Fiona M. Lewis Symptoms relating to vulval disorders tend to fall into a few clear categories. Itch, soreness, and pain are the common descriptions that women will give. It is always important to clarify exactly what the patient experiences when they report symptoms, as misunderstanding is easy. If a patient describes irritation, this does not always correlate with itch, and so asking them if they have the desire to scratch (which does define pruritus) is helpful. The same is true for signs. Patients may report ‘blisters’, but these are rarely, if ever, true bullae, which can then lead to unnecessary investigations. As different specialties are involved in treating women with vulval disease, it is important to have a clear and common terminology for describing lesions. This should ensure that the same language is spoken when discussing cases with colleagues and in research. There are classifications of disease according to clinical [1] and histological patterns [2]. These may be helpful initially, but they can be simplistic as some disorders can fit into more than one category and there can be atypical presentations of common disease. Some common causes of vulval symptoms are shown in Table 6.1. There are two specific situations where there is a more extensive differential diagnosis: vulval ulceration and vulval oedema. An approach to patients presenting with these symptoms is considered here, with more details on the specific conditions in the appropriate chapter. Patients presenting with one or more vulval ulcers can pose a diagnostic challenge [3]. Some clinical patterns of disease such as herpes simplex infection are easy to recognise. However, some chronic ulcers will require extensive further investigation in order to make a diagnosis. There are four main causes of vulval ulcers: A full history must be taken, as outlined in Chapter 5. When examining the patient, the site, number, and characteristics of any ulcer should be noted. A differential diagnosis can then be formulated (Figure 6.1). In a similar way, there is a wide differential diagnosis in patients who present with vulval swelling as the predominant symptom. The potential causes are shown in Figure 6.2. Table 6.1 Common causes for vulval symptoms.
6
Symptoms and Signs in Vulval Disease
Symptoms in vulval disease
Vulval ulceration
Vulval oedema
Pruritus
Soreness/discomfort
Pain
Dyspareunia 
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
