There are many different conditions that can affect your vulva, ranging from mild infections to skin conditions and, very rarely, to cancer. They can all cause very different symptoms, including itching, bleeding, rashes or a lump. It is very important that if you notice any new symptoms or lumps in your vulval region then you see a doctor promptly. Your doctor will be able to examine you and decide which treatment will be appropriate to you. This will depend on the underlying cause of your symptoms.

Some vulva conditions include:

  • VIN (covered in precancerous colposcopy section)
  • Lichen sclerosus
  • Lichen planus
  • Lichen simplex chronicus

Most conditions that affect your vulva can be diagnosed by examining you. This is usually done with the aid of a microscope called the colposcope. However, it is sometimes necessary for other tests to be undertaken.

  • Internal swabs may be taken – A swab is a small ball of cotton wool on the end of a thin stick.  It can be gently rubbed in various places to obtain samples.
  • A biopsy may be carried out – In this procedure, a small sample of tissue is taken from a lump. The sample can then be examined under a microscope in the laboratory.

Lichen sclerosus
Most cases of lichen sclerosus are in postmenopausal women, although it can occur in prepubescent girls and young women. It can be familial and may affect the male prepuce too.

The risk of developing invasive disease is around 4%.

There is an association with other autoimmune diseases, usually a thyroid disorder.

Lichen sclerosus may present with pruritus vulvae, vulvodynia, superficial dyspareunia, or visible lesions. It has an appearance called ‘cigarette paper’ skin as it is thin, white, and crinkly. The introitus may shrink with fusion of the labia minora. Treatment is with potent topical corticosteroids.

Lichen planus causes painful erosive vulvitis. It usually affects women over the age of 45 There is intense redness, swelling and superficial ulceration. It leads to scarring and introital narrowing resembling chronic lichen sclerosus.

Biopsy will distinguish it from other ulcerative disorders, including pemphigus, pemphigoid and erythema multiforme.

Treatment is with potent topical steroids