VULVAR DISEASES
The vulva, the external female genitalia
The Vulva comprises the labia minora and majora, the clitoris, the urethral opening, and the vaginal vestibule. The vulva forms a natural barrier to the vaginal mucosa and plays an essential role in the experience of femininity and sexuality. Common vulvar complaints include itching, burning, pain, and visible skin changes, such as swelling, redness, blisters, and rashes and also changes in discharge. These symptoms should be taken seriously and investigated further. Infections, inflammatory skin diseases, and even precursors of vulvar cancer can be diagnosed and treated early.
Unfortunately, vulvar problems are often a taboo subject in our society. Certain clinical pictures, such as lichen sclerosus, are often little known even to doctors, which is why women often wait years for the correct diagnosis.
Break the taboos and talk to us about your symptoms! Thanks to my many years of experience at a center hospital, where I set up a vulva consultation and ran it for almost fifteen years, I am very familiar with the diagnosis and treatment of vulvar complaints.
Lichen sclerous: Itching is not always caused by a vaginal fungus. The chronic autoimmune disease lichen sclerosus can manifest as recurring itching or burning. Early diagnosis and proper treatment are important for managing the disease.
What is Lichen sclerosus
Lichen sclerosus is an autoimmune disease that primarily affects the skin of the vulva and the perianal region. Patients often suffer from recurring itching and burning. Fissures in the skin and whitish changes are also typical. The disease progresses in bursts; physical strain or stress can trigger recurrences. If the disease remains untreated scarring and adhesions of the skin occur. The risk of vulvar cancer is slightly increased (5%).
Why do I have lichen sclerosus?
Lichen sclerosus is not contagious and has nothing to do with a lack of hygiene. Autoimmune, inflammatory processes in the skin are suspected to be the cause, but this has not yet been fully clarified. Women are significantly more frequently affected than men and can fall ill at any time in their lives. Even babies can be affected. At least one in 50 women suffers from lichen sclerosus.
How is the diagnosis made?
The diagnosis can usually be made on the basis of the patient's medical history, skin conditions or a good response to treatment. A biopsy is rarely needed.
How do you treat Lichen sclerosus?
Treatment usually involves applying an ointment containing cortisone and a fatty cream. Initially, the cortisone ointment should be applied daily for several weeks to reduce inflammation completely. In the longer term, cortisone should be applied once or twice a week to prevent inflammation from flaring up again. This maintenance dose can be continued for years, or even for life. Under maintenance therapy, the disease is brought to a standstill and the risk of further scarring or development of cancer is significantly reduced. Regular specialist examinations are recommended at least once a year to recognise any progression of the disease. In recent years, several studies have shown the effectiveness of laser treatment. However, there is still insufficient scientific evidence to recommend laser treatment as an unconditional alternative to topic cortisone.
You can find more information about lichen sclerosus in the following video
Vulvodynia: Pain in the vulva and dyspareunia (pain during sexual intercourse) can indicate the clinical picture of vulvodynia. However, the diagnosis can only be made after a gynecological examination and after ruling out other causes for the pain.
Definitions and symptoms:
Vulvodynia (formerly vestibulitis) is defined as chronic pain in the vulva without an identifiable cause that persists for at least three months. The symptoms manifest themselves as burning, stinging, pain or tenderness and can occur through touch as well as without any skin contact. There is no evidence of infection or skin disease in the gynecological examination; vulvodynia is a diagnosis of exclusion. The symptoms can vary in severity. They range from mild pain to the feeling of being stabbed or burned. Flush-like reddening of the skin can also occur. Localized vulvodynia describes individual areas of the vulva that are painful: Labia, clitoris, vaginal entrance; in generalized vulvodynia, the entire vulva and vaginal entrance are painful.
Causes:
The cause of vulvodynia is largely unknown. Recurrent infections, operations in the external genital area, skin diseases such as lichen sclerosus, but also psychological stress or sexual abuse can be triggers for its development. However, vulvodynia can also occur without any recognizable cause. The pain in the vulva leads to tension in the body, which increases the basic tension in the pelvic floor. This further intensifies the vulvodynia. Conversely, chronic pain in the abdomen or other parts of the body can also lead to increased pelvic floor tone, which in turn can promote and maintain vulvodynia.
Treatment:
The treatment of vulvodynia is often individual and follows the 'trial and error principle'. What is helpful for one woman may be ineffective for another patient. There is no single medication for the treatment of vulvodynia; in most cases, the combination of different methods is decisive. An important first step is making the diagnosis itself. Many women rush from one doctor to the next, supposed infections are treated without success, the worry of having an unrecognized ailment increases tension and pain.
- Pelvic floor relaxing physiotherapy is a scientifically proven pillar of treatment. The therapy sessions should be carried out under the guidance of an experienced physiotherapist who specializes in pelvic floor therapy.
- Drug treatment ranges from local therapies with ointments containing a local anesthetic or a pain-relieving antidepressant to drugs that influence the pain stimulus conduction of the nerve fibers.
- The effectiveness of treatment with acupuncture has been scientifically proven and is recommended.
beeinflussen. - Other relaxation-promoting techniques such as autogenic training or other methods can be helpful.
- Weitere Entspannungsfördernde Massnahmen wie autogenes Training oder andere Methoden können hilfreich sein.
- Psychological care, possibly with a psychosomatic approach, or sex therapy may also be necessary.
- The social environment of those affected should also not be neglected. Conflicts with partners that arise due to restricted or no longer experienced sexuality often represent an additional burden. Educating and, if possible, involving the partner is often helpful.
Prognosis:
It is very difficult to make a prognosis for the development of the disease. The outcome is very individual. Some patients become completely symptom-free again. In others, the symptoms only occur in stressful situations. With the use of therapies and learned strategies, some women are able to live a normal everyday life again, even if the symptoms are not completely gone.
In the following podcast you can listen to an exchange between Dr. Gabi Landmann and a patient affected by vulvodynia (Duration 46 minutes)
Dysplasia, precursors of vulvar cancer: As on other parts of the body, cell changes can also occur on the vulva, which can lead to skin cancer if left untreated. If detected early, dysplasia can be treated before cancer develops.
What does the perfect vulva look like? The perfect vulva does not exist and there are no standards that dictate what a vulva should look like. The size, color, shape and texture of the vulva differ from person to person and vary greatly