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Disorders of the Vulva

The appearance of the vulva changes with age, hormone status, and hygiene. Patients or their parents may be uncomfortable discussing vulvar complaints or may be reluctant to have the area evaluated. Sensitivity to adolescents' concerns is of the utmost importance because these complaints may be related to body image. A discussion regarding sexual activity as it pertains to vulvar complaints requires vulva, vulvodynia, bulva, vulvadinia, vulvodynea, vulvadynia, valva, vagina pain, painful vagina, pain in vagina

SOLID LESIONS OF THE VULVA

Acrochordon

Acrochordon is a polypoid, fleshy lesion that is usually pedunculated and arises on the vulva or the medial thigh. It is usually asymptomatic, but repeated trauma and irritation can cause it to become ulcerated. If the lesion is in a troublesome location, such as the panty line or groin fold, it can be removed in the clinic with local anesthesia in a similar fashion as described for a vulvar biopsy. Occasionally, a  vulva, vulvodynia, bulva, vulvadinia, vulvodynea, vulvadynia, valva, vagina pain, painful vagina, pain in vagina

Nevus

The significance of pigmented nevi lies in their potential for transformation into a malignant lesion (malignant melanoma). Melanomas are

Molluscum Contagiosum

Dome-shaped, umbilicated papules with an indentation in the center, from which whitish material can be extracted, are the clear manifestation of molluscum contagiosum virus (MCV). The causative agent is a mildly contagious, growth-stimulating poxvirus. Two distinct types that are

Condyloma Acuminatum

The most common solid vulvar tumors in adolescents are associated with the human papillomavirus (HPV). They present as white or flesh-colored firm, wartlike lesions that are usually multifocal. They

Vulvar Intraepithelial Neoplasia

The classification of vulvar intraepithelial neoplasia (VIN) has changed significantly over time. 

Vulvar intraepithelial neoplasia lesions are often associated with HPV. Studies have found HPV-DNA in the majority of cases of VIN. Multiple types of HPV are found within the lesions, most commonly HPV-16 but also other types, such as HPV-18 and HPV-33. Physicians now postulate that two types

Non-Neoplastic Epithelial Disorders (Vulvar Dystrophies)

The terminology in this category has been confusing in the past. A new nomenclature is currently used to encompass the entire group of lesions, including leukoplakia, lichen sclerosus et atrophicus, kraurosis vulvae, lichen simplex, and atrophic and hyperplastic vulvitis. The new 

Squamous cell hyperplasia

Lichen sclerosus

Other dermatoses

The age of women with these diseases varies considerably. The hyperplastic lesions are mostly seen in the reproductive years (< age 50 y). Lichen sclerosus is more common after menopause and before

Lichen sclerosus may involve any part of the vulva but usually is present on the labia minora and the perianal area. It is often seen in a symmetric pattern and has a figure-of-eight or h

Most patients with these diseases present with intense pruritus. This then leads to a scratch-itch cycle and the presence of ulcers and ecchymotic areas, which make the diagnosis more difficult to e

Hygiene measures, including 100% cotton underwear, should be recommended. Treatment consists of

CYSTIC LESIONS OF THE VULVA

Inclusion Cysts

Inclusion cysts are usually related to trauma from childbirth or lacerations. They are implantations of mucosa under the skin that develop after surgery or trauma. The cystic lesions are round and white,

Bartholin's Duct Cysts

Bartholin's duct cysts arise in the duct of the Bartholin's gland, located in the vestibule at the 5- and 7-o'clock positions. An occlusion occurs because of inflammation, mucus, or congenitally narrowed

ULCERATIVE DISORDERS OF THE VULVA

Ulcerative disorders of the vulva fall into two major categories. The first group includes ulcerative lesions caused by STDs, such as chancroid, lymphogranuloma venereum, herpes, and syphilis. These diseases are considered in other articles in this issue. The second group consists of non-STDs and

Behcet Syndrome

Behcet syndrome, a triad of oral ulcers, genital ulcers, and various ophthalmologic inflammations, may first present during adolescence. The cause is unclear. It causes painful, persistent ulcerations of the vulva, vagina, and cervix. They do not involve the genitocrural folds or interlabial sulci. Healing can be

Crohn's Disease

Crohn's disease is a chronic, noncaseating, granulomatous disease of the gastrointestinal tract that may result in vulvar ulcerations. The vulvar disease typically consists of multiple ulcers that are deep and

PYOGENIC CONDITIONS OF THE VULVA

Follicular Infections

Infections arising within the hair follicles are common. Three varieties exist: (1) folliculitis, (2) furuncles, and (3) carbuncles. The infectious agent is usually a staphylococcal organism that enters the follicle.

Glandular Infections

Hidradenitis suppurativa is a chronic infection of the apocrine glands. The vulva, perineum, and axilla are the most common sites (Fig. 8) (Figure Not Available) . These glands are stimulated by androgens and suppressed by estrogen. Although the exact cause remains uncertain, research to date favors a follicular origin with apocrine involvement. Hidradenitis is

MISCELLANEOUS LESIONS

Tinea

Dermatophytoses are superficial fungal infections that involve only the skin and appendages. Tinea cruris (jock itch in men) is an infection of the genitocrural areas. The most common causes are Epidermophyton floccosum, Trichophyton mentagrophytes, and Trichophyton rubrum. The

Psoriasis

Psoriasis is a multifactorial genetic skin disorder. It develops at an early age, and the median age of onset is during puberty.  This disease has a tendency for spontaneous remissions and exacerbations. Patients with psoriasis improve with sunlight exposure, weight changes, and during pregnancy. Psoriasis most

Allergic Reactions

Contact vulvitis is an inflammatory reaction of the skin to a primary irritant or an allergic substance. Most commonly, the reaction is to a substance that is placed on the vulva by the patient or by the health care provider's prescription.  The vehicles of many preparations contain propylene glycol and parabens,

Labial Hypertrophy

Labial hypertrophy is an uncommon disease but one that can cause adolescents much distress. Most commonly, both labia minora are enlarged, with asymmetry being present in only 12% of 

Vulvodynia or Vulvar Pain Syndrome

Vulvodynia or vulvar pain syndrome is defined by chronic vulvar discomfort characterized by patients as burning, stinging, irritation, or rawness. Two categories exist: (1) organic and (2) dysesthetic (essential). The organic causes that need to be excluded are chronic yeast infection, contact dermatitis, withdrawal from long-term steroid use, herpes genitalis, and 

The evaluation of these patients should be comprehensive, including a thorough history with questions regarding timeline, nature of the pain, and aggravating and alleviating factors. The examination should be performed with a cotton-tipped applicator to gently touch the entire vulva and map out the

A subset of these patients suffers from vulvar vestibulitis, an exquisitely tender inflammation of the vestibule. Their complaints include dyspareunia and burning with tampon use and other activities that