Chapter 8 Diseases of the Vulva
Vulval dermatoses
Vulval dermatoses is the term applied to non-infective non-neoplastic diseases of the vulval skin. Their management has evolved into a multidisciplinary approach involving specialist nursing staff, dermatologists and gynaecologists. Specialist clinics may have direct referrals, but the symptoms of itching, soreness and dyspareunia will usually take the patient in the first place to the gynaecologist.
Classification
The following classification is recommended by the International Society for the Study of Vulvar Disease (ISSVD – 2004).
Lichen sclerosus
Lichen sclerosus is a common condition found in postmenopausal women complaining of vulval itch. Premenopausal women may also be affected, as well as men and children. The aetiology is unknown, but it appears to be associated with autoimmune disorders.
It is most commonly seen in the vulvo-perineal skin of women, but can affect skin in any region of the body.
Appearance
The disease starts as a flat pinkish-white macula. As it progresses, there is atrophy of the labia as well as clitoral recession with loss of normal architecture. With further deterioration, labial fusion and perineal fissuring occur. Scratching may induce lichenification (thickening).
Histology
There is atrophic thinning of the epidermis with some hyalinisation of the dermis. The keratinised layer is thickened, giving a whitened appearance (‘leukoplakia’).
Benign tumours of the vulva
The complaint is usually of a ‘lump’ or ‘swelling’ at the vaginal introitus. (In many cases, the patient may mistake prolapse of various types for tumour growth.)
Cyst of Bartholin’s gland This is the commonest simple tumour of the vulva. Caused by obstruction of the duct, the cyst often becomes infected and requires surgical treatment (see p. 133).
Vulval haematoma is a result of direct violence or wounding (it is most commonly found with childbirth). Treatment is by incision, evacuation and drainage if the patient is symptomatic.
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