General Information for All Women with Vulvar Disorders
The vulva refers to the visible or outer parts of the female genitalia. The appearance, shape and size of the vulva can vary from woman to woman. Most of these variations are normal. It is also normal to have one side of the vulva look slightly different than the other side of the vulva.
The vulva includes the pubic mound, the outer lips, the inner lips and the entrance to the openings of the bladder and vagina. The vagina (or birth canal) is the inner part of the female genitalia and is not visible from the outside.
Starting from the top down is the pubic mound or mons pubis. This is a pad of soft fatty tissue above the pubic bone. The skin in this area is covered with pubic hair. Below the mons pubis are the outer lips and inner lips of the vulva.
The outer lips (or skin folds) are large and have pubic hair. These lips are called the labia majora.
The inner lips are smaller and hairless. These lips are called the labia minora. The small lips join together, below the pubic mound to form a hood (or prepuce) above the glans (or tip) of the clitoris. The clitoris is very sensitive. The tip is visible on the outside but a larger portion (the shaft) is not visible.
Between the inner lips of the vulva is the vestibule. The urethra (a tube leading to the bladder) is located in the vestibule above the opening to the vagina. There are a number of glands that open into the vestibule – minor vestibular glands, Skene’s glands and the Bartholin’s glands. These glands produce secretions that make the vestibule moist.
Below the vestibule is the perineum. This skin lies between the opening to the vagina and the opening to the rectum (anus). Many skin conditions that affect the vulva will also affect the skin around the anus or even in between the buttocks.
There are a broad range of medical conditions that can involve the vulva. These conditions can be divided into benign, pre-cancer and or cancer.
Inflammatory conditions (Infectious)
Chronic Vulvar Purpura
Systemic disorders with vulvar manifestations
Lupus, Crohn’s Disease, Hidradenitis Suppurativa,
Reiter’s Disease, Bechet’s Disease, Blistering disorders (e.g. pemphigoid)
Lymphatic Disorders Lymphedema, Lymphangitis Circumscriptum
Benign Cysts, and benign tumors of the vulva
Sebaceous cysts, epidermal inclusion cysts, vestibular cysts, bartholin’s duct cysts, Skene duct cysts, Lipomas, Fibromas, Leiomyoma, endometriomas, acrochordons, seborrheic keratosis, pyogenic granuloma
High Grade Squamous Dysplasia/ Vulvar Intraepithelial Neoplasia (usual type, differentiated type)
Melanoma in situ/Melanoma
Verrucous Carcinoma, Basal Cell Carcinoma
Invasive Squamous Cell Carcinoma of the Vulva
Paget’s Disease (Adenocarcinoma)
Vulvodynia: Generalized or Localized, Provoked or Unprovoked, Vestibulodynia, Clitorodynia
Once an accurate diagnosis is made, the appropriate medical treatment can be started. However, treating the vulvar skin may not be enough to restore a woman’s overall health.
Many women with chronic vulvar disorders report that the vulvar condition affects their overall sense of well-being, body image and sexual self-esteem.
A healthy vulva is critical for comfortable daily living activities such as: sitting, walking, and wearing clothes. If the vulvar skin is unhealthy it can make urination, menstruation, and or defecation uncomfortable. A healthy vulva is necessary for pain free and enjoyable sex. Vulvar disorders can interfere with a woman’s ability to get pregnant, be comfortable during pregnancy and have a safe vaginal delivery.
We understand that women who have vulvar symptoms or notice changes to their vulvas are often too embarrassed to seek help from a health care provider. However, it is often difficult to ignore these conditions. Women will often try numerous home remedies or over the counter treatments before seeking medical help.
First Step – Good Skin Care
We strongly discourage self-treatment with over-the-counter medications and vaginal preparations. While many women will find that applying any type of cream on the skin seems to help initially, over time they find the skin seems to get more and more sensitive and the creams are in fact making the discomfort worse. Women should be aware that they cannot “wash their symptoms away” and that the symptoms are NOT due to being “unclean” or having an “infection”.
Safe options for lubricants include:
Water based: Easy to apply and clean up after. Compatible with sex toys and latex condoms. A thicker gel consistency of some of these lubes may provide more protection to the vulva.
Silicone based: Easy to apply, “slippery”, compatible with latex condoms but not silicone vaginal inserts or sex toys, longer lasting than water based but do not simply rinse off.
Hybrid: a combination of a water based and silicone based lubricant.
Vaginal moisturizers are an alternative to lubricants. The moisturizer can be used daily to relieve dryness or at least 2 hours prior to sexual penetration.
Oil based: mineral oil, almond, canola. Some women prefer to use oils prior to sex but in general the lubricants developed for sexual activity are more helpful.
Unfortunately, when women do seek help they are often treated over and over again for a suspected vaginal infection. However, vulvar symptoms such as burning, itch or soreness may be due to a skin condition, NOT an infection. In this case, these treatments may in fact make the symptoms worse over time. If you are a woman with chronic vulvar symptoms it is important to get an accurate diagnosis. Do not give up. You are not alone.
Second Step – Find an Expert
The second step towards better vulvar health is to see a health care provider with experience and expertise in vulvovaginal disorders. The BCCVH works collaboratively with primary care physicians and the experts embedded within the Centre to quickly confirm, diagnose and treat vulvar conditions.
Third Step – Holistic Health
Many women who suffer from vulvar disorders have concerns about their sexual health.
Some vulvar conditions change the appearance of the vulva and that can make women feel uncomfortable or embarrassed in a sexual setting.
Vulvar diseases can cause significant discomfort when the genitalia are touched. Women report significant pain with sexual intercourse, reduced sexual frequency and decreased sexual desire. Women avoid sexual activity because of pain, and often choose to be sexually inactive. The avoidance of sex creates interpersonal conflict within relationships, which further compounds the stress of their condition.
Some vulvar conditions (and the treatment of these conditions), can make it physically difficult for a woman to have penetrative sex. For example, Lichen Planus can cause scarring inside the vagina.
A sexual health expert can help women to address these sexual concerns and return to having a fulfilling sexual life.
Women with vulvar conditions may experience changes to their Mental Health.
Women may experience embarrassment, fear, anxiety, negative body image, and depression. Some vulvar conditions are associated with a small increased risk of vulvar cancer and thus require long term treatment and follow-up. Women may have difficulty coping with the need for chronic treatment and surveillance of a condition that affects the genitals.
The stress generated by these conditions can, in fact, intensify any discomfort or pain the woman experiences. This is because the increased stress increases the number of excitatory signals from the brain to the spinal cord. It has been shown that psychological techniques focused on stress reduction, anxiety control and relaxation have a positive benefit on vulvar pain.
(604) 875-4111 ext. 63445
6th Floor, Gordon and Leslie Diamond Health Care Centre
2775 Laurel Street, Vancouver, BC, V5Z 1M9
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