VULVA
• The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or
covering) consists of the external female sex organs. The vulva includes
the mons pubis (or mons veneris), labia majora, labia
minora, clitoris, vestibular bulbs, vulval vestibule, urinary meatus,
the vaginal opening, hymen, and Bartholin's and Skene's vestibular glands.
The urinary meatus is also included as it opens into the vulval vestibule.
Other features of the vulva include the pudendal cleft, sebaceous glands,
the urogenital triangle (anterior part of the perineum), and pubic hair. The
vulva includes the entrance to the vagina, which leads to the uterus, and
provides a double layer of protection for this by the folds of the outer and
inner labia. Pelvic floor muscles support the structures of the vulva. Other
muscles of the urogenital triangle also give support.
INFLAMMATION
Vulvitis is an inflammation of the vulva. This is the soft folds of skin outside
the vagina. It's a symptom that can result from an array of diseases.
Symptoms
Redness and swelling on the labia and other parts of the vulva.
Intense itching.
Clear, fluid-filled blisters.
Sore, scaly, thick, or white patches on the vulva.
Causes
1. Allergy
soaps
lubricants
vaginal washes and douches
tampons and pads
vaginal contraceptives
body lotions and creams
latex condoms
Swelling may appear in response to a new product, but a product the body is familiar with can also cause an
allergic reaction. If a person suspects that they are allergic to a particular product, it may be a good idea to stop
using it and consult a dermatologist.
2.Irritation
3.Rough intercourse
Even if an allergy is not present, the body may react
adversely when it comes into contact with specific
products.
Sexual intercourse can cause the vagina to swell. If
the vagina is not sufficiently lubricated, added
friction may lead to discomfort or pain during sex,
and swelling of the vagina after sex.
• laundry detergent
• perfumes
• toilet paper
• body washes
• bath bombs and soaps
• Some types of cloth may also cause vaginal
irritation and swelling. Lace or polyester
underwear, in particular, may irritate the skin.
DERMATOLOGIST
Nonsteroidal anti-inflammatory drug (NSAID)
4. Gartner’s duct cysts
• A duct that forms in fetuses when the urinary
and sexual organs are developing usually
disappears after birth. If part of this duct
remains, it is known as a Gartner’s duct. The
remaining tissue may attach to the vaginal
wall and develop into a cyst.
• Gartner’s duct cysts tend to be harmless, but
they can become problematic when they
grow. A Gartner’s duct cyst may become
infected or cause pain and swelling in the
vagina.
• In some cases, the cyst will appear as a
growth on the outside of the vagina.
• Surgery is often necessary to remove a
troublesome Gartner’s duct cyst. Once the
cyst is gone, symptoms should diminish.
5. Bartholin’s cysts
• The Bartholin glands are on either side of
the vaginal opening. They secrete
moisture and help to provide lubrication.
• A cyst on one of these glands may go
unnoticed until it becomes infected, at
which point an abscess may form. Also,
the skin around the vagina may become
inflamed and painful. In some cases,
there may be a burning sensation or
bleeding.
• If the cyst or abscess is small, it may drain
on its own. A warm, shallow bath may
help to ease the pain, and over-thecounter medications can reduce pain and
swelling.
• In more severe cases, a doctor may
recommend antibiotics, surgical drainage,
or removal of the cyst.
6. Cellulitis
• Cellulitis is a bacterial infection of the
inner layers of the skin that may cause
the skin to become swollen, red, and
tender. A person can develop cellulitis
when the bacteria enter a cut, such as
one sustained when shaving the pubic
area.
• Cleaning a cut regularly may help to
combat infection. In some cases, a doctor
will recommend antibiotics.
7. Bacterial vaginosis
• An overgrowth of harmful bacteria
in the vagina may lead to vaginosis.
Symptoms may include swelling
and a grayish discharge with a foul
smell.
• Many cases resolve on their own,
but a doctor may recommend
antibiotics to speed up recovery.
• Cleaning the vaginal area regularly
and avoiding potential irritants can
help to prevent bacterial vaginosis.
• It may also be a good idea to avoid
products such as douches, which
disrupt the bacterial balance in the
vagina.
• 8. Yeast infection
A yeast infection is caused by an
overgrowth of the Candida fungal species. It
can cause vaginal swelling, and other
symptoms may include:
• burning
• pain during sex and urination
• redness
• thick, chunky discharge
• irritated skin
Yeast infections are treated with antifungal
medications.
• 9. STD
Below are some STD that can cause
swelling of vulva
• Chlamydia: This can seriously damage a
woman’s reproductive system and may also
lead to painful urination and unusual
discharge.
• Gonorrhea: Symptoms in women are often
mild and are easily confused with those of an
infection in the urinary tract or bladder. Other
symptoms include bleeding between periods
and increased discharge.
