What is "vulvar health"?

Vulvar health is a term that covers the many health issues of a woman's – or young girl's vulva.  This includes vulva care, gynecology,feminine hygiene, vaginal health, vaginalhygiene, menstruation, and the changes inwomen's vulvas from menarcheto menopause.

Husbands and fathers – as well as women and mothers need to learn more about vulva health, to provide the care and support the special women in their lives may need. Husbands and fathers have a unique role in providing the health care and knowledge, especially those single dad's that have young daughters.

Vulvar health is an area that is related to the health and care of the vulva. Many men and women are afraid to use the term "vulva" due to it's technical, and medical sound, and most simply prefer to call the vulva a "vagina."  Yet that would be incorrect.  The vagina is justone part of the vulva. Nobody, with the exception of a doctor, can see a woman'svagina, and only he/she can see a woman's vagina by looking into the vagina,using a special instrument called a speculum.

It's time to begin calling a "spade a spade." When mother's and fathers are bathing, or toilet training their daughters, they should explain that the vulva, which is on the outside, has several parts, and that her vagina, is on the inside.

What is/are Vulvar Diseases?

Vulvodynia-chronicvulva discomfort, vulvar vestibulitis,dysesthetic vulvodynia. Vulvar dystrophy-broad term to describe various epithelial changes. In 1987-ISSVD International Society Studies of Vulvar disease found the following symptoms;

1. Non neoplastic.
2. Intraepithelial neoplasms – spuamous cell CIS.
3. Non squamousintra epithelial neoplasia

LESIONS AND DISEASES

Lesions and deseases

HSV

Women with HSV reports flu like symptoms, pain, itching, UTI symptoms, vaginaldis charge, sores on labia, anus, perineum, buttocks, thighs, dyspareunia Vesicles, ulcers, pustules, tender adenopathy, 70% will have lesion in vagina.

Syphilis

Women with syphilis report painless sores in vulvovaginal area. Primary – red, round, firm ulcer with granular base with well-formed edges. Secondary- moist, mucus lesions which resemble herpes. Moist cutaneous lesions called condylomalata, appear flat and gray. Adenopathy, maculopapular rash.

Condyloma Acuminata

Women with CA report new bump: itching, generalized pruritus, last pap.  Warty, flesh colored, sharp and pointed, cauli flower, + acetowhite.

Candidiasis

Women with candidiasis report burning, itching, discharge, dyspareunia, vulvar edema, h/o diabetes, high carbohydrate diet, use of AB, frequent intercourse, h/o steroids, HIV.

Bartholin'sGland Infection

Women with barthloin's gland infections report unilateral bump. Reports active sex, recent trauma, new sexual partner leading to infections, fever, complaints of pain with intercourse, warmth, tender to touch, difficulty walking, sitting. H/O Crohn’s disease.

Contact Dermatitis

Women with contact dermatitis report vulvovaginal itching, rash, and increased incidence when wearing tight pants. The vulva skin is red, inflamed, edematous, vesicles or bullae if severe, weeping, crusting and lichenification.

Lichen Sclerosus

Women with LS report vulvovaginal itching, familial linkage, edema, superficial ulcers, burning, area feels different. Women with LS in all ages, show symptoms in clitoris, prepuce, labial majora, minora, edema, scarring, color, appearance of tissue paper of skin.

Lichen Planus

Women with lichen planus report vulvar itching, burning, with vulvovaginitis symptoms on mucosal surface of vulva. Dyspareunia, painful erosive areas. Bleeding on contact, stenosis of introitus. The vulva has white raised lesion with reticular, lacy pattern. Erosive reddened area bordered byreticular white epithelium. External labia has appearance of lichen sclerosus +acetowhite. Other signs may appear in her mouth.

Vulvar Neoplasm-Melanoma

Affects mostly post menopausal women that affects the clitoris and labia majora. Usually no symptoms.

Vulvar Intraepithelial Neoplasm

Pruritus, vulvar burning, pain, discharge, bleeding, may report urethra, vaginal and anal symptoms. White, dk, red, ulcerated, raised warty, or nodular lesions. Labia mayora most common site, minora, clitoris and perineum.

Vulvodynia (Vulvar Pain Syndrome)

Various levels of burning, stinging, pain, dryness, irritation, rawness. No pruritus. May report long term hx.

Vulvar Vestibulitisis a burning, dysuria, frequency, with repeated yeast infections or HPV.  Significant/severe pain with touch or attemptingintercourse.

VulvarPruritis, usually affecting older women. The vulva appears red/tan withscaly lesions.

What is Vulvar Cancer?

Vulvar cancer is cancer that is found in and on the vulva.

What is Vulvar Vestibulitis?

