Approach to the patient with vulvovaginal complaints (original) (raw)

The commonest causes of symptomatic vulvar disease: A dermatologist's perspective

Australasian Journal of Dermatology, 1996

A prospective study of 141 consecutive adult patients with chronic vulvar symptoms referred to a dermatologist was carried out to determine the commonest conditions seen. Eighty-nine per cent of patients underwent vulvar biopsy. The commonest cause of chronic vulvar symptoms in this group of patients was dermatitis, seen in 54% of patients. The other commonly seen conditions were lichen sclerosus (15%), chronic vulvovaginal candidiasis (10%), dysaesthetic vulvodynia (9%) and psoriasis (5%). Although 38% of patients had previously been diagnosed as suffering from human papillomavirus (HPV) vulvitis, histopathological evidence of HPV was seen in only 5%.

Vulvar dermatoses: a histopathologic review and classification of 183 cases

Journal of Cutaneous Pathology, 2015

Background: Vulvar dermatoses are often difficult to classify due to histopathologic overlap. We aimed to report our experience at a single institution. Methods: A total of 183 non-neoplastic, non-infectious vulvar biopsies were reviewed. Associations between histopathologic features and specific diagnoses were analyzed by Chi-squared tests. Results: Twenty-two biopsies (12.0%) showed two concurrent processes. A limited differential rather than a definitive diagnosis was rendered in 15 cases (8.2%). The final diagnoses included lichen sclerosus (LS) (38.8%), lichen simplex chronicus (LSC) (29.0%), eczematous dermatitis (23.0%), Zoon vulvitis (8.2%), non-specific/resolved dermatitis (5.5%), hidradenitis suppurativa (2.7%), Behçet disease (2.2%), lichen planus (1.6%), ruptured cyst (1.6%), ulcer not-otherwise-specified (1.6%), psoriasis (1.1%), radiation dermatitis (1.1%), sebopsoriasis (1.1%), seborrheic dermatitis (1.1%), epidermolytic hyperkeratosis (0.5%) and granular parakeratosis (0.5%). Early LS and Zoon vulvitis were commonly included as part of a differential diagnosis. LS was associated with wiry collagen with lymphocyte entrapment (p = 0.0188). LSC was associated with zones of pale epithelium (p = 0.0084), and often displayed prominent fibroblasts (p = 0.0555). Zoon vulvitis was frequently misdiagnosed, and was associated with basal keratinocytic crowding (p < 0.0001). Conclusions: Our study has determined the relative frequencies of a wide variety of vulvar dermatoses, and identified new diagnostic clues for early LS, LSC and Zoon vulvitis.

2006 ISSVD classification of vulvar dermatoses: pathologic subsets and their clinical correlates

The Journal of reproductive medicine, 2007

The International Society for the Study of Vulvovaginal Disease (ISSVD) has, as one of its major societal goals, the development and promulgation of nomenclature and classification of vulvar disease. A committee of the ISSVD has developed new nomenclature and classification for the specific area of vulvar dermatoses. This classification was approved by the ISSVD members at the most recent international congress, held in New Zealand in February 2006.

Most frequent dermatoses at a vulvar pathology outpatient clinic

Anais brasileiros de dermatologia, 2018

The vulva corresponds to the external female genitalia. Special features of this region favor a wide range of diseases, whose knowledge allows for better clinical management, impacting on the quality of life. This is a cross-sectional and descriptive study carried out at a vulvar pathology outpatient clinic, between May and December/ 2015. Data obtained from a standard form included demographic parameters, habits, and vulvar dermatosis and allowed to identify the epidemiological profile of patients with vulvar dermatosis treated in this outpatient clinic and to determine the most prevalent dermatoses. Our results, partially concordant with the literature, provide original data that should stimulate further studies.

Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1

Journal of Gynecology and Obstetrics, 2022

Three rings vulvoscopy (TRIV) has previously been described to facilitate the diagnosis and treatment of vulvar discomfort. The distinction between outer, middle, and inner vulvar rings is based on differences in anatomy, histology, and embryology. The vulvoscopy index was designed considering the patient's history, clinical exam, and assessment of the specificity and localization of the lesion relative to the vulvar ring. This paper evaluated the sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index in detecting vulvar dermatosis compared with histopathology as a reference test. Structured ISSVD vulvodynia pattern questionnaire and TRIV form data were utilized for the study. The data obtained were analyzed using StatSoft (Dell, Austin, Texas), Statistica 12 (TIBCO®, Palo Alto, CA), and SPSS 20 (IBM, Armonk, NY). Ethical approval for the study was obtained from the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. The histopathological diagnosis of vulvar dermatosis was confirmed in 72 patients at first biopsy. Lesions specific for vulvar dermatosis were visible by TRIV in 82 patients. The resulting difference of ten patients were participants with early vulvar dermatosis. In six of them, vulvar dermatosis was confirmed at a later biopsy during the study period. There was no statistically significant difference between the scores of points (median and range), frequency and relative frequency of vulvar findings within one item of the vulvoscopy index and histopathology, except for ten patients with early forms of vulvar dermatoses. The sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index for detecting vulvar dermatosis were 100%, 96.1%, and 96.9%, respectively. The positive and negative predictive values were 0.88 and 1.00, respectively. The vulvoscopy index represents a compelling clinical test for detecting vulvar dermatoses. Differences between vulvoscopic and histopathological diagnostics implicate the impossibility of histopathology in recognizing early forms of vulvar dermatoses. Accordingly, early dermatoses could represent a key area for applying this test. ClinicalTrials.gov Identifier: NCT02732145.

