN SCLEROSUS?
Lichen sclerosu (LS) is a chronic inflammatory benign skin disease that can occur in females of any age, even babies and young children. The true prevalence is not known but it is one of the most common conditions treated in vulvar clinics. It mostly affects the vulva and in about 50% of cases, LS will aslo affect the skin around the anus. Fewer than 20% of women affected have additional lesions on their neck, trunk, arms and legs.
WHAT IS THE CAUSE OF LICHEN SCLEROSUS ?
Although the cause of lichen sclerosus is has not yet been elucidated, it is most likely that lichen sclerosus is an auto-immune disorder as it is highly associated with other auto-immune conditions such as viteligo, thyroid disease, pernicious anemia, and lichen planus. It also tends to run in families. LS is not contagious and cannot be passed to a sexual partner.
WHAT ARE THE SIGNS AND SYMPTOMS OF LICHEN SCLEROSUS ?
Most women with LS experience intense itching around the vulva and the vaginal opening. Other women have vulvar pain or pain with sexual intercourse. Some women do not have any symptoms at all.
Skin affected by lichen sclerosus appears wrinkled, thin, and white and may have the appearance of "cigarette paper". If the anal area is involved, there can be a “figure of eight” shape. Because the tissue becomes thin and fragile, sores and fissures can appear, especially after scratching or friction such as after sexual intercourse. In women who have untreated lichen sclerosus for an extended period of time, the chronic inflammation can cause scarring. This may lead to a narrowing of the opening of the vagina, shrinking of the labia minora and covering over of the clitoris by the thickened prepuce skin.
Lichen simplex chronicus
WHAT IS LICHEN SIMPLEX CHRONICUS ?
Lichen simplex chronicus is caused by chronic scratching. The cause of the initiating "itch" that leads to lichen simplex chronicus includes irritation or allergies from chemicals (soaps, laundry detergent, fabric softeners, menstrual pads, wipes, scened and colored toilet paper, bath soaps, excessive washing, condoms with lubricants or spermicides, latex condoms, thight clothes, synthetic underwear, yeast creams), infections (most commonly yeast), dermatological conditions (eczema, psoriasis, contact dermatitis).
WHAT ARE THE SIGNS AND SYMPTOMS OF LICHEN SIMPLEX CHRONICUS ?
Intense chronic itching results in repetitive rubbing and scratching. Often the itch and/or burning is so intense that women will wake up at night from scratching in their sleep. The skin that may look white, thick with increased skin markings (like leather) and the presence of abrasions from scratching. Small nerve endings under the skin become sensitized and itch more, creating an itch-scratch-itch cycle.
Lichen planus
WHAT IS LICHEN PLANUS ?
The cause of lichen planus (LP) is unknown. It is probably an inflammatory, autoimmune disorder of the skin and mucous membranes. Lichen planus affects approximately 1% of all women. It occurs most commonly at the age of 50-60 years, though both younger and older women can be affected. The most common site of involvement is the mucosa of the mouth and gums. Approximately 25% of women with oral lichen planus also have vulvovaginal involvement.
WHAT ARE THE SIGNS AND SYMPTOMS OF LICHEN PLANUS ?
Erosive lichen planus is characterized by glassy, bright red erosions and ulceration involving the vulva and vagina. It may cause severe scarring of the vulva and the vagina and can lead to obliteration of the vagina. Vaginal involvement has been reported in up to 70% of patients with erosive lichen planus.
Women with lichen planus of the vulvovaginal region may present with pain, burning and irritation that may be responsible for severe pain during sexual intercourse and pain while urinating. Itching is less common. Vaginal involvement may result in bleeding after intercourse, sticky yellow discharge and destruction of the vulvovaginal architecture.
Plasma Cell Vulvitis / Zoon’s Vulvitis
WHAT IS PLASMA CELL VULVITIS / ZOON’S VULVITIS ?
Plasma Cell Vulvitis (also known at Zoon’s vulvitis) is a rare chronic, inflammatory disorder of the vulva. The cause is unknown. It does not appear to be a sexually transmitted or infectious disease.
WHAT ARE THE SIGNS AND SYMPTOMS OF PLASMA CELL VULVITIS / ZOON’S VULVITIS?
Most women complain of itching, burning, or pain with sexual intercourse. Some women are without symptoms. It causes bright, red, well-defined, often solitary mucosal plaques, usually located on the vulvar vestibule.
Psoriasis
WHAT IS PSORIASIS ?