• Trichomoniasis: This is caused by a parasite
and may have no symptoms. When they
appear, symptoms can include itching,
soreness, pain while urinating, and changes in
discharge.
• ANTIBIOTICS
10. Genital herpes
• The herpes simplex virus often causes
clusters of tiny, painful blisters to
appear near the vagina. These can
burst and become painful sores.
• While some people notice no
symptoms, others find that swelling,
pain, and body aches accompany
these sores.
ANTIVIROTIC drugs
VULVAR DYSTROFY
Nonneoplastic diseases of the skin and mucosa (vulvar dystrophies) according to
thr Society for the Study of Vulvar Disease (ISSVD) classification were
defined as:
Squamous cell hyperplasia
Lichen sclerosus
Other dermatoses (psoriasis, seborrheic dermatitis, tinea, lichen
simplex chronicus, lichen planus, etc.).
Vulvar dystrophy can also be called genital itchy disease
Squamous Cell Hyperplasia (SHH)
Lesions that can be seen in the reproductive and postmenopausal age groups,
regardless of a specific cause.
Apart from the anogenital region, they can also be seen on the neck and legs, and
increase with stress.
They often occur secondary to long-term use of topical treatments such as
antifungals or steroids
Skin burning sensation, itching and traces of itching are common signs and
symptoms.
The disease may progress with different appearances depending on epithelial
thickening and hyperkeratosis In the presence of mild keratosis, the vulva may
often appear dark red. Lesions may be in the form of white patches, or as white
and red regions with different localizations.
Pubic hair is often broken and reduced, the skin is dull.
Careful evaluation of the vulva is important to rule out carcinoma. In the biopsy,
hyperkeratosis, acanthosis and sometimes parakeratosis are detected.
Lichen Sclerosus (LS)
Usually the disease of postmenopausal women.
Juvenile LS lesions in 10% and may disappear spontaneously without sequelae
Autoimmune diseases, familial genetic factors, sex hormones, infection, trauma, connective tissue
and immunocytological changes may be involved in the pathogenesis.
It is characteristic that it progresses with severe itching, especially at night, leading to ecchymosis,
cracks, abrasions and even ulcers, and itching is not proportional to the spread of the disease. A
burning sensation is observed due to irritation of nerve endings or tension of the skin due to edema
and loss of elasticity.
Although the lesions may be localized, the main location is the anogenital region, and perinealperianal skin involvement may form an 8-shaped lesion.Involvement may occur in the clitoris,
internal surfaces of the labia majora, labia minora, introitus and perianal region. Disease can also be
seen in the back, neck, armpits, forearms, over the collarbone, intramammary regions, and rarely in
the lips and oral cavity, but unlike those in the genital region, lesions in these localizations are
usually asymptomatic.
Primary LS lesions are slightly pink or ivory, uniformly shaped, well-demarcated, centrally
depressed, papules that form plaques in places.The skin can give the appearance of wrinkled
cigarette paper or parchment paper with its atrophic, white, glossy, thin and loose appearance
Biopsy reveals hyperkeratosis, thickened epithelium, flattening of rete pegs, and cytoplasmic
vacuolization in basal cells. Lichen sclerosus is often seen accompanied by hyperplastic
epithelium.Squamous cell hyperplasia is observed in 27-35% of patients.
Treatment
• Before long-term treatment, it is essential to establish a tissue diagnosis by
taking biopsy, especially from areas of fissure, ulceration, induration and
thickened plaque
• Especially in cases of squamous cell hyperplasia, a rapid response can be
obtained with lotions or creams containing corticosteroids. Moderate or
strong topical steroid application 2-3 times a day relieves itching and
inflammation. In very severe cases, oral steroids can be used to provide
initial control
• Adding antihistamines to the treatment and sedatives to relieve anxiety
may be beneficial.
• PRP treatment
• Patients should be followed up at 3-6 month intervals in terms of
recurrence.
Benign neoplasm of the vulva
Common benign tumors of the vulva include the Bartholin gland cyst
or abscess, epidermoid inclusion cysts, and angiomas.
Many benign vulvar tumors are asymptomatic and are found only on
self-examination.
Depending on the type of lesion, most do not require excisional
treatment.
Vulvar Intraepithelial Neoplasia (VIN)
Most women with vulvar intraepithelial neoplasia (VIN) have no symptoms at
all. When a woman with VIN does have a symptom, it is most often itching
that does not go away or get better.
An area of VIN may look different from normal vulvar skin. It is often thicker
and lighter than the normal skin around it. However, an area of VIN can also
appear red, pink, or darker than the surrounding skin.
Because these changes are often caused by other conditions that are not
pre-cancerous, some women don't realize that they might have a serious
condition. Some try to treat the problem themselves with over-the-counter
remedies. Sometimes doctors might not even recognize the condition at first.
