The vulva refers to the genital parts of woman that comprises of Labia majora, Labia minora, vaginal orifice, clitoris, vestibule, skene ducts, hymen and urinary meatus. There are different disorders of the vulva caused by congenital abnormalities, infections, dermatological conditions, swelling, potentially pre-malignant conditions, malignant conditions and sexual abuse.
The congenital abnormalities are present right from birth. Virilisation and congenital adrenal hyperplasia are the examples of congenital abnormalities of vulva. Labial adhesions can be seen in little girls but not in neonatal period. It can be treated with 1% estrogen cream. If the adhesions are thick, then some sedation is required.
Some disorders of the vulva are caused by the infections. This infection may be due to nappy rash, varicella, candidiasis, genital herpes, genital warts, shingles, infestations etc. In case of Candida infections and nappy rash, antifungal creams are suggested. Management of genital herpes includes analgesics, salt baths, abstention from sexual intercourse until the ulcers are cured and use of anti-viral therapy. Treatment for genital warts involves an application of podophyllin paint compound BP, electrocautery and cryotherapy.
The dermatological disorders such as Lichen planus, Psoriasis and Behcet’s syndrome can give rise to the disorders of the vulva. They can be managed using the systemic steroids.
Edema or Swelling of the vulva may be because of venous or lymphatic obstruction. Secondary edema may be due to malignancy in pelvis, dependant edema due to prolonged sitting in the bed and haematoma suggests the sexual trauma. They can be treated using appropriate medications depending upon the cause.
Potentially pre-malignant conditions are called as the vulvar dystrophies which include squamous cell hyperplasia and lichen sclerosus. Lichen sclerosus and lichen sclerosus with squamous cell hyperplasia are treated using clobetasol propionate 0.05% ointment twice daily.
Vulvar cancer is one of the common forms of disorders of the vulva. It may be of various types such as squamous cell carcinoma, melanoma and Paget’s disease of the vulva. They can be managed by surgical procedures, chemotherapy and radiotherapy.