Psoriasis is a very common skin rash. It can occur on the genital skin as part of more general disease but in some people, it affects only this area.
WHAT ARE THE SIGNS AND SYMPTOMS OF PSORIASIS ?
Psoriasis can cause itching, splits or cracks in the skin that can be painful and bleed. Some women have no discomfort.
Vestibulodynia
WHAT IS VESTIBULODYNIA ?
Vestibulodynia (previously named as vulvar vestibulitis syndrome or vestibular adenitis) is a subset of vulvodynia. It is defined as a localized chronic vulvar pain localized at the vestibule of the vulva.
The vestibule surrounds the opening of the vagina. It starts at the hymenal remnant of the vaginal opening and extends to approximately half way along the inner surface of the labia minora. The vestibule contains mucous-secreting glands that release lubrication during sexual arousal. These glands, called minor vestibular glands, surround the opening to the vagina. There are also two major vestibular glands, called Bartholin’s glands. There are important embryologic differences among tissues of the vulva, the vagina and the vestibule.
WHAT ARE THE SIGNS AND SYMPTOMS OF VESTIBULODYNIA ?
Provoked vestibulodynia, the most commen subtype of vulvodynia, is characterized by severe pain during attempted vaginal entry (intercourse or tampons insertion), tenderness to pressure localized to the vulvar vestibule and redness of the vulvar vestibule.
Vulvodynia
WHAT IS VULVODYNIA ?
Chronic or recurrent vulvar pain can be devided into two categories :
Pain related to a specific disorder, including infections (such as recurrent herpes or yeast infections), dermatologic disorders (such as lichen sclerosus, lichan planus, lichen simplex chronicus, plasma cell vulvitis), hormonal conditions (such as atrophic vaginitis), neoplastic disorders (cancerous changes), neurologic conditions (such as pudendal neuralgia, post-herpetic neuralgia), female genital mutilation/cutting,…
Vulvodynia : Odyne was the "Greek goddess of pain." Therefore, the term vulvodynia literally means "vulvar pain." Vulvodynia is currently defined as "vulvar discomfort occurring in the absence of relevant visible findings or a specific, clinically identifiable disease and present for at least 3 months"
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Vulvodynia most likely is the result of many different causes and represents many different disease processes. These may include hormonal factors, inflammatory and infectious disease processes, congenital conditions, peripheral and central neurologic conditions, genetic factors, allergic reactions, stress factors, adverse life experiences and abuse, and tightness of the muscles of the pelvic floor. Different contributing factors are present in different women.
Many women with chronic vulvar pain are told that their symptoms are “all in their head,” implying that their pain is not real. It is rare that vulvodynia occurs directly as a result of a psychological or sexual dysfunction. However, for many women chronic vulvar pain has significant negative consequences on the interpersonal, psychological and sexual well-being.
WHAT ARE THE SIGNS AND SYMPTOMS OF VULVODYNIA ?
Women with vulvodynia may experience severe burning, irritation, stinging, cutting or raw-like pain at the vulva. Vaginal intercourse is often painfull or even impossible.
The pain can be provoked by contact (vaginal intercourse, bicycle riding, tight clothes,…), unprovoked (occurring spontaneously without touch or pressure) or mixed. The pain can be generalized (pain all over the vulva or a non-specific area) or localized (pain on a specific area of the vulva). Depending on the area that is involved one can talk about clitorodynia (chronic pain at the clitoris), vestibulodynia (chronic or recurrent pain at the vestibule or opening of the vagina),…
Vulvar and vaginal atrophy
WHAT IS VULAR/VAGINAL ATROPHY ?
One of the most common causes of vulvovaginal discomfort comes from hormonal changes that causes vaginal and vulvar tissue to become thin and atrophic. A shift in pH and overgrowth of normally commensal organisms may occur, with resulting infection, adding to the discomfort.
WHAT IS THE CAUSE OF VULVAR/VAGINAL ATROPHY ?
There are many causes for these hormonal changes, including the intake of hormonal contraception, postpartum period and lactation, certain infertility treatments, hormonal treatment for endometriosis, the use of anti-estrogen drugs, and menopause.
WHAT ARE THE SIGNS AND SYMPTOMS OF VULVAR AND VAGINAL ATROPHY ?
Common symptoms of vulvar and vaginal atrophy include: pain upon vaginal penetration, vaginal dryness, irritation, burning, fissuring of the vulvar skin, and decreased lubrication during sexual arousal. Women may complain of bleeding, unusual vaginal discharge and sometimes odor.