Vulvar Disease
Whatis/are Vulvar Disease(s)?
Vulvodynia-chronicvulva discomfort, vulvar vestibulitis,dysesthetic vulvodynia
Vulvardystrophy-broad term to describe various epithelial changes. In 1987-ISSVDInternational Society Studies of Vulvar disease found the following symptoms; nonneoplastic, intraepithelialneoplasms - squamous cell CIS, nonsquamousintraepithelial neoplasia
HSV
Womenwith HSV reports flu like symptoms, pain, itching, UTI symptoms, vaginaldischarge, sores on labia, anus, perineum, buttocks, thighs, dyspareuniaVesicles, ulcers, pustules, tender adenopathy, 70% will have lesion in vagina
Syphilis
Womenwith 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.
CondylomaAcuminata
Womenwith CA report new bump: itching, generalized pruritus, last pap. Warty,flesh colored, sharp and pointed, cauliflower, + acetowhite
Candidiasis
Womenwith candidiasis report burning, itching, discharge, dyspareunia, vulvar edema,h/o diabetes, high carbohydrate diet, use of AB, frequent intercourse, h/osteroids, HIV.
Bartholin'sGland Infection
Womenwith barthloin's gland infections eportr unilateral bump. Reports active sex,recent trauma, new sexual partner leading to infections, fever, complaints ofpain with intercourse, warmth, tender to touch, difficulty walking, sitting. H/OCrohn’s disease.
ContactDermatitis
Womenwith contact dermatitis report vulvovaginal itching, rash, and increasedincidence when wearing tight pants. The vulva skin is red, inflamed,edematous, vesicles or bullae if severe, weeping, crusting and lichenification.
LichenSclerosus
Womenwith LS report vulvovaginal itching, familial linkage, edema, superficialulcers, burning, area feels different. Women with LS in all ages, showsymptoms in clitoris, prepuce, labial majora, minora, edema, scarring, color,appearance of tissue paper of skin.
LichenPlanus - Women withlichen planus report vulvar itching, burning, with vulvovaginitis symptoms onmucosal surface of vulva. Dyspareunia, painful erosive areas. Bleeding oncontact, stenosis of introitus. The vulva has white raised lesion withreticular, lacy pattern. Erosive reddened area bordered by reticular whiteepithelium. External labia has appearance of lichen sclerosus + acetowhite.Other signs may appear in her mouth.
VulvarNeoplasm-Melanoma -affects mostly postmenopausal women that affects the clitoris and labia majora.Usually no symptoms.
VulvarIntraepithelial Neoplasm - Pruritus, vulvar burning, pain, discharge, bleeding, may report urethra, vaginaland anal symptoms. White, dk, red, ulcerated, raised warty, or nodularlesions. Labia mayora most common site, minora, clitoris and perineum.
Vulvodynia(Vulvar Pain Syndrome) - Variouslevels of burning, stinging, pain, dryness, irritation, rawness. No pruritus.May report long term hx.
VulvarVestibulitis is a burning,dysuria, frequency, with repeated yeast infections or HPV. Significant/severe pain with touch or attempting intercourse.
Paget'sDisease
VulvarPruritis, usually affecting older women. The vulva appears red/tan withscaly lesions.
Whatis Vulvar Cancer?
Vulvarcancer is cancer that is found in and on the vulva.
Whatis Vulvar Vestibulitis?
VulvarVestibulitis is a condition which causes redness and pain of the vestibule.Vestibulitis is an inflammation of this skin and the mucous secreting glandsfound in the skin. The mucous secreting glands are called the lesser vestibularglands.
VulvarVestibulitis may include all the area around the opening of the vagina but isnormally seen in the lower part of the vaginal opening.
Vulvar vestibulitis occurs inwomen of all ages. It can occur in women who are sexually active and also inwomen who have never been sexually active.
Manywomen with this problem have suffered physically and emotionally for months oryears, have seen a number of physicians, and have tried many unsuccessfultreatments in search of relief.
Whatare the signs and symptoms of Vulvar Vestibulitis?
* Severe pain with pressure (for example: biking, exercise,tight fitting clothes ).
* Vaginal entry such as tampon use or intercourse.
* Burning, stinging, irritation, or raw sensation within thevestibular area.
Yourdoctor or health care provider will examine the vulva and vestibule to identifythe common skin changes seen with vulvar vestibulitis. Pain is usually felt ifthe vestibule area is touched with a cotton tipped applicator. A sample of yourvaginal discharge is collected and tested to rule out infection.
Whatcauses vulvar vestibulitis?
The exact cause is unknown, but many studies are being conducted to determinethe cause of vulvar vestibulitis.
Thefollowing factors have been associated with vulvar vestibulitis:
* HPV (Human Papilloma Virus)
* Chronic Yeast Infections
* Chronic bacterialinfections
* Chronic changes of pH (acid-basebalance in the vagina)
* Chronic use ofchemicals/irritants such as detergents, soaps, spermicides or lubricants.
Whatis the treatment for vulvar vestibulitis?
Treatmentmay include any of the following:
* Follow the Guidelinesfor Vulvar Skin Care
* Steroid Ointments
Howit is used: A thin layer is applied to the vulvovaginal areas.
Howit Works: Decreases redness, irritation, and burning. Caution: Use only asprescribed by your doctor. Overuse may result in thinning of the skin which willmake your problem worse rather than helping it.
* Trichloroacetic Acid (TCA)may be used in some cases as determined by the severity of the symptoms youhave. TCA is a chemical that is used to destroy small areas of the irritatedskin allowing new healthy skin to grow in its place.
* Interferon Injectionsare used to increase your body's response to infection.
Helpfultreatment hints for vulvarvestibulitis:
* Vitamin A and D Ointment Howit is used: Apply to the areas of discomfort.
Howit Works: Protects the skin, decreases irritation, heals, and soothes.
* Lidocaine Gel may be prescribed after initial treatment.
How it isused: Apply lidocaine gel to thevulvovaginal areas ofdiscomfort.
How it Works: Numbs areas before intercourse.
Caution: Afterapplying, wait until area becomes less sensitive before intercourse.Burning may occur for a short time (
* Witch Hazel Pads (TUCS Pads) How it is used: Apply to the vulvovaginal areas ofdiscomfort.
How itWorks: Decreases burning and irritation after intercourse and urinating.
* Cleansing Bottle - Pour plain luke-warm water over the vulva afterurinating 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 maycause burning.
* Cranberry Juice How itis used: Drink an 8oz. glass every day.
Howit Works: Increases the acid content of the urine to decrease bladderirritation.
* Limit High Oxalate Foods - May decrease amount of oxalate crystalsin urine. Oxalatecrystals cause urinary symptoms such as the urge to urinate frequently orsuddenly.
* 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 a day for 10 to 15minutes. If you are using a sitz bath, use 1 to 2 teaspoons of baking soda.
Whatis a Vaginal Vault Prolapse?
The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward theintroitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterineprolapse, and in about 1% of women who have had a hysterectomy for other reasons.
Whatis 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 be called; genital prolapse, pelvic relaxation,pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wallprolapse.
Whatis Pelvic Prolapse?
Pelvic Prolapse is anotherterm used for "pelvic organ prolapse." Pelvic 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 Prolapse may also be called; genital prolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wallprolapse.
Whatis a Prolapsed Uterus?
A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation 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, and various 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:
• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.
• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.
• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.
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