Vulval disease

The vulva is the female external genitalia. The vagina, urethra, labia majora and labia minora and so on. For the purpose of talking about vulval disease we include the perineum – the area between the vagina and rectum – and the mons pubis. Vulval disease is thus that series of illnesses, infections and conditions that affect this area of the body.

A number of conditions can affect this area, most obviously sexually transmitted disease and cancers, but these are not normally what we consider to be part of vulval disease management or treatment. They have specific causes and are treated as the specific conditions or problems that they are. There are lesser known problems like a Bartholin gland blockage. The specific treatment here is well known and is the drainage of that gland.

Most of these specific problems with their known and curable causes will be identified and dealt with by a GP or gynaecologist. Vulval disease, or vulval pain management, is best thought of as the stage beyond that. When the obvious causes of vulval pain have been dealt with and yet the pain remains.

Vulval pain can be significant and life changing. There can be obvious problems with sex and intimacy as a result. Such interference with relationships is a serious restriction upon life. When there is no obvious physical cause of vulval pain there can be a tendency to just insist it's one of those things.

Acute problems are something that the standard and traditional medical system deals with well. Chronic conditions sometimes less so which is why vulval pain that persists even after examination for direct causes is worth continuing to investigate.

Sometimes the cause of vulval plain cannot be cured, but it can be managed. This requires the specialist vulval disease investigation. To check that no acute conditions are present, to see which of the possible chronic ones are and then to recommend how they be managed.

An important part of this is the physical demonstration of exactly how the appropriate treatments are to be applied.

 There are those direct and obvious causes of vulval problems which need to be treated. The concern is that these are not all of the instances when further investigation might be desired. Pain and itching that has no clear cause still needs to be investigated and treated. Even when a reason cannot be found, management and reduction of the symptoms can be done and needs to be done.

Treatment of vulval disease needs to be done when any symptom interferes with the living of life. It is the presence of the symptom, from itching to pain, that requires the investigation. There might, for example, be vulval pain on intercourse. Or a more general itching in the area. It is the existence of even discomfort that is to be investigated.

The course of the treatment is the investigatory and diagnostic pathway to discovering the cause of the symptom. Each possible reason can be investigated and accepted and treated as required. Thrush  will be dealt with in one manner, lichen sclerosus another and so on until all of the directly treatable causes are eliminated.

Even when the end result is simply non-specific vulval pain then still management is possible. The aim of the whole process is to identify why and even if that cannot be done then to reduce and minimise symptoms to enhance life.

It is the pathway of investigation that is the first part of the treatment. As candidate causes are considered the direct cause of pain and or itching can be either treated or discarded as a contributor.

The first stage is often to isolate the position of the pain. This can be done with a cotton bud pressed to the possibly affected part.  

Treatment then branches out dependent upon what is identified as the cause. A speculum test can be done for lichen planus. Observation and the cotton bud test can identify lichen sclerosus. That can be associated with vaginal cancer, so that can be treated.

Thrush is tested for and that is then amenable to direct intervention. Swab tests can be done to check for infections, a vulval skin biopsy will aid in other diagnoses. Some symptoms are associated with menopause and hormonal changes – those again can be considered directly.

The specific treatment will depend upon the specific cause. Sometimes this will be surgical intervention as with pre-cancerous lesions or blocked glands. Sometimes antibiotics to treat an infection will be recommended. Some to most of these directly attributable symptoms and causes will be noted and treated by a GP or gynaecologist.

Vulval disease and treatment is often considered to be when that has not worked and the pain and discomfort remain. The treatment is really the identification of the cause and then management of those symptoms.

Dependent upon the diagnosis, treatment itself might be a change in hygiene habits. Perfumed and scented soaps can, in the susceptible, cause problems. Douches can be contraindicated for some yeast infections such as thrush.

Vulval disease can be considered as a collection of symptoms, the treatment is the investigation. Some causes will yield to direct intervention, others to changes in habit. Even in cases of non-specific discomfort management and reduction of the symptoms is possible.

The recovery time for any one specific treatment or management technique for vulval disease or vulval pain management will depend upon that specific treatment or technique.

There are few vulval pain treatments that are surgical or invasive. So recovery in that sense is not really an issue. It would not be usual to have a general anaesthetic for a vulval pain procedure and so on.

There is another sense of recovery time that is important concerning vulval pain.

The treatment is really the investigative process of why the pain is occurring. This in itself can take time as options for the causes are ruled out.

Then it is, sadly, true that treatment and or pain management processes can take time to have an effect.

Recovery from the vulval pain or vulval disease may take time, that is. Recovery time from vulval pain procedures is not the issue, recovery time from vulval pain itself might be.         

The issues with vulval pain or vulval disease that might require active intervention or surgery are likely to be caught and dealt with by your GP and or gynaecologist.

This is where the risks might lie, in such treatments. The issue then becomes one of working out what is still causing what vulval pain might remain.

Or that has not had that direct cause amenable to such intervention identified.

This stage of the vulval disease treatment process is therefore investigatory.

It is a pathway to working out what is the cause and how it can and should be managed at least, if not treated.

There is little to no risk in this process.