Vulvar Vestibulitis is a condition which causes redness and pain of the vestibule. Vulvar Vestibulitis is an inflammation of this skin and the mucous secreting glandsfound in the skin. The mucous secreting glands are called the lesser vestibular glands.

Vulvar Vestibulitis may include all the area around the opening of the vagina butis normally seen in the lower part of the vaginal opening.

Vulvar Vestibulitis occurs in women of all ages. It can occur in women who aresexually active and also in women who have never been sexually active. Many women with this problem have suffered physically and emotionally for months oryears, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.

What are the signs and symptoms of Vulvar Vestibulitis?

1. Severe pain with pressure (for example: biking, exercise,tight fitting clothes).
2. Vaginal entry such as tampon use or intercourse.
3. Burning, stinging, irritation, or raw sensation within the vestibular area.
4. Vestibular redness
5. The urge to urinate frequently or suddenly.

How is Vulvar Vestibulitis diagnosed (identified)?

Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes seen with vulvar vestibulitis. Pain is usually felt if the vestibule area is touched with acotton tipped applicator. A sample of your vaginal discharge is collected and tested to rule out infection.

What causes Vulvar Vestibulitis?

The exact cause is unknown, but many studies are being conducted to determine the cause of vulvar vestibulitis. The following factors have been associated with vulvar vestibulitis:

1. HPV (Human Papilloma Virus)
2. Chronic Yeast Infections
3. Chronic bacterial infections
4. Chronic changes of pH (acid-basebalance in the vagina)
5. Chronic use of chemicals/irritants such as detergents, soaps, spermicides or lubricants.

What is the treatment for Vulvar Vestibulitis?

Treatment may include any of the following:

1. Follow the Guidelines for Vulvar Skin Care
2. Steroid Ointments

How it is used:

A thin layer is applied to the vulvovaginalareas.

How it Works:

Decreases redness, irritation, and burning. Caution: Use only as prescribed by your doctor. Over use may result in thinning of the skin which will make your problem worse rather than helping it.

Trichloroacetic Acid (TCA) may beused in some cases as determined by the severity of the symptoms you have. TCA is a chemical that is used to destroy small areas of the irritated skin allowing new healthy skin to grow in its place.

Interfer on Injections are used to increase your body's response to infection.

Helpful treatment hints for Vulvar Vestibulitis:

Vitamin A and D Ointment

How it is used: Apply to the areas of discomfort.

How it Works: Protects the skin, decreases irritation, heals, and soothes.

Lidocaine Gel may be prescribed after initial treatment.

How it is used: Apply lidocaine gel to the vulvovaginal areas of discomfort.

How it Works: Numbs areas before intercourse.

Caution: After applying, wait until area becomes less sensitive before intercourse. Burning may occur for a short time (5 to 10 mins.) after the gel is applied.

Witch Hazel Pads (TUCS Pads)

How it is used: Apply to the vulvo vaginal areas of discomfort.

How it Works: Decreases burning and irritation after intercourse and urinating.

Cleansing Bottle

Pour plain luke-warm water over the vulva after urinating to remove urine from irritated area.

Calcium Citrate Tablets

How it is used: Take orally 1200-1800mg elemental calcium every day.

How it Works: Thought to decrease certain crystals in the urine which may cause burning.

Cranberry Juice

How it is used: Drink an 8oz. glass every day.

How it Works: Increases the acid content of the urine to decrease bladder irritation.

Limit High Oxalate Foods

May decrease amount of oxalate crystalsin urine. Oxalate crystals cause urinary symptoms such as the urge to urinate frequently or suddenly.

Baking Soda Soak

Soak in luke warm bath water with 4 to 5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 1 to 3 times aday for 10 to 15 minutes. If you are using a sitz bath, use 1 to 2 teaspoons ofbaking soda.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent tothe cervix. It can only “fall” or descend downwards toward the introitus, orthe entrance of the vagina, after a woman's womb has been removed(hysterectomy). Vaginal Vault Prolapseoccurs in about 15% of women who have had a hysterectomy for uterine prolapse,and in about 1% of women who have had a hysterectomy for other reasons.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Organ Prolapse may also becalled; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginalwall prolapse.

What is Pelvic Prolapse?

Pelvic Prolapse is another term used for "pelvic organ prolapse". Pelvic prolapse is a very common condition, particularly among older women. It'sestimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Prolapse may also be called; genitalprolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvicfloor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapseduterus, or descended uterus, or other change in the position of the uterus inrelation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, andvarious ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis.

A Prolapsed Uterus may be one of three types, depending on the severity:

1. First-degree prolapse occurs when the uterus sags downward into the upper vagina.
2. Second-degree prolapse occurs when the cervix is at or near the outside ofthe vagina.
3. Third-degree prolapse (sometimes referred to as total prolapse) occurs whenthe entire uterus extends outside the vagina.