“Dalagang Filipina ako,” we Pinays often say to avoid blush-inducing conversations. We mostly shy away from sensitive topics—but some things do need to be heard.
The vulva is the external part of the female genital area. It includes the mons pubis, or mound of fatty tissue over the pubic bone; the outer and inner labia; the clitoris; the urinary and vaginal openings; and the perineum, or skin between the vagina and the anus. Because the skin and tissues of the vulva are very delicate, the area is susceptible to irritation and inflammation. Many women experience discomfort or pain in this area at some time in their lives, which can cause considerable distress and interfere with sexual functioning and self-image.
Sydney-based dermatologist Gayle Fischer, M.D. and gynecologist Jennifer Bradford, M.D. have treated women with complex vulvar conditions. Below is their guide to demystifying vulval problems.
Vulval discomfort can take a wide variety of forms: itching, burning, pain, soreness, swelling, lumps, ulcers and vaginal discharge. It is important to understand that a particular symptom does not necessarily mean a particular diagnosis; any vulval symptom may be due to just about any vulval diagnosis.
This discomfort can often remain unnoticed until severe. Some women with badly inflamed vulval skin don’t even notice discomfort on entry to their vaginas, but will seek help from their doctors when they have deep dyspareunia, or abdominal pain during sex because of pelvic muscle spasm. These women are not ‘neurotic’: the natural lack of pain sensation in their vulval and vaginal regions allowed the inflammation to become severe without their realizing it.
Cycles of vulval discomfort
Sometimes, vulval discomfort may be worse at a particular time of the month, often during periods. This cycling discomfort is usually due either to thrush or to an allergy to the body’s natural estrogen production. Estrogen allergy is something that has been suspected for some time, and recently proven to exist by research done by Dr. Fischer and her colleagues. It should be stressed, however, that the oral contraceptive pill does not cause or exacerbate an estrogen allergy, which is caused by a woman’s own natural estrogens.
You may have had the frustrating experience of being told by your doctor that they cannot see any visible abnormality on your vulval skin, despite your discomfort in the area. The problem with recognizing vulvar skin problems is that they do not look the same as when they occur on outside skin. The local conditions of heat, wetness and friction modify the textbook signs of skin disease when it occurs on the vulva, so it may look normal, when in fact there may be a subtle, but significant, rash on it.
Vulval symptoms: often dermatologic, not gynecologic
Most women with vulval symptoms actually have ordinary dermatitis, also known as eczema. Normally simple dermatological diagnoses are often missed by doctors because they are looking for a gynecological problem.
Even when a skin diagnosis is considered, the treatment is often not effective because dermatological treatment principles need to be modified to work effectively on vulval skin: