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Vulva Talk Screeners

This document discusses common symptoms, causes, and conditions related to vulvar health. It describes common symptoms patients may report like itching, soreness, and difficulty with sex. Potential causes include infections like candida, irritant contact dermatitis, seborrheic dermatitis, psoriasis, and three types of lichens. It provides images and descriptions of normal and abnormal vulvar anatomy and various conditions like lichen sclerosus, lichen planus, and vulvar intraepithelial neoplasia. The document emphasizes that vulvar conditions can have significant psychological and social impacts for patients.

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Hervis Fantini
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We take content rights seriously. If you suspect this is your content, claim it here.
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173 views79 pages

Vulva Talk Screeners

This document discusses common symptoms, causes, and conditions related to vulvar health. It describes common symptoms patients may report like itching, soreness, and difficulty with sex. Potential causes include infections like candida, irritant contact dermatitis, seborrheic dermatitis, psoriasis, and three types of lichens. It provides images and descriptions of normal and abnormal vulvar anatomy and various conditions like lichen sclerosus, lichen planus, and vulvar intraepithelial neoplasia. The document emphasizes that vulvar conditions can have significant psychological and social impacts for patients.

Uploaded by

Hervis Fantini
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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The Vulva

Terminology
Normal Anatomy
Normal Anatomy
Symptoms your patients will tell you
about
Pruritus (itch). General or just one spot
Soreness: stinging / burning / pain
Difficulty with sex
Lumps
Causes of pruritus vulvae and/or pain
Candida albicans infection
Irritant contact dermatitis
Seborrhoeic dermatitis
Psoriasis
The three lichens:
-Lichen simplex
-Lichen sclerosus
-Lichen planus
Candida albicans vulvovaginal
Candida albicans vaginal
Irritant contact dermatitis
Erythema
Oedema
Fissuring

Soap, water, rubbing


Irritant contact dermatitis
Burn-like
Glazed erythema
Superficial erosions
Oedema

Faecal and urinary incontinence


Seborrhoeic dermatitis
Usually patient has it at other sites also
Mons pubis and flexures
May or may not be scaly
Mild or absent symptoms
Seborrhoeic dermatitis
Causes of pruritus vulvae
Candida albicans infection
Irritant contact dermatitis
Seborrhoeic dermatitis

The three lichens:


