Vulval Disorders - Causes and Treatments

As gynaecologists we see many vulval conditions that can be resolved, treated and managed effectively. What follows is a list of commonly presenting vulval disorders we treat within our Adelaide practice. Please never be embarrassed to ask questions, or have your concerns addressed. As female gynaecologists, woman-centered care is our second nature.

Lichen Sclerosis

What is Lichen Sclerosis?

Lichen Sclerosis (LS) is an inflammatory condition involving the skin of the vulva and around the anus. It can cause itchiness, skin splitting and pain. LS usually has a white appearance and can lead to changes in vulval skin structures - including narrowing of the vaginal opening.

Diagnosing and treating LS is important. If untreated, it can lead to the vaginal opening becoming small and sexual intercourse becoming painful. It also carries a lifetime risk of 2-6% of developing vulval cancer. Diagnosis, treatment, and regular monitoring with a gynaecologist are of utmost importance.

What causes Lichen Sclerosis?

The cause remains unknown, but it is thought to be an autoimmune condition which means your immune system attacks your own body. It can also run in families. LS affects approximately 1 in 80 women and is more commonly diagnosed in middle-aged and elderly women.

How is Lichen Sclerosis diagnosed?

Your doctor can diagnose Lichen Sclerosis by looking at your vulva. A vulval biopsy is usually done in adults to confirm the diagnosis and to check that no cancer cells have formed.

How is a vulval biopsy performed?

The idea of a vulval biopsy can sound scary. Don’t worry, it’s not as painful as it sounds. Your doctor will gently inject some local anaesthetic, this stings for a couple of seconds and then the skin will go numb. A punch biopsy is then performed, which involves taking a very small sample of skin (usually 3-4mm diameter). A stitch is then usually placed to stop any bleeding and help the area heal faster. The specimen is sent for evaluation and usually takes about 2 weeks for results to be available. It’s important to keep the area clean and dry afterwards.

How is Lichen Sclerosis treated?

There is no cure for Lichen Sclerosis, but it can be well managed so that your symptoms are lessened and you can live comfortably with it. Your doctor will prescribe a cortisone-based cream to be applied sparingly to the affected areas. Regular checkups are important at this stage to monitor progress and response. Steroid cream is safe to use in the long term and will help prevent scarring and reduce the risk of possible cancer. If you have gone through menopause, some vaginal oestrogen cream or pessaries may also help.

In rare circumstances, surgery may be necessary to remove cancerous or pre-cancerous skin. Surgery can also remove scarring or adhesions that cover the entrance to your vagina.

Yearly checks are recommended to monitor for complications such as vulval scarring or cancer. If you develop any areas of ulceration or any lumps please seek an earlier review.

Can I have sex if I have Lichen Sclerosis?

Once your symptoms are under control it is safe to have sex again. If you have any discomfort or pain please speak with your doctor. Dilators to help open the vagina and exercises that relax the muscles in your pelvis can help.

Vulvodynia

What is vulvodynia?

The term ‘vulvodynia’ simply means vulval pain. The pain can be described as burning, stabbing, stinging, pins and needles, or an itch. The pain can often get worse with movement.

What causes vulval pain?

• Skin conditions such as dermatitis, psoriasis, lichen sclerosis and lichen planus

• Vaginal and vulval infections such as thrush, genital herpes, bacterial vaginosis, chlamydia, gonorrhoea, syphilis

• Allergic reaction to something applied to the vulva or medication taken

• Urinary tract infections

• Referred pain from a back or hip injury

• Nerve disease or damage

• Pelvic floor muscle spasm

What treatment is available for vulval pain?

Treatment depends on the cause of the pain. Treatment of skin conditions or infections if identified may lead to a full recovery. Physiotherapy and medication may be helpful. Counselling from a psychologist may also be beneficial. Treatment can take weeks or months to start taking effect, therefore it is important to persevere with therapy and stay in regular contact with your team looking after you.

What about pelvic floor muscle spasm?

Pelvic floor muscle spasm or vaginismus can result from inflammation, infection, or psychological stress.  It is a protective reflex that your body is doing to stop harm. It is important to identify and treat any antecedent factors. A pelvic floor physiotherapist can help you overcome symptoms with relaxation exercises.

If the pelvic floor muscles are in spasm from ongoing pelvic inflammation, then Botox injections may help. These injections usually last 3-6 months and can be expensive. 

Our female gynaecologists will listen attentively and with compassion, and provide comprehensive treatment options.

Bacterial Vaginosis (BV)

What is BV?

BV is a common cause of abnormal discharge that can be associated with an unusual smell. The discharge can cause inflammation and pain in the vulva. The cause of BV is not fully known but can be associated with changes in vaginal bacteria.  

How is BV treated?

A swab of the vagina is usually taken to check for bacterial overgrowth. Antibiotics work in 70-90% of cases; however, the rate of recurrence is high (60% over six months). Treating BV in pregnancy is recommended as it can be associated with preterm birth and pregnancy loss. BV can also be associated with sexually transmitted infections and pelvic inflammatory disease. If you are diagnosed with BV your doctor will discuss some other potential screening also.

Vaginal Thrush

What is vaginal thrush?

Thrush or candidiasis is a fungal infection that is very common. It occurs in approximately 70% of women at some stage in their life. Thrush can cause vaginal and vulval pain with associated itchiness, redness and a white discharge.

What causes vaginal thrush?

A vaginal swab can confirm a fungal infection, most commonly called Candida Albicans. There are occasionally other strains of Candida that can cause thrush too. They all respond to anti-fungal therapy. Thrush can be associated with recent antibiotic use, a suppressed immune system or diabetes.

What is the treatment?

Anti-fungal therapy is the mainstay of treatment and this can be as a capsule, cream or vaginal pessary. These can be purchased from the chemist and no script is necessary. Following a good vulval care routine is also very important for symptom relief and preventing recurrence.

If thrush is recurrent, treatment may need to continue for months. For resistant cases of thrush, boric acid capsules may be beneficial also. There is no evidence to recommend using probiotics to treat or prevent thrush; it also doesn’t cause harm. 

We look forward to treating you with care and sensitivity at your next gynaecology appointment. You will find our entire team warm, empathetic, and incredibly knowledgeable.