WHAT EVERY WOMAN SHOULD KNOW
ABOUT VULVAR HEALTH
The mysterious vulva has been referred to by more names than any
other part of the female anatomy: private parts, down there, pookie, yoni,
and many others. In a culture that has discouraged women from
understanding or exploring their intimate body parts, women are missing
out on an important opportunity to positively affect their health. From
common concerns like vaginitis to more serious conditions like cancer, this
is a part of the body women should become familiar with in order to receive
the best health care possible. If you know what’s normal for you, than you
will be more capable of detecting when something goes wrong.
Anatomy of the Vulva
The vulva is a multipart organ consisting of many sensitive parts. As
you move down from your belly button, you come to the mons veneris, or
mons pubis, which is sometimes called the mound of Venus, which is the
protective fatty tissue that lies on top of the opening to the vagina and is
covered by skin and pubic hair.
Moving further south, the outside vaginal lips are called the labia
majora. Shrinking or swelling in response to both temperature and touch,
these “lips” are extremely sensitive. Inside the labia majora is a second set
of “little lips” known as the labia minora, which serve to protect the interior
of your vagina. The labia minora have no hair, but oil glands within them
can be felt through the thin skin as tiny bumps. Even more sensitive than the
labia majora, they also swell with blood during sexual excitement. Both sets
of lips sweat and produce discharges which serve to waterproof the vulva
and defend the vagina from disease organisms.
The clitoris is a tiny organ made of soft, spongy tissue and is covered
by a hood of skin called the prepuce. The clitoris sits atop of the labia
minora and, like a penis, it becomes engorged with blood when you are
sexually stimulated. The clitoris has more than 8000 nerve ending which is
twice the number in the penis!
Located just below the clitoris is the urethra, which serves as the
passageway for urine. It also has erectile tissue which responds when the
vulva is stimulated. The perineum is the short piece of skin that stretches
from the bottom of the vagina to the anal opening. Forming the entryway
into the vagina is the vestibule. The Bartholin’s glands, located on either
side of the vaginal opening, produce lubricating fluid to the vulva and
vagina.
Women’s vulvas can look very different from each other in shape,
size, and color. Therefore, it is important for women to learn what a
“normal” vulva for them personally looks like, smells like, and feels
like to the touch.
Vulva Self-Exam (VSE)
Experts now advise that doing a vulva self-exam (VSE) on a regular
basis, just like you do monthly breast exams, is one of the best ways to catch
changes and health problems early on. You should perform VSE in-between
menstrual periods or choose a date each month that will help you remember
to perform your VSE. You can view your vulva by getting in a comfortable
position and holding a hand mirror. Here are the steps you should take:
* Separate the outer lips with your fingers. A normal vulva is pink to
medium red, with no white or reddened areas. Look for any new freckles or
moles and feel for any cuts or sores, lumps, or cysts.
* Now look a little deeper inside by separating your inner lips. Look
for the same signs mentioned above. Also, check the entrance to your
vagina.
* Examine your clitoris, which is under a hood or fold of skin. It
should resemble a small, fleshy mound and is soft to the touch and pink in
color.
* Check outside the lips: your urethra, perineum, and anus for any
soreness, irritation, itching, or signs of bleeding.
Most changes in your vulva will NOT be cancerous, but you should
discuss all changes with your doctor at the earliest opportunity.
Common Problems of the Vulva
Vaginitis is the single most common health problem affecting women
and usually causes vulvar problems secondarily. It is the general term used
to describe a variety of conditions caused by everything from bath products
to complex infections. Vaginitis commonly means you have an infection
known as bacterial vaginosis (BV). When treated early on with pills or
creme, BV is usually cured with no complications. But left untreated, BV
can increase your risk of pelvic inflammatory disease (PID), infertility, and
other sexually transmitted diseases. The vaginal discharge with BV is
usually thin, watery, milky-white or gray, sometime sticky, and may smell
“fishy”. This discharge typically becomes worse after intercourse, but
doesn’t always itch or become inflamed.
Another form of vaginitis which causes vulvar itching, burning, and
even pain, is a vaginal yeast infection. When the balance of your good
lactobacillus bacteria drops in the vaginal environment or when other things
alter this environment, the candidiasis or yeast fungus multiplies. The
vagina and vulvar environment can change due to many things including:
antibiotics, douching, birth control pills, vaginal products, diabetes,
hormonal patterns, HIV, or poor bathroom hygiene. The most obvious sign
of infection is a white, clumpy, cottage cheese-like discharge. Both overthe-counter and prescription medications are available to treat yeast
infections. However, experts advise that every first-time yeast infection
should be diagnosed by a doctor, and not just over the phone. Your yeast
infection should clear within seven days with medication. If is doesn’t, or if
it recurs within ten days, see you doctor right away.
