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The vulva monologues

Doctors share a few words on uncomfortable issues down under.

MAY 2012 

“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 V-word

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.

General symptoms

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:

• Treatment needs to be continued for much longer than on outside skin.
• Much more attention should be paid to eliminating all forms of friction and chemical contact.
• Long-term cases are often complicated by secondary infections with normal vaginal flora—usually ignored by either the pathologist or clinician.

Vulval dermatitis

Many women with dermatitis are atopic and suffer from allergic conditions like asthma. Often they become itchy if they wear inappropriate fabrics, do housework or gardening, or use a soap or bubble bath. Dermatitis is made worse by irritation or allergy.

Think for a moment about all the rubbing that your vulval skin has to put up with: panties or G-strings; panty liners and pads; pantyhose; gym clothes; jeans—the list is endless! When you have sexual intercourse, the rubbing involved is merely the last straw in a long line of irritants. But having sex is not the main problem: the big problem is the inflammation of your vulval skin from all the other irritants.

Alternatively, your problem down there might be due to an allergic reaction to any one of a number of chemicals:

• perfume and dyes in toilet paper, soaps, cleansers and bath additives, even hypo-allergenic products;
• talcum powder and some brands of personal lubricant;
• vaginal creams and creams used for hemorrhoids; and
• latex in condoms.


myDr, 2005
©Copyright: myDr, UBM Medica Australia, 2000-2012. All rights reserved.

myDr, 2000. Adapted from material supplied by Dr Gayle Fischer, FACD, and Dr Jennifer Bradford, FRANZCOG.
©Copyright: myDr, UBM Medica Australia, 2000-2012. All rights reserved.  

For an approach to treating this condition, get a copy of HealthToday’s May issue, out now in newsstands and bookstores.

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