Fiona M. Lewis Patients with thrombocytopenia or other disorders of coagulation, or those taking anticoagulant medication may be more prone to develop purpura on the vulva with minor trauma, just as elsewhere on the skin. Sometimes purpura can be induced by scratching in pruritic conditions, and the purpura (ecchymosis) seen in lichen sclerosus is a pathognomonic feature of the disease. Ecchymosis of the abdominal wall is a sign of severe acute pancreatitis and has also been reported to occur on the vulva [1]. Vascular tumours are discussed in Chapters 38 and 45. Vascular malformations of the vulva are rare. They can occur in isolation or be part of syndromes that include vascular anomalies [2]. They are classified as slow‐flow (venous, capillary, or lymphatic) or fast‐flow (arterial, arteriovenous malformations, or arteriovenous fistulae). It is important to obtain good imaging with techniques such as ultrasound, colour Doppler ultrasound, magnetic resonance imaging, or venography before contemplating treatment as they can involve other structures. This is particularly important if there is extension in the neurovascular bundle. Management is undertaken by specialist teams, especially for large complex lesions. Venous malformations can be limited to the labia majora but are often an extension of more diffuse lesions affecting the lower limbs [3]. Localised lesions affecting the clitoris are reported [4]. Sclerotherapy is generally effective [5]. AVMs are thought to be due to incomplete differentiation of vascular tissue. They are present at birth but may not present until later and are generally seen in children and young adults. However, one case in a post‐menopausal woman is reported [6]. They usually present with swelling [7] or vaginal bleeding [8]. They can grow slowly with time and compressible haemangiomatous changes are seen (Figure 34.1). Rapid enlargement can occur with infection, hormonal change, or trauma. Endovascular ablative techniques can be used to treat the lesions but sometimes need to be combined with other modalities [9].
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Vascular Abnormalities and the Vulva
Vascular malformations
Venous malformations
Arteriovenous malformations (AVM)
Syndromes with vascular anomalies
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