Diagnosis and treatment of vulvar dermatoses

Abstract

Vulvar symptoms of pain, dyspareunia, and pruritus are common and may significantly affect a woman's sense of well-being and sexual function. Despite this, vulvar symptoms are often underreported by women. When identified, however, vulvovaginal symptoms should be addressed by health care providers to optimize care. The evaluation of patients with vulvovaginal complaints begins with a thorough history and physical examination. Biopsy is indicated when concern exists for malignancy or the diagnosis is uncertain. Treatment, if possible, should be evidence-based, although for many vulvar disorders including vulvar dermatoses, treatment is based on limited evidence and anecdotal experience. Although many vulvar dermatoses represent chronic conditions and thus cannot be simply cured, control is possible for the majority of women. Patient education regarding vulvar hygiene and skin care is the foundation for optimal management of inflammatory vulvar dermatoses. These conditions may be triggered or worsened by aggressive hygiene. Additionally, patients should be counseled regarding the need for individually tailored long-term maintenance to achieve optimal outcomes.