Husbands and fathers - as well as women and mothers need to learn more about vulva health, to provide the care and support the special women in their lives may need. Husbands and fathers have a unique role in providing the healthcare and knowledge, especially those single dad's that have young daughters.  

Vulva health is an area that is related to the health and care of the vulva. Many men and women are afraid to use the term "vulva" due to its' technical, and medical sound, and most simply prefer to call the vulva a "vagina."  Yet that would be incorrect.  The vagina is just one part of the vulva. Nobody, with the exception of a doctor, can see a woman's vagina, and only he/she can see a woman's vagina by looking into the vagina, using a special instrument called a speculum.  

It's time to begin calling a "spade a spade."  When mother's and fathers are bathing, or toilet training their daughters, they should explain that the vulva, which is on the outside, has several parts, and that her vagina, is on the inside.   

What is/are Vulvar Diseases?

Vulvodynia-chronic vulva discomfort, vulvar vestibulitis, dysesthetic vulvodynia

Vulvar dystrophy-broad term to describe various epithelial changes.  In 1987-ISSVD International Society Studies of Vulvar disease found the following symptoms; a. nonneoplastic.  b.intraepithelial neoplasms - spuamous cell CIS c. nonsquamous intraepithelial neoplasia

LESIONS AND DISEASES

HSV

Women with HSV reports flu like symptoms, pain, itching, UTI symptoms, vaginal discharge, sores on labia, anus, perineum, buttocks, thighs, dyspareunia Vesicles, ulcers, pustules, tender adenopathy, 70% will have lesion in vagina

Syphilis

Women with syphilis report painless sores in vulvovaginal area.  Primary - red, round, firm ulcer with granular base with well-formed edges. Secondary- moist, mucus lesions which resemble herpes. Moist cutaneous lesions called condyloma lata, appear flat and gray. Adenopathy, maculopapular rash.

Condyloma Acuminata

Women with CA report new bump: itching, generalized pruritus, last pap.  Warty, flesh colored, sharp and pointed, cauliflower, + acetowhite

Candidiasis

Women with candidiasis report burning, itching, discharge, dyspareunia, vulvar edema, h/o diabetes, high carbohydrate diet, use of AB, frequent intercourse, h/o steroids, HIV.

Bartholin's Gland Infection

Women with barthloin's gland infections eportr unilateral bump. Reports active sex, recent trauma, new sexual partner leading to infections, fever, complaints of pain with intercourse, warmth, tender to touch, difficulty walking, sitting. H/O Crohn’s disease.

Contact Dermatitis

Women with contact dermatitis report vulvovaginal itching, rash, and increased incidence when wearing tight pants.  The vulva skin is red, inflamed, edematous, vesicles or bullae if severe, weeping, crusting and lichenification. 

Lichen Sclerosus

Women with LS report vulvovaginal itching, familial linkage, edema, superficial ulcers, burning, area feels different.  Women with LS in all ages, show symptoms in clitoris, prepuce, labial majora, minora, edema, scarring, color, appearance of tissue paper of skin.

Lichen Planus - Women with lichen planus report vulvar itching, burning, with vulvovaginitis symptoms on mucosal surface of vulva. Dyspareunia, painful erosive areas. Bleeding on contact, stenosis of introitus. The vulva has white raised lesion with reticular, lacy pattern. Erosive reddened area bordered by reticular white epithelium. External labia has appearance of lichen sclerosus + acetowhite. Other signs may appear in her mouth.

Vulvar Neoplasm-Melanoma - affects mostly postmenopausal women that affects the clitoris and labia majora. Usually no symptoms.

Vulvar Intraepithelial Neoplasm -  Pruritus, vulvar burning, pain, discharge, bleeding, may report urethra, vaginal and anal symptoms.  White, dk, red, ulcerated, raised warty, or nodular lesions. Labia mayora most common site, minora, clitoris and perineum. 

Vulvodynia (Vulvar Pain Syndrome) - Various levels of burning, stinging, pain, dryness, irritation, rawness. No pruritus. May report long term hx.

Vulvar Vestibulitis is a burning, dysuria, frequency, with repeated yeast infections or HPV.  Significant/severe pain with touch or attempting intercourse.

Paget's Disease

Vulvar Pruritis, usually affecting older women. The vulva appears red/tan with scaly lesions.

What is Vulvar Cancer?

Vulvar cancer is cancer that is found in and on the vulva. 

What is Vulvar Vestibulitis?

Vulvar Vestibulitis is a condition which causes redness and pain of the vestibule. Vulvar Vestibulitis is an inflammation of this skin and the mucous secreting glands found in the skin. The mucous secreting glands are called the lesser vestibular glands.  