Vulval psoriasis
Vulval psoriasis
Causes of pruritus vulvae and /or pain
Candida albicans infection
Irritant contact dermatitis
Seborrhoeic dermatitis
Psoriasis
:
Lichen simplex
Lichen sclerosus
Lichen planus
Lichens
All three cause similar skin change
The skin becomes thickened, pale, with
increased skin markings [grooves]and fissures
Lichen Simplex
Chronic irritation causes the skin change
Remove the irritant and the skin recovers
Lichen simplex
Perineum - ?Candida
Skin thickening
Fissuring
Skin coloured
Dyspigmentation
common
Lichen simplex
Unilateral, labium major
Due to rubbing because
of intense itch
Well-demarcated
Skin thickening
Increased skin markings
Skin coloured
Dyspigmentation
common
Lichen sclerosus
Probably an immune system disease
Itch: nil to very severe
Soreness: nil to very severe
Altered anatomy from tissue destruction
Dyspareunia / apareunia because of
symptoms or changed anatomy
The Itch of lichen sclerosus
Mainly the labia minora, clitoral hood and/or
perineum
Perianal in 50%
Extragenital in 15%
Who gets Lichen Sclerosus
Most are 50 years or older but children and
teenagers may be affected
May have other associated autoimmune
conditions
25% thyroid antibodies;
10% psoriasis
LS and VIN
Lichen Sclerosus is associated with pre
malignant change
VIN, Vulval Intraepithelial neoplasia
VIN untreated may become SCC
Lichen sclerosus
Distribution: figure of 8
with wings
Usually bilateral
Colour white,crinkly
(cigarette-paper)
Sclerosis firm
Lichen sclerosus
White, like vitiligo
Anatomic change
Loss of labia minora
Lichen sclerosus
Distorted clitoral hood
and labia minora
Postinflammatory white
areas
Postinflammatory
brown pigmentation
Lichen sclerosus
Resorption of labia
minora
Fissures in the labial
sulcus and onthe
perineum
Lichen sclerosus
Flattening of clitoral
hood
Resorption of labia
minora
Haemorrhages
Lichen sclerosus
Flattening of clitoral
hood
Resorption of labia
minora
Lichen sclerosus
Severe introital
narrowing
Splitting of posterior
forchette
Lichen sclerosus
Bridging / fusion /
agglutination of left and
right labia
Ulceration
Lichen sclerosus
Distortion of labia
minora
Ulceration
Haemorrhage
Lichen sclerosus
Ulcer right labium
minor
Lichen sclerosus
Hyperkeratosis
Consider biopsy
LS in a teenager
Psoriasis + lichen sclerosus
Psoriasis less
symptomatic but more
impressive
Psoriasis outside
Lichen sclerosus inside
Psoriasis does not alter
anatomic features
Lichen sclerosus: treatment
Ultrapotent topical steroid, usually clobetasol
ointment
Once daily until clear (one to three months)
Then alternate days for the same duration
Then once or twice per week long-term or
PRN
Explain to patient precisely where to apply the
ointment
Lichen planus
Less common
More painful
Just as destructive
More likely to be seen on other parts of the
patient
Two types: cutaneous and mucosal
Lichen planus: cutaneous type
Violaceous plaques
Wickhams striae
Labia majora
Irregular distribution
Lichen planus: mucosal type
May be very itchy
More often very painful
Very tender to touch
Destructive loss of clitoral hood, labia minora
May cause introital narrowing
More likely to involve vagina (unlike lichen sclerosus)
May also affect oral mucosa
Buccal mucosa, inner lips, tongue
Desquamative gingivitis
Erosive lichen planus
Red glistening painful
mucosal patch
Loss of labia minora
Erosive Lichen Planus
Erosive lichen planus
Erosive lichen planus
Mucosal disease may
result in
postinflammatory
pigmentation
Erosive lichen planus
Destruction of tissue
Introital narrowing
Eaten-away appearance
Erosive lichen planus: treatment
Topical clobetasol daily
May be required daily long-term
Topical calcineurin inhibitors, e.g.,
pimecrolimus cream
Oral prednisone
Methotrexate
Often symptoms respond better than signs
Plasma cell Vulvitis
Much less common
Much less destructive
Often asymptomatic
Plasma cell vulvitis
Deeper red than LP
Haemorrhagic
More internal
More patchy
Plasma cell vulvitis
May extend
periurethrally
Contact bleeding
Plasma cell vulvitis: treatment
Topical antibiotic
Clindamycin cream
Metronidazole cream
Hydrocortisone cream
Symptoms your patients will tell you
about
Pruritus (itch). General or just one spot
Soreness : stinging / burning / pain
Difficulty with sex
Lumps that might not cause
symptoms
Frightening things
Not so frightening things
Pre malignant and Malignant lesions
Vulval intraepithelial neoplasia, VIN
Invasive squamous cell carcinoma
Melanoma
Vulval intraepithelial neoplasia
This is a pre malignant lesion
Mild or no symptoms but does have signs
Two types: Usual and Differentiated
Usual VIN = HPV related
Differentiated VIN = Lichen sclerosus or lichen
planus related
more likely to become an aggressive SCC
HPV
Human Papilloma Virus
Low risk and High risk, but HrHPV types are
associated with cancers in many parts of the
body: cervix, vagina, vulva, anal canal, mouth.
Sexually transmitted
Vaccine
ENT surgeons now very interested
VIN
VIN
VIN
VIN

+ Lichen sclerosus
Invasive squamous cell carcinoma
Arises within VIN [HPV or lichen sclerosus]
Irregular, hard nodule, often ulcerated
May be multifocal
Often aggressive
Invasive squamous cell carcinoma
Invasive squamous cell carcinoma
Melanoma
Rare
Not related to fair skin or sun exposure
Mild or no symptoms
Vulval melanoma
Melanoma
Less frightening things
You will often notice lumps or bumps
Ask about them
The patient may be waiting to see if you think
its abnormal.
Sebaceous Cyst
Vaginal Wall prolapse
Prolapse
Varicosities
Genital Warts
Others
Urethral caruncle
Bartholins cyst
Asymmetrical labia
Bartholins cyst
Urethral caruncle
Its a very private area
Our perception of our vulva is effected by:
Culture
Religion
Age
Education
Marital status
Sexual experiences
Facebook
Vulval Disease
Most women present late, and very distressed
They often feel guilt or ashamed
They always feel embarrassed
They worry its an STI
If there is a lump they think its a wart
Results of surveys of the impact of vulva
disease are alarming
Vulval disease
Any one of the conditions I have discussed
today, even the most innocuous will disrupt
their sex lives no matter their age.
Patients can become very socially isolated and
their relationships severely altered.
There is usually something we can do to help
Vulva Sign

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