Patients with vulvar problems commonly present with one of two symptoms; pain and itching. However, many women also describe their discomfort as burning, stinging, and rawness. While there are several disorders that can occur in the vulvar, two of the most common are vulvodynia and vulvar vestibulitis syndrome (VVS).
Vulvodynia means vulvar pain. The pain can occur when the area is touched or it can occur without touch. There are two types of vulvodynia: generalized and localized. With generalized vulvodynia, the pain occurs over a large area of the vulva. With localized vulvodynia, the pain is felt on a smaller area, such as the vestibule (the area around the opening of the vagina).
Vulvar vestibulitis syndrome (VVS) is a specific form of localized vulvodynia. In VVS, the pain is felt only in the vestibule (the area around the opening of the vagina), usually in response to touch or pressure.
Treatment of vulvodynia and vulvar vestibulitis syndrome require a multi-pronged approach that includes antidepressants, anticonvulsants, physical therapy, biofeedback, and treatment of pain-related depression. “These patients do not have depression or seizure disorders, but antidepressants and anticonvulsants can be highly effective in regulating pain signals,” says Dr. Wang.
Many patients suffer from dermatologic conditions that may affect other parts of their body, including lichen sclerosis, lichen simplex chronicus, hidradenitis suppurativa, psoriasis, and eczema. Because it affects the vulva, however, they do not think of it as a dermatologic issue.
Lichen sclerosis. This condition is characterized by white patches that are extremely itchy and can develop into painful erosions and ulcerations. If left untreated, lichen sclerosis can scar the vulva, narrowing the vaginal opening. Extensive scarring can prevent intercourse, and may close the urethra, causing women to have trouble voiding. Fortunately, if treatment is instituted before anatomic distortion occurs, response is excellent. Close monitoring is recommended, since recurrence is common.
Lichen simplex chronicus. This condition is caused by chronic exposure to irritants, leading to excessive scratching, which further traumatizes and irritates skin. Treatment is focused on eliminating potential irritants and preventing scratching. Patients are instructed to wear gloves to bed, and a sleeping medication may be given to reduce scratching at night. Patients are told to wash the vulva with water only, wear white cotton underwear, use white toilet paper, and to wash clothes with certain laundry detergents without fabric softeners.
Hidradenitis suppurativa. This condition causes acne-like lesions to grow into the skin, resulting in chronic inflammation. Patients experience various degrees of pain, drainage, and scarring. It is more common in overweight women, African-American women, and women with family history. Treatment begins with antibiotic wash, hormonal intervention, and weight loss. Advanced disease requires aggressive surgical management.
Center for Vulvar Medicine
101 Halton Village Circle
Greenville, SC 29607
A physician referral is not required. Please check with your insurance company regarding coverage.