Invasive squamous cell cancer of the vulva
Almost all women with invasive vulvar cancers will have symptoms. These can include:
•An area on the vulva that looks different from normal – it could be lighter or darker
than the normal skin around it, or look red or pink.
•A bump or lump, which could be red, pink, or white and could have a wart-like or raw
surface or feel rough or thick
•Thickening of the skin of the vulva
•Itching
•Pain or burning
•Bleeding or discharge not related to the normal menstrual period
•An open sore (especially if it lasts for a month or more)
•Dg/ HP
•TH Surgical treatment/ Radical vulvectomy
Vulvar melanoma
Patients with vulvar melanoma can have many of the same symptoms as
other vulvar cancers, such as:
•A lump
•Itching
•Pain
•Bleeding or discharge
Most vulvar melanomas are black or dark brown, but they can be white,
pink, red, or other colors. They can be found throughout the vulva, but most
are in the area around the clitoris or on the labia majora or minora.
VAGINA
The vagina is a closed muscular canal that extends from the outside
of the female genital area (vulva) to the neck of the uterus (cervix).
VAGINITIS
Vaginitis is a medical term that describes various disorders that cause
vagina to become infected or inflamed.
Vulvovaginitis refers to inflammation of both the vagina and vulva (the
external female genitals).
These conditions can result from an infection caused by organisms
like bacteria, yeast or viruses. Irritations from chemicals in creams,
sprays or even clothing that come in contact with this area can also
result in vaginitis. In some cases, vaginitis results from organisms that
are passed between sexual partners, vaginal dryness and lack of
estrogen.
The most common types of vaginitis are:
• Candida
• Bacterial vaginosis
• Trichomoniasis
• Chlamidia
• Gonorrhea.
•Viral vaginitis (herpes).
•Non-infectious vaginitis/ irritation
•Atrophic vaginitis/ lack of estrogen
BENIGN TUMORS OF VAGINA
The frequency of benign lesions ranges from rare to very rare
Neoplasms that may develop in other locations within the genital tract
may also be found in the vagina.
Most vaginal tumors produce no symptoms until significant size is reached.
Symptoms and signs may include a sensation of pressure, dyspareunia,
obstruction of the vagina or urethra, or vaginal bleeding. However, most
lesions will be detected during a routine exam in the asymptomatic patient.
Vaginal neoplasms may be divided into cystic or solid lesions and a third
category best described as related conditions.
As is true for any neoplasm, biopsy provides a definitive diagnosis.
CYSTIC TUMORS
Gartner's Duct Cyst develop as a result of incomplete regression of the
mesonephric or wolffian duct during fetal development
Paramesonephric Duct Cyst In contrast to Gartner's duct cysts,
paramesonephric duct cysts suggesting müllerian origin. These cysts may be
found anywhere in the vagina and frequently contain mucus.
Inclusion Cyst result from mucosa trapped in the submucosal area by surgical
procedures such as episiotomy, colporrhaphy, or trauma including childbirth
Endometriosis may develop at the site of a previous operation or as primary
implants.
SOLID TUMORS
Leiomyoma rare lesions usually located in the anterior vaginal wall. Between 250 and
300 cases have been reported in the world literature.
Fibroepithelial Polyp uncommon and usually asymptomatic
Condyloma Acuminatum clinical manifestation of HPV infection
VAGINAL CANCER
• Vaginal cancer is a very rare cancer that's found anywhere in the vagina.
• Vaginal cancer is nearly always caused by an infection from certain types of
the human papillomavirus (HPV).
• It's often found and prevented by attending cervical screening
• Vaginal cancer usually grows very slowly and how serious it is depends on
how big it is, if it has spread and your general health.
• Main test for diagnosis is COLPOSCOPY
• Vaginal squamous cell carcinoma, which begins in the thin, flat cells
(squamous cells) that line the surface of the vagina, and is the most common
type
Symptoms
•bleeding from the vagina after the menopause
•bleeding after sex or pain during sex
•smelly or bloodstained vaginal discharge
•bleeding between periods
•an itch in vagina
Vaginal cancer is often treatable.
The treatment will depend on:
• the size and type of vaginal cancer
• where it is in the vagina
• if it has spread
• general health of the patient
The main treatment for vaginal cancer is radiotherapy
Radiotherapy for vaginal cancer can be given from outside or inside the body
brachytherapy.
Surgery is usually only used on vaginal cancer that's found early. It's also used if
radiotherapy has not worked.
Different surgeries involve removing:
part of the vagina – this is only possible if the cancer is small and is in the upper
section of your vagina
all of the vagina – sometimes lymph nodes are removed too
the vagina, cervix and womb (hysterectomy) – this can include removal of the
ovaries and fallopian tubes
the vagina, cervix, ovaries and fallopian tubes, and all or parts of the bladder,
bowel and rectum – this is only offered if the cancer has spread and other
treatment is not possible