Vulvar Dystrophy

What is vulvar dystrophy?

Vulvar dystrophy is a change in the skin of the vulva. It is a white spot of thick or thin skin on the vulva.

The vulva is the outer part of the female genitals. It includes the mound of tissues over the pelvic bone that becomes covered with hair at puberty. The vulva also includes the outside and inner lips called the labia, and the clitoris (at the top of the inner lips). The vagina opens into the part of the vulva between the lips called the vestibule. The urethra, which empties urine from the bladder, also opens into the vulva.

How does it occur?

Four types of vulvar dystrophy are:

• Squamous cell hyperplasia is an irregular white or gray patch of the skin of the vulva that is slightly raised (thickened).
• Lichen simplex chronicus is a thickened white area usually on just one side of the vulva.
• Lichen sclerosis may cause an area of thin skin in the vulva. It happens mostly during puberty and menopause, but it can occur at any age.
• Lichen planus is a chronic inflammatory skin disease. It can cause symptoms on the skin or in the mouth and sometimes in the vulvar or vaginal area. Severe cases in the genital area can cause painful red areas or sores.

The cause of vulvar dystrophy is often not known. Sometimes irritation of the vulvar skin appears to be a cause, or irritation worsens the symptoms.

What are the symptoms?

Possible symptoms of vulvar dystrophy are:

• itching
• burning
• pain with sex
• white or gray patch of thickened or thin skin on the vulva, sometimes with scaling, cracking, bleeding, or wrinkling
• redness or sores.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine your genital area. Your provider may do a biopsy. If you have a biopsy, your provider will numb the area and take a small sample of skin, which will be then viewed with a microscope.

How is it treated?

If you have squamous cell hyperplasia or lichen simplex chronicus, your healthcare provider may prescribe a steroid cream. You may need to put the cream on the vulvar area a couple of times a day for several weeks.

If you have lichen sclerosis, your provider may prescribe a testosterone cream to put on the area. You may need to use this cream up to 3 times a day for several months. You may then need to continue using the cream less often for the rest of your life. If the testosterone cream does not help or causes undesired side effects, your provider may prescribe a progesterone cream. Clobetasol cream is another medicine that may be prescribed.

Lichen planus may be treated with steroid vaginal medicine or steroid cream. Steroid medicine helps your skin heal and helps prevent scarring.

In addition to using any medicines prescribed, you should try to reduce irritation of your vulva. For example, avoid use of strong or perfumed soaps, lotions, or deodorants in your genital area.

In some cases, if itching continues after treatment you may need shots of alcohol into the problem area. These shots may need to be done every 6 months.

How long will the effects last?

Avoiding irritation of your vulva and using the medicine prescribed by your healthcare provider should help your skin heal and help prevent the problem from occurring again.

If not treated, some types of dystrophy, such as lichen sclerosis, can cause scarring and shrinkage of the inner lips of the vulva. The vaginal opening may become smaller and might even close. Using the medicine prescribed by your healthcare provider will help prevent these problems. The medicine can also help keep the problem from recurring.

How can I take care of myself?

Follow your healthcare provider's directions for using medicine on the area. Continue using the medicine for as long as your provider instructs.

To help relieve irritation and your symptoms:

• Bathe with nonirritating, unscented soap. Rinse your genital area thoroughly but gently. Pat dry without rubbing.
• If you have sores in the genital area, your symptoms may be soothed by soaking in a bath to which you have added aluminum acetate solution (Burrows solution). You may also soak a cloth in Burrows solution and put the moist cloth on the sore area.
• Wear loose-fitting, cotton underwear.
• Keep your genital area dry.
• Do not use strong or perfumed soaps. Do not use feminine hygiene products, such as sprays or powders. Avoid bubble baths and oils.
• Do not use perfumed laundry detergent or fabric softener.
• Do not use tampons or scented toilet paper.
• Avoid using spermicides. Use a different form of birth control.