In early November 2012 I was privileged to attend a fantastic and informative conference in Auckland run by the AUSTRALIA AND NEW ZEALAND VULVOVAGINAL SOCIETY. I want to share some of what was discussed.
Firstly I want to explain the anatomy. The vulva is the collective term applied to the female external genitilia,comprising the outer parts of the female genital tract. It is the parts that are visible to the naked eye. The vulva extends from the mons pubis at the top to the anus at the bottom and the groin on both sides.
Starting at the top and working downwards.
- Mons Pubis this is the fatty part that covers the pubic bone. It is where pubic hair grows.
- Labia are what are termed the lips. The outer lips are called the labia majora and the inner lips the labia minora.The labia majora are covered with hair and the labia minora are not. The labia minora size does vary from individual to individual.
- Clitoris. This is found where the two labia minora unite at their upper end. The clitoris is made out of erectile tissue. It is similar in design to the male penis with a glans, prepuce and spongy tissue.
- Urethral orifice. This is where the urine comes out. It is a short tubular structure and is found between the vaginal opening and the clitoris.
- Fourchette. As with the clitoris being at the top of the labia minor the fouchette is at the bottom.
- Introitis. This is the opening of the vagina.
That very briefly is the anatomy. I have developed over the years an interest in this part of gynaecology. The conditions that affect the vulva and vagina are very debilitating, embarising and unpleasant. They are however mostly very treatable or at the very least manageable. I will briefly discuss the more common conditions. As with any medical condition it is always best to consult your usual health professional for a diagnosis and treatment.
The itchy sensitive vulva
The vulval skin is a very specialized skin and therefore extremely sensitive to a number of irritants. Irritation can cause stinging, burning and itching.
The commonest cause is not thrush but a local chemical that causes irritation. The most common ones are soaps, scented and dyed toilet paper, perfumes, deodorants, sanitary towels, waxing, flavoured lubrication products, shaving and condoms.
Itching due to thrush is less common but obviously must be excluded as a cause.
The treatment is to try and identify the causative agent, remove it and treat the symptoms. A topical steroid cream will alleviate the itch and burn.
If thrush is documented then anti fungal medication will cure it.
Lichen Sclerosis is an inflammatory skin condition. It can affect people of all ages and both sexes. On the genital area it is more common in women and more common in older women with the peak age being peri and post menopausal.
The symptoms are itch, soreness, and painful intercourse (dyspareunia) bleeding and white areas on the skin. About one quarter of patients are asymptomatic.
The best way of making an accurate diagnosis is to take a biopsy which is to take a small skin sample or a few under local anesthetic.
The long term consequences of Lichen Sclerosis are loss of tissue of the labia minora , narrowing of the vaginal entrance and adhesions (scarring) across the clitoris with resultant loss of clitoral exposure and loss of clitoral tissue.
There is also a small malignant potential.
The treatment of choice is long term high doses steroid cream or ointment.
Although there is no cure this form of treatment alleviates symptoms and retards tissue loss.
Very important. Because of the malignant potential regular check up are essential.
This is an auto immune skin conditions less common that Lichen Sclerosis.
The symptoms are pain, dyspareunia, discharge, loss of anatomy and ulceration
It also has a malignant potential.
The diagnosis is again made with a biopsy.
The treatment is also steroid cream and long term follow up.
Lichen Simplex Chronicus
This condition is a chronic dermatitis. (Inflammation of the skin).
It is often caused by chronic itching and scratching. The labia majora is often involved.
The treatment is to try and identify the causative agents that are causing the irritation and avoid those.
Topical steroid cream is used and night sedation as the itching is worse at night.
This is a condition of oestrogen deficiency. It is usually seen in post menopausal women.
Symptoms are vaginal dryness, itching, painful intercourse, recurrent thrush infections, and a urgency feeling in the bladder.
The treatment is local topical oestrogen creams or pessaries.
I have tried to briefly summarize a very complex distressing and difficult problem to manage. I have developed an interest in this challenging subject.
I have also written an article for my website on the practical approach to vulval itching that would be worth a read.