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What are the different types of vulvar dystrophies? >
For many years there has been controversy in naming vulval diseases and this often resulted in several terms being used to describe the same condition. In 1989 the International Society for the Study of Vulval Disease (ISSVD) developed new terminology to better identify these diseases and reduce patient and doctor confusion. This terminology is used in the West London Colposcopy Unit and is listed below.
Vulvar Dystrophies (Classification of Vulvar Non-Neoplastic Epithelial Disorders)

What are the symptoms of benign vulvar disease? >
The commonest early symptoms are itching or a burning sensation in the vulval area.

What is Lichen Sclerosus? >
It is one of the commonest vulval diseases and is sometimes referred to as Lichen sclerosus et atrophicus. It most often occurs on the vulva but other areas of the body may also be affected. It may begin at any age, even in childhood, but it usually occurs in women over the age of 40. In this condition the vulval skin becomes thin, white and fragile. The causes are unknown but there is a recognized familial occurrence and inherited skin hormone enzyme deficiencies may be responsible. It can not be sexually transmitted.

What are the symptoms of Lichen Sclerosus? >
As with other benign vulval disorders early symptoms include itching or burning. Other symptoms may include painful intercourse, splitting of the skin and bleeding. If treatment is delayed the appearance of the vulva may change significantly. In addition to the skin becoming thin and white the small lips (labia minora) may start to shrink and eventually disappear. The clitoris may become buried in shriveling skin folds and the vaginal opening may close completely.

Can Lichen Sclerosus be treated? >
The diagnosis must first be confirmed clinically or by a biopsy and then appropriate therapy can be recommended. Treatment usually involves the use of a topical cream or ointment in addition to general measures for care of the vulva. The most effective therapy utilizes a potent cortisone cream called dermovute which is applied to the disordered skin two times a day then the reduced to once daily once the symptoms under control.

How long will therapy be needed? >
Lichen sclerosus is a life long disease that can be controlled but at the present time there is no cure. A comprehensive treatment routine will control symptoms and in most cases will reverse skin changes. Some form of treatment and surveillance of the vulva will be necessary for the rest of the patient's life.

What is Squamous Cell Hyperplasia >
Squamous cell hyperplasia was formerly call hyperplastic dystrophy. Like Lichen sclerosus it is characterized by the development of very itchy white skin which often appears thickened with an irregular surface contour. However, this condition is not associated with loss of skin folds or shrinkage of the labia unless it is occurring in combination with Lichen sclerosus.

What causes Squamous Cell Hyperplasia? >
It is believed that there are many inciting factors responsible for this condition including infections and skin irritants. However once it becomes established the patient's natural response of scratching may be the most important reason for persistence of the disorder. The so called itch-scratch cycle can thus perpetuate the problem and when entrenched this specific dermatosis is call lichen simplex chronicus

Can Squamous Cell Hyperplasia be treated? >
Therapy for this condition often involves the application of a corticosteroid (steroid) cream. One mild preparation is a cream containing Hydrocortisone 1%. Medium strength medications include Betamethasone valerate 0.1% and Triamcinolone 0.1% (Kenalog). Examples of stronger medications are Fluocinonide 0.05% (Lidex) and the very powerful Clobetasol propionate 0.05%. These medications should always be used in conjunction with general measures which encourage better health of the vulval skin.

Other Dermatoses >
There are a number of other skin conditions that can affect the vulva. These include dermatoses such as psoriasis and lichen planus, allergies, and skin changes secondary to chronic infections with yeast or similar organisms. In each instance a specific diagnosis should be reached. If cells suggestive of pre-cancer or cancer are found the condition is classified as vulvar dysplasia or Vulvar Intraepithelial Neoplasia (VIN), not as dermatoses or dystrophy. VIN could be treated either surgically or with a topical cream.

General Vulval advice.

  1. Following the instructions below will likely help you with your vulval problem. Many vulvar problems are multifactorial, caused often by subtle environmental influences or a unique combination of irritants or allergens. Sometimes the substance that is causing the problem is something you have been using for a long while and it will not be the obvious culprit at first. Please be patient while you are sorting this out. If you have problems, call the Colposcopy unit and the doctor or nurse will be happy to talk to you.
    When you shower or bath do not use soap until the very end and even then do not apply it directly to the vagina or vulva. Dry yourself with a hair drier (set on cool), or pat yourself dry. Do not rub. Alloys use mild soaps when showering.
  2. Do not use nylon underwear or nylon underwear with a cotton gusset. Use all-cotton underwear. Avoid panty liner whenever possible. Avoid tight fitting pants or jeans. Avoid spandex, lycra and other tight fitting clothing during workouts.
  3. Do not use deodorized tampons, feminine deodorant sprays, talk powder coloured soaps, bubble bath, shampoo, vaseline or perfumes in the genital area (this includes specialty shop coloured soaps).
  4. Do not douche unless instructed to do so.
  5. Only use white, non-recycled, non-scented toilet paper.
  6. Whenever possible, do not wear underclothing as this will allow the vulva to be in contact with the air. Do not wear underwear to bed at night.
  7. If the vulva is itchy, take a cold bath (not hot), and then apply Vitamin E cream, aloe-vera gel or diprobase moisturisarordered by your physician.
  8. If itching at night is a problem, your doctor may prescribe a mild antihistamine (Piritone Tablets) or other medication to take at bedtime.
  9. It is best to wash underclothing with a mild soap. Do not use detergents. Do not use bleach or fabric softeners.
  10. During menstruation use tampons or unscented female pads.
  11. Avoid wearing a wet bathing suit for prolonged periods. Change at the pool or beach rather than at home.
  12. If you think you may be reacting to latex condoms, spermacides or other agents, please contact the colposcopy unit.