Spectrum of vulvar lesions: a clinicopathologic study of 170 cases

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2014

Background: A wide range lesions may occur in the vulvar region. The clinician is often confronted with the challenge to draw a distinction between normal variants, benign entities and a potentially serious pathology. The aim of the present study is to have an insight into the diverse morphologic spectrum of vulvar lesions. Methods: The present retrospective study was carried out by compiling the data from archival records over a period of eight years from January 2005 to December 2012. The vulvar biopsies/vulvectomy specimens were studied for histomorphological features. The lesions were categorized as non neoplastic, neoplastic and inconclusive; neoplastic ones were further divided into benign, malignant and premalignant. Results: The age of the women ranged from 6 to 80 years (mean 38.2±6.4) with the maximum number of patients between 31 to 40 years of age. Most common clinical presentation was itching and white plaque on the vulva (85 cases; 50%). The commonest site of vulval lesions was labia majora (87 cases, 51.18%). Non neoplastic lesions were more common (n = 94; 55.29%) than the neoplastic lesions (n =50; 29.41%). There were 23 (46%) benign lesions while 27 cases (54%) were malignant or premalignant ones. In 26 cases, no definitive histologic diagnosis could be rendered. Conclusion: Early recognition of vulvar lesions and a prompt biopsy diagnosis for all lesions with suspicious changes is of great significance. The term leukoplakia is imprecise and should be replaced by a precise histological description.

Determining the Cause of Vulvovaginal Symptoms

Obstetrical & Gynecological Survey, 2008

Both patients and clinicians may incorrectly diagnose vulvovaginitis symptoms. Patients often self-treat with over-the-counter antifungals or home remedies, although they are unable to distinguish among the possible causes of their symptoms. Telephone triage practices and time constraints on office visits may also hamper effective diagnosis. This review is a guide to distinguish potential causes of vulvovaginal symptoms. The first section describes both common and uncommon conditions associated with vulvovaginitis, including infectious vulvovaginitis, allergic contact dermatitis, systemic dermatoses, rare autoimmune diseases, and neuropathic vulvar pain syndromes. The focus is on the clinical presentation, specifically 1) the absence or presence and characteristics of vaginal discharge; 2) the nature of sensory symptoms (itch and/or pain, localized or generalized, provoked, intermittent, or chronic); and 3) the absence or presence of mucocutaneous changes, including the types of lesions observed and the affected tissue. Additionally, this review describes how such features of the clinical presentation can help identify various causes of vulvovaginitis.

Abnormal vulval lesions: diagnosis and management

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Vulval symptoms are commonly found and cause considerable distress for women. Symptoms are often chronic and can significantly affect the quality of women's lives including sexual function and wellbeing. Despite the frequency of vulval symptoms, women often find it difficult to seek medical advice due to multiple reasons, mostly cultural and emotional. This part is not easily self-observable neither are women aware of the fact that a vulvar lesion could also be a manifestation of a systemic disease. The idea behind this study was to identify whether presenting vulval lesion is dermatological or non-dermatological and to control the symptoms, to identify nature of the various vulvar lesions (inflammatory or neoplastic) and to identify those skin lesions not responding to treatment which require biopsy and further management. It was a clinical descriptive study. Cases included women with vulvar lesions who attended Gynaec OPD at Dhiraj General Hospital affiliated to S.B.K.S. Medical Institute and Research Centre of Vadodara. After taking their informed consent ,all the women who had symptoms like vaginal discharge, itching or discomfort associated a with vulvar lesion, visible lesion or growth over vulva were thoroughly investigated to rule out any systemic illness causing vulvar lesion following which biopsy was taken if solid growth or a non-healing lesion was present. Treatment was done according to the lesions. In the presence of vulvar complains, a diagnostic pathway including systematic physical examination is always mandatory to detect SCC early. A non-healing lesion must be subjected to biopsy mandatorily. Women should be educated to avoid ODC drugs or creams when they face vulval lesions.

Skin disorders affecting the vulva

Obstetrics, Gynaecology & Reproductive Medicine, 2008

The skin of the vulva constitutes a complex mixture of keratinized hairbearing skin of the labia majora and pubic area, the thinner rugeose but keratinized skin of the labia minora, and the adjacent vaginal introitus where the mucosal surface of the vagina begins. The surrounding buttock, natal cleft and inner thigh skin contribute to the relatively occluded microenvironment and high humidity. Skin disorders that can affect any part of the skin can appear slightly different in the vulval area; various disorders occur more frequently at ano-genital sites than elsewhere on the body.