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Managing common vulvar skin conditions.

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Managing common vulvar skin conditions

The vulva is subject to a range of skin problems, many of them inadvertently self-inflicted.

You may routinely pamper your face and work hard to keep it moisturized and irritation-free, but what have you done lately for the more sensitive skin of your vulva, the external genital area surrounding your vagina?

Many women have been primed to think no further than "itch equals yeast infection." But with age and the decline in estrogen after menopause, we become more prone to a variety of conditions that irritate vulvar skin. These conditions aren't getting the medical attention they need * and women aren't getting the relief they deserve.

"The differential diagnosis of vulvar problems is as complicated as for headache, chest pain, or diarrhea. There are many, many causes," says Elizabeth G. Stewart, M.D., assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and director of the vulvovaginal service at Harvard Vanguard Medical Associates.

Anatomy of the vulva

The vulva (Latin for womb or covering) consists of several layers that cover and protect the sexual organs and urinary opening. The fleshy outer lips of the vulva * the labia majora * are covered with pubic hair and contain fat that helps cushion the area. Inside the labia majora are the thinner, more pigmented and delicate flaps of skin called the labia minora. The labia minora join at the top to enclose the clitoris. The labia majora, labia minora, and clitoris are made up of erectile tissue, that is, tissue that can become engorged with blood. The area between the labia minora, the vestibule, contains the openings to the urethra and the vagina, as well as the Bartholin's glands, which are located on either side of the vaginal opening and produce lubricant for the vestibule. The flesh between the vaginal opening and the anus (not part of the vulva but often involved in vulvar skin problems) is the perineum. This is where the incision called an episiotomy is sometimes made during childbirth.

Getting a diagnosis

Vulvar skin conditions are highly treatable, but the treatment depends on the specific cause. Few physicians specialize in vulvar problems, and few medical schools provide much training in this field. If your primary care physician can't help, call the gynecology or dermatology department of the nearest...

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