lecture recording on 14 March 2025 at 13.19.28 PM

Objectives of the Discussion

• Focus on benign lesions, excluding cancer.

• Address vulvodynia and vulvar pain, relevant in practice.

Dermatosis in the Vulva

• Common Types of Lesions:

  • Hypopigmented lesions: Often associated with lichen sclerosus (white lesions).

  • Red lesions: Tend to cause burning and stinging.

• Symptoms:

  • White lesions: More itchy.

  • Red lesions: More burning sensation.

• Treatment Options:

  • Topical steroids (e.g., clobetasol) for lichen sclerosus may be prescribed for 7-10 days.

Vulvar Dermatitis

• Causes: Allergens, irritants, or systemic reactions.

• Common Symptoms: Reddish or hypopigmented patches, itching, irritation.

• Diagnosis and Treatment of Vulvar Dermatitis:

  • Diagnostic Techniques: Patch testing to identify allergens or irritants.

  • Standard Treatments: Use of topical steroids; avoid known irritants.

Vaginal and Vulvar Pain

• Chronic Issues: Many women experience vaginal and lower vulvar pain but often don’t discuss it.

• Role of Sexual Health: Vital for overall quality of life; persistent pain impacts interpersonal relationships.

• Types of Dyspareunia:

  • Superficial Dyspareunia: Pain during penetration potentially linked to structural issues like endometriosis.

  • Deep Dyspareunia: Can be associated with other organ issues such as ovaries or uterus.

• Common Causes:

  • Decreased estrogen levels in new patients, non-opioid medicated patients, or postmenopausal individuals leading to vaginal atrophy.

Inflammatory Conditions

• Types: Infectious vaginitis (e.g., BV, trichomoniasis) and non-infectious vaginitis.

• Symptoms: Itching, burning, chronic inflammation.

• Bacterial Vaginosis: Not a sexually transmitted disease; results from an imbalance in the vaginal flora.

  • Symptoms include fishy odor, especially after intercourse or menstruation.

  • Treatment often involves restoring vaginal pH levels.

Diagnosis and Treatment of Vaginitis

• Infectious Types:

  • Bacterial Vaginosis: Characterized by thin, homogenous discharge, often presents as fishy smell.

  • Fungal Infections: Classic presentation is thick, white discharge with itching.

• Requirements for Diagnosis: Physical examination and appropriate testing—self-diagnosis can lead to misdiagnosis.

Herpes and HPV

• Herpes Simplex Virus (HSV):

  • Symptoms develop within days; involves painful lesions; clinically diagnosed using samples from vesicles.

• Human Papillomavirus (HPV):

  • More common and can lead to cervical cancer; typically asymptomatic; can clear from the body in some individuals.

  • Vaccinations available for prevention; recommended for individuals under age 26.

  • Screening involves primary HPV testing instead of routine Pap smears for younger populations.

Conclusion and Recommendations

• Importance of Clinical Evaluation: Necessary to consider a full sexual history, symptoms, and condition tracking.

• Preventative Measures: Encourage education on pH balance, irritation, and proper care to prevent recurrent issues like BV and yeast infections.