Crohn’s disease of the vulva is a rare manifestation of Crohn’s disease. It usually occurs when the patient has intestinal Crohn’s disease as a complication of that disease, but it can sometimes occur on its own without any bowel disease.
Symptoms
Symptoms of Crohn’s disease of the vulva include:
• Swelling of the labia and/or clitoral hood
• Redness and inflammation
• Cracks in the skin
• Ulcers on the vulva, labia, perineum and inside the vagina
The most common area for ulcers to occur is on the perineum.
Diagnosis
If you haven’t already been diagnosed with Crohn’s disease of the bowels, investigations will be done to see if you have this as most cases of Crohn’s disease of the vulva are driven by disease in the bowel.
A physical examination will be carried out so the doctor can assess your general health and see if there are any other potential causes for your symptoms. He’ll take a full medical history, in addition to checking your pulse, blood pressure, temperature and weight.
You’ll be offered blood tests to check for anaemia (people with Crohn’s often cannot absorb enough nutrients) and to check the level of inflammation in your body.
You may also be asked to provide a stool sample to check for blood in the stools and to rule out worms as a cause of bowel symptoms.
A colonoscopy may be done to look at the condition of your colon and see if there is any inflammation. A small, lighted telescope with a camera on it will be inserted into your rectum and up into the colon.
The telescope is called an endoscope and can be fitted with surgical tools so that a biopsy may be taken. The tissue sample can then be examined for signs of disease.
To look at the inside of the small intestine, the doctor has to perform a barium enema of the small bowel, as the endoscope cannot see into the small intestine. After being given a local anaesthetic spray to numb the area, a tube will be passed up your nose and down your throat.
Barium liquid is then put down the tube to coat the intestines. This makes them show up on X-ray pictures and the doctors will be able to see any inflammation caused by Crohn’s.
If you have ulcers or swelling in the vulval area, you will also be given a vaginal examination and a biopsy make be taken so the tissue can be analysed.
Treatments
Treatments include:
• Strong steroid ointments
• Topical immune-suppressants
• Oral or injectable medication for Crohn’s
• Removal of vulval ulcers followed by supplementary oral zinc sulphate
If there is bowel disease present, surgery to remove diseased bowel tissue may be advised since vulval lesions often do not heal until the bowel symptoms are addressed. However, 50 percent of patients who have sections of bowel removed suffer from unhealed wounds afterwards so it is important to discuss all the pros and cons with your surgeon before a surgical procedure is carried out.
Sources:
Crohn’s Disease of the vulva, British Society for the Study of Vulval Disease. Web. 27th February 2012.
http://bssvd.org/index.php?option=com_content&view=article&id=33:crohns-disease&catid=8:vulval-conditions&Itemid=8
Crohn’s Disease of the Vulva, Journal of the Royal Society of Medicine, Volume 84, April 1991. Full Text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1293193/pdf/jrsocmed00125-0062.pdf
Diagnosing Crohn’s Disease, NHS Choices. Web. 27th February 2012. http://www.nhs.uk/Conditions/Crohns-disease/Pages/Diagnosis.aspx
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.
Reviewed February 27, 2012
by Michele Blacksberg RN
Edited by Jody Smith