Feature Article

Vulval disease. Part 3: patients with a rash, a lesion, or other symptoms, alone

Gayle Fischer, Jennifer Bradford
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Vulval conditions may present with a rash but no other symptoms or with symptoms but no significant rash. Causes of the former include tumours, cysts and warts; causes of the latter include referred and neuropathic pain and atrophic vaginitis.

Key Points

  • Causes of a vulval rash or lesion in the absence of other symptoms include VIN III, lichen sclerosus, melanosis vulvae, benign and malignant tumours, molluscum contagiosum, cysts and warts.
  • Any lesion suspected of being a melanoma or squamous or basal cell carcinoma should be biopsied.
  • A patient with vulvitis but without macroscopic warts should not be assumed to have symptoms attributable to the human papilloma virus – this concept has been disproven.
  • Vulval pain, burning and/or unexplained dyspareunia may be due to atrophic vaginitis, referred pain, neuropathic pain, psychogenic pain, vestibular hypersensitivity and/or vulval varices.
  • Symptoms due to vaginal atophy should respond to topical oestrogen therapy within one month; if not, seek another cause.
  • Vestibular hypersensitivity does not respond to medical management; biofeedback using pelvic floor exercises is the treatment of choice.