Lichen sclerosus is a chronic skin disorder of the vulva which causes
itching and inflammation and occurs in an hour-glass pattern with ivorycolored patches. For most women, early treatment of lichen sclerosus with
cortisone-like preparations or hormone preparations controls symptoms.
Lichen planus is a common skin inflammation that presents with
tiny, itchy white bumps on the inside or outside of the vulva. It requires a
biopsy for accurate diagnosis and to rule out the rare chance of having
cancer of the vulva. Lichen planus can be treated with a variety of
prescription creams.
A round, bulging growth on the vulva will probably be due to a cyst a liquid or semisolid filled sac - commonly found in, or next to, the
Bartholin’s glands. If you are over forty and experiencing recurring cysts,
your doctor may need to perform a draining procedure, or in rare cases,
remove the gland and biopsy it for cancer. Another very common cyst is
one which develops when a hair follicle grows inward. These are often
tender to the touch and hot, moist compresses can help relieve the
inflammation and drain the cyst. Some women develop sebaceous, or oilfilled cysts on the vulva, but all cysts should be diagnosed by a doctor.
Serious Diseases of the Vulva
Human papilloma virus known as HPV can cause genital warts
which may be transmitted sexually. While warts can be painful, they pose
no serious danger to your health. If you feel a wart or any irregularity, it
should be checked out by a specialist. However, some strains of HPV have
been linked to cancerous growths, and they present no obvious signs, like
warts. Some women are now choosing to be tested for HPV when they
receive their annual pap test.
One of the most alarming of vulvar infections to discover is genital
herpes. Herpes simplex type 1 is common in fever blisters on your lips.
With fever blisters, it is important to avoid infected lips contacting the vulva
or penis. Similarly, herpes simplex type 2, a close cousin to type 1, almost
always spreads by sexual contact. When active lesions of the vulva or penis
are present, sexual contact must be avoided. These small blisters can
develop anywhere on the vulva and are usually itchy and burn.
Other sexually transmitted viruses and infections which women
should become familiar with the symptoms of, include: hepatitis B (HBV),
HIV, chlamydia, gonorrhea, syphilis, and trichomoniasis.
Finding raised brown, pink, or white lesions on the inside of your
vulva should be checked by a doctor for vulvar intraepithelial noeoplasm,
or VIN. This is a precancerous condition that occurs when changes in the
cells of the vulva cause abnormal growth. Cancer of the vulva is relatively
rare (4,000 cases annually in the US) and is almost always curable when the
growth is less than two centimeters (about 3/4 of an inch) in size. This kind
of cancer most often occurs in women over 60 and almost all cases are
associated with a chronic itching.
Vulva Self-Care Tips
Some common vulvar self-care tips include:
* Wash the vulvar skin with water and one’s hand only - soaps and
washcloths can dry out or irritate the vulva.
* Wash your undergarments with detergent made for babies or those
with sensitive skin and even run them through a second rinse with water
only.
* Go without underwear when possible, such as at night. Make sure
underwear is 100% cotton in all places and avoid panty hose. Change out of
wet bathing suits as soon as possible.
* Avoid fragranced products, such as perfumed shower gels, scented
toilet paper, douches and genital sprays, on the vulvar skin and vagina.
* After bowel movements, wipe from front to back.
* Dry your vulva thoroughly before dressing or use a hair dryer set on
cool to the outside of the vulva only.
* Cotton menstrual products may be preferable over synthetic
versions.
* Baking soda or oatmeal sits baths or soaking in a bath of
chamomile tea bags may help reduce itching.
* Use non-irritating lubricants for sexual intercourse.
* Learning about gluten free, dairy free or yeast free diets may help
chronic vulvar problems.
For more information on the vulva and treatment options visit the website:
vulvar.health.org, or take out one of the following books from the WHRC
free lending library: The V-Book: A Doctor’s Guide to CompeteVulvovainal
Health by Dr. Elizabeth Stewart, The V Zone: A Women’s Guide to Intimate
Health Care by Colette Bouchez, or The Vulvodynia Survival Guide: How
to Overcome Painful Vaginal Symptoms and Enjoy an Active Lifestyle by
Dr. Howard Glazer and Dr. Gae Rodke. Our staff can also provide you with
information about DHMC’s multidisciplinary vulvar clinic.