Problemas vulvares

How are vulval problems diagnosed?

• There are various conditions that can affect your vulva. Some are more serious than others. If you notice a new lump or swelling on your vulva or have any bleeding from around your vulva then you must see a doctor promptly.

• Most conditions that affect your vulva can be diagnosed by examining you. However, it is sometimes necessary for other tests to be undertaken - eg, swabs or a biópsia.

• The symptoms will depend on the underlying condition. Symptoms may range from pain, itching (pruritus vulvae), and finding a lump to noticing a change in appearance of your vulva. See the separate leaflet called Vulvitis.

Playlist: Vulvar Itch

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What is vulvar itch?

Dr Sarah Jarvis MBE, FRCGP

00:55

What is vulvar itch?

Dr. Sarah Jarvis MBE, FRCGP

01:19

How do you stop vulvar itch?

Dr. Sarah Jarvis MBE, FRCGP

Infecções

• Candidíase (yeast infection).

• Genital herpes infection.

• Verrugas genitais.

• Catapora.

• Other infections: these include sarna e piolhos pubianos.

Skin conditions

• In babies and toddlers wearing nappies, assadura de fralda can occur and be very irritating and distressing. Nappy rash can lead to the skin of the vulva and the area round the back passage (anus) becoming bright red and very sore.

• Any skin condition can affect the vulval area too - eg, eczema, psoríase, líquen plano e líquen escleroso.

• Vulval intraepithelial neoplasia (VIN). This is confiar vulval cancer but it is a pre-cancerous condition, as VIN (after several years) may develop into vulval cancer in some women.

Lumps in the vulva

• Some infections such as genital herpes and sífilis can cause lumps.

• Cisto ou abscesso de Bartholin.

• Cancer of the vulva.

Infecções

• Candidíase is usually treated with clotrimazole cream from the pharmacy, or sometimes a fluconazole oral tablet. Usually only a short course is required but occasionally longer courses are needed.

• Herpes genital is treated with aciclovir tablets. You can also soothe the symptoms by bathing in salt water, taking over-the-counter painkillers and drinking more water to dilute your urine. Petroleum jelly or local anesthetic ointments can also be helpful.

• Verrugas genitais are usually treated at sexual health clinics, often with a self-applied topical treatment such as podophyllotoxin, imiquimod or sinecatechins. However in 30% of people they will disappear with no treatment. People with suppressed immune systems and pregnant women may require different treatments.

• Catapora affecting the genital area can be itchy or sore and this can be alleviated by paracetamol, calamine lotion or antihistamines such as chlorphenamine.

• Sarna e piolhos pubianos are treated with permethrin cream or malathion lotion. The itching from scabies can continue for up to four weeks after treatment.

Skin conditions

• Assadura de fralda is mostly treated by measures such as frequent nappy changes, cleaning with water or non-fragranced wipes, patting rather than rubbing dry, and avoiding irritants such as talcum powder and bubble bath/soap. Barrier creams such as white soft paraffin, Metanium® and Bepanthen® help protect the skin. Occasionally, antifungal and steroid creams are needed if the rash is severe and simple measures are not helping.

• Eczema, psoriasis e lichen planus of the vulva are treated very similarly to other parts of the body, with emollients (moisturising creams/ointments) and steroid creams, as well as other more specialised creams in some cases.

• Líquen escleroso is treated with emollients and stronger steroid creams/ointments

• Vulval intraepithelial neoplasia (VIN) is usually treated with a small operation to remove the affected area.

Nódulos

• Bartholin's cyst/abscess often requires antibiotics and sometimes surgical removal.

• Cancer of the vulva requires treatment by specialist gynaecologists/oncologists and can involve surgery, chemotherapy and radiotherapy.

Vulval skin is very sensitive so it is important to avoid anything that may irritate it. Soap can dry the skin so soap substitutes are preferred - for example, Doublebase® or E45 wash®. Only clean the vulval area once per day as too much washing can make symptoms worse. Showering is preferred to baths but if you do bath, avoid adding bubble bath. Avoid using flannels. Pat gently dry afterwards.

Sanitary towels/panty liners and coloured toilet paper can cause irritation. Avoid tight-fitting underwear/clothing and synthetic materials - cotton is best. Fabric conditioners and biological washing powders can also irritate.

Using an emollient/moisturiser can help protect the skin, especially if it is dry. Various types are available over the counter.