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Introduction Description: Vulvar vestibulitis (provoked vulvodynia) is an uncommon syndrome of intense sensitivity of the skin of the posterior vaginal introitus and vulvar vestibule, with progressive worsening, leading to loss of function. Provoked pain in other areas of the vulva is possible, but much less common. Vestibulitis is one possible cause of the broader syndrome of chronic vulvar pain, vulvodynia. Unlike undifferentiated vulvodynia, vestibulitis causes pain…

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Introduction Description: Vulvar hematoma is the swelling of one or both labia because of interstitial bleeding, most often after blunt trauma. Predominant Age: Most common in childhood and teen years but may occur at any age. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Blunt trauma (straddle injury, sexual abuse, rape, water skiing), vaginal surgery or delivery, varicose veins of vulva. Risk Factors: Sports activities; uncommonly,…

Introduction Description: Squamous cell cancer of the vulva generally manifests as an exophytic ulcer or hyperkeratotic plaque. It may arise as a solitary lesion or develop hidden within hypertrophic or other vulvar skin changes, making diagnosis difficult and often delayed. Other malignancies (25%) such as sarcoma, melanoma, clitoral malignancy, and metastatic malignancies can also affect the vulva. Prevalence: Roughly 6330 new cases of and 1560 deaths…

Introduction Description: Lichen sclerosus is a chronic condition of the vulvar skin that is characterized by thinning, distinctive skin changes, and inflammation. It is non-neoplastic and involves glabrous skin and the vulva. The term lichen sclerosus et atrophicus has been dropped because the epithelium is metabolically active and not atrophic. At one time, the condition was also referred to as kraurosis vulvae. Prevalence: Common. Predominant Age:…

Introduction Description: Lichen planus is a non-neoplastic epithelial disorder that affects glabrous skin, hair-bearing skin and scalp, nails, mucous membranes, or the oral cavity and vulva. Prevalence: Unknown, but relatively common. Estimated to affect 0.5%–2% of the population. Predominant Age: 30–60 years; peak age 50–60 years. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Unknown. Proposed—autoimmune disorder, possibly initiated by certain drugs such as β-blockers and…

Introduction Description: Labial adhesions (synechia vulvae) are agglutination of the labial folds that result in fusion in the midline. Prevalence: 1%–2% of female children. Predominant Age: Peak is 2–6 years; may be found at any age up to puberty. May also occur in postmenopausal women with significant vulvar atrophy or lichen sclerosus. May also occur as a complication of cosmetic vaginal or vulvar procedures. Genetics: No…

Introduction Description: An imperforate hymen is the most commonly encountered anomaly that results from abnormalities in the development or canalization of the müllerian ducts. Prevalence: Uncommon. Thought to be 1/5000 live-born females. Predominant Age: Generally not diagnosed until puberty; occasionally diagnosed soon after birth (mucocolpos). Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Failure of the endoderm of the urogenital sinus and the epithelium of the…

Introduction Description: Hypertrophic vulvar dystrophy (lichen simplex chronicus) is a thickening of the vulvar skin over the labia majora, outer aspects of the labia minora, and clitoral areas. Eczematous inflammation or hyperkeratosis may be present. Prevalence: Common, 40%–45% of non-neoplastic epithelial disorders. Predominant Age: Middle to late reproductive age and older. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Unknown. Dermal reaction to chronic itch-scratch cycle.…

Introduction Description: Hymenal stenosis is the thickening or narrowing of the hymenal opening, resulting in difficulty with tampon use and intercourse. Prevalence: Uncommon. Predominant Age: Congenital, although generally diagnosed in the early reproductive years. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Congenital narrowing of the hymen or scarring after trauma or surgery (eg, previous excision, trauma). Risk Factors: Introital surgery (for iatrogenic cases). Signs and…

Introduction Description: A collection of symptoms and changes that occur in the female reproductive tract due to a lack of estrogen. Previously known as vulvovaginal atrophy, urogenital atrophy, or atrophic vaginitis. Prevalence: Occurs to some extent in 100% of postmenopausal women who do not undergo estrogen therapy; roughly 10%–40% will experience one or more symptoms of vaginal atrophy (eg, vaginal dryness affects up to 85% of…

Introduction Description: Female circumcision is the removal of part or all of the external genitalia, including the labia majora, labia minora, clitoris, or all three. Female circumcision (female genital mutilation, infibulation, genital mutilation) is generally performed as a ritual process, often without the benefit of anesthesia and frequently under unsterile conditions. The resulting scarring may preclude intromission. The amount and location of tissue removed determine the…

Introduction Description: Pain that occurs with sexual penetration is insertional dyspareunia. This may be in the form of mild discomfort that may be tolerated, pain that completely prevents intromission, or any level of pain in between. In severe cases, pain may lead to severe vaginal spasms that prevent penetration (vaginismus). Prevalence: Approximately 15% of women each year (severe, <2% of women). Predominant Age: Reproductive age and…

Introduction Description: Contact vulvitis is characterized by vulvar irritation caused by contact with an irritant or allergen. Prevalence: Relatively common. Contact dermatitis accounts for roughly half of cases of vulvar itching. Predominant Age: Any, but most common in reproductive and menopausal years. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Irritants may be primary or immunologic in character. The list of potential irritants can be extensive,…

Introduction Description: A chronic cystic dilation of the Bartholin gland and duct, generally secondary to past infection. Prevalence: 2% of adult women develop infection or enlargement of one or both Bartholin glands. Predominant Age: Of all Bartholin gland cysts, 85% occur during the reproductive years (peak, 20–29 years). Occurrence after the age of 40 years is rare and should raise concerns about malignancy. Abscesses are almost…

Introduction Description: An infection may occur in one or both Bartholin glands, resulting in swelling and/or abscess formation. Usually, the process is unilateral and marked by pain and swelling. Systemic symptoms are minimal except in advanced cases. Prevalence: 2% of adult women develop infection or enlargement of one or both Bartholin glands. Abscesses are almost three times more common than cysts. Predominant Age: Of all Bartholin…

Introduction Description: In general, vulvar ulcers are deep defects through the epidermis into the dermis that generally heal with scarring; they are deeper than erosions. They may be of infectious or noninfectious origin. Acute aphthous ulcers (acute genital ulceration, Lipschütz ulcers [named for Benjamin Lipschütz, who first described it in October, 1912], non-sexually acquired genital ulceration [NSAGU], and vulvar aphthae) are like the more common oral…

Introduction Description: Acne inversa (formerly hidradenitis suppurativa, Verneuil disease) is a chronic, unrelenting, refractory infection of the skin and subcutaneous tissue that is initiated by the obstruction and subsequent inflammation of follicles and apocrine glands, with resultant sinus and abscess formation. This process may involve the axilla, vulva, and perineum. Prevalence: Uncommon. Four to five times more common in females than in males. It is reported…

The Challenge Description: Excess body weight results in adverse medical, social, economic, and personal outcomes. Women’s healthcare providers are frequently the first point of care to identify, counsel, and assist women in achieving a more appropriate body weight. Scope of the Problem: Obesity is the most common medical condition in women of reproductive age. Roughly 42% of women are obese or very obese. This proportion rises…