According to the American Congress of Obstetricians and Gynecologists educational resources, vulvar dystrophy is the growth of abnormal skin on the vulva. The vulvar skin can be too thin, too thick (hyperplasia), or a mixture of both. There are several types of vulvar dystrophy. Two common types include:
- Squamous cell hyperplasia - an irregular white or gray patch of the skin on the vulva that may be slightly raised
- Lichen simplex chronicus - a thickened white area usually on just one side of the vulva
When the skin becomes too thick, it may appear wrinkled and the vaginal opening may shrink. When thickened it may also appear hard. The exact cause of vulvar dystrophy is not known; however, it may be associated with a prior irritation or inflammatory response.
The symptoms of vulvar dystrophy include: redness or whiteness, itching, and burning in the vulvar region. Some women complain of painful intercourse also known as dyspareunia.
For lichen simplex chronicus (LSC), the vulvar skin may appear to be thickened, white or grey and is usually located only on one side of the vulva. The vulva may also scale, crack and bleed at touch or penetration. It may also have sores.
A diagnosis of vulvar dystrophy can be made with a careful review of a patient's history and a physical examination. It is important to report all symptoms to your health care professional so that he or she can better understand the history of the symptoms.
With lichen simplex chronicus, the patient will report intense itchiness and relief upon scratching; recurrent itchiness does occur however. The skin will become red, thickened, and may exhibit erosion, fissures or have loss of hair in the genital area. Vaginal infections may occur in addition to these conditions so it is also important to rule out vaginitis.
It may be necessary to complete a vulvar biopsy to get a definitive diagnosis. During a biopsy, a small amount of vulvar tissue is removed and sent for pathological evaluation. A numbing medication is used and placed in the area of concern before the biopsy is performed. A specialized health care professional analyzes the biopsy and determines its diagnosis.
Vulvar dystrophy requires long-term treatment with creams or ointments that are rubbed into the vulvar tissue. If you have squamous cell hyperplasia or lichen simplex chronicus, your health care professional may prescribe a high potency topical corticosteroid cream that is put on the vulvar area a couple of times a day for several weeks. The cream should be rubbed into the genital area for approximately 2 minutes.
It is important to remove all irritants or allergens. Sitz baths may be helpful as well. Good vulvar hygiene is also helpful to minimize symptoms.
Medications like amitriptyline (10-50mg) may be helpful at night to prevent sleep itchiness. Ice may soothe the area as well. Dr Andrew Goldstein, a world expert and vulvar specialist, has researched the use of pimecrolimus, instead of corticosteroid, for lichen simplex chronicus.
It is advisable to seek out a vulvar specialist who is experienced in vulvar disease, vulvoscopy and the new treatments of vulvar dystrophy. A vulvar specialist may be located at The National Vulvodynia Association (NVA- www.nva.org). This organization has a comprehensive data base of health care providers who treat vulvar conditions including vulvar dystrophy. It provides web addresses and additional information concerning specialty, type of practice and number of cases seen on a monthly basis. It can be searched by geographical area as well.
The International Society for the Study of Vulvovaginal Disease (www.issvd.org) may also be an excellent resource for up-to-date information, research and providers who specialize in vulvovaginal disorders.
If you are suffering from sexual complaints associated or caused by vulvar dystrophy, a good therapist or counselor who specializes in sexual pain may be located at the International Society for the Study of Women’s Sexual Health (www.isswsh.org) or American Association of Sexual Educators, Counselors and Therapists (www.aasect.org). The International Society for Sexual Medicine (www.issm.info) and the European Society for Sexual Medicine (www.essm.org) are also excellent resources.