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Common vulval symptoms include soreness, itching, discharge, pain, burning, swellings and bleeding.
Vulval conditions include:
Thrush is a common vulval infection and is caused by a yeast, usually Candida. Predisposing factors include antibiotic usage, diabetes, pregnancy and the Pill. The typical symptoms are vulval soreness, itching and a thick white non-offensive vaginal discharge. It is reasonable for women who suspect that they have thrush to get some treatment from the Chemists who can sell a Canestan pessary or Fluconazole (Diflucan) tablet without a prescription. If this is ineffective or the symptoms recur within a short time, women should see their GP so that the correct diagnosis can be confirmed.
Some women have recurrent thrush and may benefit from a longer course of treatment. Diabetes should be excluded in these women and they need to pay attention to good vulval hygiene.
Vulval absces - Abscesses are fairly common in the vulval area. A Bartholin's abscess is a particular type that arises from Bartholin's gland. This pair of glands sit either side of the vaginal entrance (towards the back) and secrete a lubricating liquid through a duct. Blockage of the duct lead to collection of the fluid (calleda Bartholin's cyst which can be uncomfortable but isn't painful. When a cyst gets infected, an abscess results and this is very painful indeed. In its early stages an abscess may respond to antibiotics, but most women will need surgery to drain the abscess. Surgery usually aims to provide a pathway for the gland to drain its fluid in the future - a technique known as marsupialisation.
Lichen Sclerosus - This chronic skin condition is more common in the elderly. Itching and soreness are common and intercourse can be painful or impossible due to narrowing of the vaginal entrance. The symptoms often spread around the anal area. The skin usually has a whitened appearance (Leucoplakia). The diagnosis can usually be made from the appearances alone but sometimes it is necessary to take a biopsy. Treatment is with steroid ointments and the relief of symptoms is often dramatic in women who have often put up with the condition for along time before seeking medical help.
Hypo-oestrogenic atrophy - Often called atrophic vaginitis, this condition is due to the lack of oestrogen after the menopause. Soreness and painful intercourse are common feature. Bleeding may also occur, especially if intercourse is attempted as similar skin changes are usually found in the vagina. The daignosis is usually made on the basis of the appearance and by excluding infections with a swab test. Treatment is with oestrogen which can be used either as a vaginal tablet/cream or systemically to treat the whole body. Where a woman's symptoms are confined to the vulval/vagina, it makes sense to to local applied oestrogen. However, some of this will be absorbed by the body and it should only be given to women with a history of breast cancer with caution.
General skin conditions
General skin conditions - The vulva consists of skin like the rest of the body and can be affected by general skin conditions such as eczema and psoriasis. Usually there will be clues as to the diagnosis elsewhere on the skin.
Benign lumps, bumps and cysts
These are common and it is usually easy for a doctor to provide reassurance that they are not cancerous by simply inspecting lump. Women may want the lump removed because of discomfort or because it is unsightly. Surgical excision is usually performed under local anaesthesia.
Vulvodynia is a strange condition of unknown cause. The typical symptom is vulval burning. Bladder symptoms can co-exist. The vulval appearances are entirely normal. The condition is often chronic with symptoms that come and go. It can be treated with topical local anaesthetic creams. A low dose of an antidepressant called Amitriptyline is often effective - the drug is used not for its effects on depression, but on its effect on the nerve pathways that mediate pain. Treatment is not always successful and many women must learn to live with their symptoms which will come and go.
This typically affects older women. It typically causes a lump that is itchy and sore and which may bleed. The diagnosis is usually obvious to a gynaecologist who would recommend that a biopsy is taken to confirm the diagnosis. Treatment is by surgical excision which may also involve removing the lymph nodes in the groin.
VIN (Vulval Intra-epithelial Neoplasia) is the precancerous form of vulval cancer. It typically causes soreness, itching and may bleed. The skin is often reddened and irregular. If your doctor suspects VIN, a biopsy will be recommended. Treatment may involve observation, creams or surgery depending on the type, position and extent of the changes.