Skin Disorders of the Vulva

Skin disorders of the vulva may cause significant discomfort and can lead to painful scarring. Although these disorders are easily confused with cancer of the vulva, most are not cancers.

Lichen sclerosus, the most common type of vulvar skin disorder, is characterized by white, shiny patches of parchment-like skin on and around the labia. The patches sometimes extend to the area around the anus. The cause is unknown.

Lichen sclerosus sometimes causes intense itching. However, some women have no symptoms, some have only vague discomfort of the vulva, and still others have discomfort that progressively worsens. The patches of skin affected by lichen sclerosus can bleed easily when scratched or rubbed, making sexual intercourse uncomfortable. Without treatment, the disorder can cause scarring and fusing of the labia, making sexual intercourse impossible. Lichen sclerosus can also cause deep cracks around the anus, resulting in painful bowel movements and bleeding. Skin changes caused by lichen sclerosus may increase the risk of vulvar cancer.

A doctor diagnoses lichen sclerosus by performing a biopsy. Treatment helps prevent disease progression and therefore is recommended regardless of whether the disorder is causing discomfort. A corticosteroid cream applied to the affected areas generally provides relief. Testosterone ointment can also be used. Occasionally, treatment involves retinoid drugs (drugs similar to vitamin A), which help reduce breakdown and damage of connective tissue. Antihistamines may relieve itching but can cause confusion and sedation in older women. Surgery may be necessary if the disorder leads to scarring and fusing of the labia.

Squamous hyperplasia is characterized by discrete, thick, white elevations of skin on the vulva. The cause is unknown. Squamous hyperplasia causes itching limited to the affected skin. A doctor performs a biopsy to make a diagnosis. Treatment involves maintaining good vulvar hygiene and using corticosteroid creams. Squamous hyperplasia does not increase the risk of developing cancer of the vulva.

Other skin disorders affect the vulva but may appear on other areas of the body as well. Lichen planus can cause an itchy rash or scarring ulcers in the mouth, in the vagina, or on the vulva. It is occasionally caused by drugs and is treated with estrogen and corticosteroid creams. Psoriasis and seborrheic dermatitis can affect various parts of the body.

Prevention of skin disorders of the vulva involves good vulvar hygiene, which includes avoiding irritating soaps and perfumes. Periodic self-examination of the vulva is also recommended, as is an annual doctor's examination for detection of skin changes that could signal cancer. Women who are unable to see well enough or who lack the flexibility to examine themselves can ask a spouse, partner, or caregiver to do it for them. Without such help, annual doctor's visits may not catch the progression of skin changes in women with a history of previous abnormalities.