Vulvar Disorders 

Symptoms in vulvar disorders are itching, also called pruritus, pain and burning. Discharge is sometimes present. 

Evaluation, also called the "workup", begins with a history. Important factors are time frame, diet, sexual exposures, details about bathing, and general medical history including medicines. Examination is important, and we always check for infection. However, many findings such as discoloration, thickening, erosions, ulcers, and fissures are nonspecific. Many times biopsy is indicated in adults. 

Diagnosis is very important since the treatments vary by diagnosis. 

The differential diagnosis (list of possible diagnoses) is large: 

infection (which can be a inciting or aggregating factor) 

atopic dermatitis- which is essentially an allergic reaction of the skin

Lichen sclerosis, planus, and simplex; all varieties of abnormal immune and inflammatory activity in the skin

Psoriasis

Atrophy, as occurs after menopause 

Precancerous or cancerous areas

Vulvar manifestations of other diseases such as inflammatory bowel disease like Crohn's disease.

Treatments vary by diagnosis. 

Estrogen, testosterone, cortisol type steroids, moisiturizers, antibiotics, or immunosupressives may be prescribed. Additionally, lifestyle and general health changes are almost always advised. These include healthier diet, and avoidance of irritants such as soap or detergent. 

It is very important not to self treat for vulvar symptoms since treatments for one condition will make other conditions worse. Call and get help for this vexing condition.