Vulvar Vestibulitis may include all the area around the opening of the vagina but is normally seen in the lower part of the vaginal opening. Vulvar Vestibulitis can occur in women of all ages. It can occur in women who are sexually active and also in women who have never been sexually active.  

Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.  

What are the signs and symptoms of Vulvar Vestibulitis?

*  Severe pain with pressure (for example: biking, exercise, tight fitting clothes ).

*  Vaginal entry such as tampon use or intercourse. 

*  Burning, stinging, irritation, or raw sensation within the vestibular area.

* Vestibular redness 

*  The urge to urinate frequently or suddenly.   

How is Vulvar Vestibulitis diagnosed or identified?

Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes seen with Vulvar Vestibulitis. Pain is usually felt if the vestibule area is touched with a cotton tipped applicator. A sample of your vaginal discharge is collected and tested to rule out infection.

What causes Vulvar Vestibulitis? 

The exact cause is unknown, but many studies are being conducted to determine the cause of Vulvar Vestibulitis.  

The following factors have been associated with Vulvar Vestibulitis:

*  HPV (Human Papilloma Virus)
*  Chronic Yeast Infections
*  Chronic bacterial infections 
*  Chronic changes of pH (acid-base balance in the vagina)
*  Chronic use of chemicals/irritants such as detergents, soaps, spermicides or lubricants.

What is the treatment for Vulvar Vestibulitis?  

Treatment may include any of the following:  

*  Follow the Guidelines for Vulvar Skin Care
*  Steroid Ointments 

How it is used: A thin layer is applied to the vulvovaginal areas. 

How it Works: Decreases redness, irritation, and burning. Caution: Use only as prescribed by your doctor. Overuse may result in thinning of the skin which will make your problem worse rather than helping it.

*  Trichloroacetic Acid (TCA) may be used in some cases as determined by the severity of the symptoms you have. TCA is a chemical that is used to destroy small areas of the irritated skin allowing new healthy skin to grow in its place. 

*  Interferon Injections are used to increase your body's response to infection. 

Helpful treatment hints for Vulvar Vestibulitis:

*  Vitamin A and D Ointment  How it is used: Apply to the areas of discomfort.
How it Works: Protects the skin, decreases irritation, heals, and soothes.

*  Lidocaine Gel may be prescribed after initial treatment. 
How it is used: Apply lidocaine gel to the vulvovaginal areas of discomfort. 
How it Works: Numbs areas before intercourse.
Caution: After applying, wait until area becomes less sensitive before intercourse. Burning may occur for a short time ( 5 to 10 mins.) after the gel is applied.

*  Witch Hazel Pads (TUCS Pads) How it is used: Apply to the vulvovaginal areas of discomfort. 
How it Works: Decreases burning and irritation after intercourse and urinating.

*  Cleansing Bottle - Pour plain luke-warm water over the vulva after urinating to remove urine from irritated area.  

*  Calcium Citrate Tablets- How it is used: Take orally 1200-1800mg. elemental calcium every day. How it Works: Thought to decrease certain crystals in the urine which may cause burning. 

*  Cranberry Juice  How it is used: Drink an 8oz. glass every day. 
How it Works: Increases the acid content of the urine to decrease bladder irritation. 

*  Limit High Oxalate Foods - May decrease amount of oxalate crystals in urine. Oxalate crystals cause urinary symptoms such as the urge to urinate frequently or suddenly. 

*  Baking Soda Soak- Soak in luke warm bath water with 4 to 5 tablespoons of baking soda to help soothe vulvar itching and burning. Soak 1 to 3 times a day for 10 to 15 minutes. If you are using a sitz bath, use 1 to 2 teaspoons of baking soda.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is Pelvic Prolapse?

Pelvic Prolapse is another term used for "pelvic organ prolapse."  Pelvic prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

Here's a special lesson on a very embarrassing, and sensitive topic.  How do you help your daughter - especially, after she's older than 10 or 11, about the issue of "VO" or Vaginal Odor.  How He can Help Her with this Serious, and Intimate Problem 

Here's a special lesson on a very embarrassing, and sensitive topic.  How do you help your daughter - especially, after she's older than 10 or 11, about the issue of "VO" or Vaginal Odor.  How He can Help Her with this Serious, and Intimate Problem.

HELP!! My daughter has asked me about her Vaginal Odor problem, what can I do to help her?

There are few things more annoying, or concerning to a woman than a vaginal odor problem. 

The best in this case is to be on the safe side and take her to your pediatrician for him/her to treat. A vaginal odor problem could be the indication of a more serious gynecological condition.

Otherwise, insure that when she is taking her bath or shower, that she is washing her vulva, with a very mild soap, and washing in between the labia and the creases. Make sure she is changing her panties every day.

Help!  My wife has a VO problem, what do I do? 

First of all, if you have noticed a recent change in your wife's vaginal scent, she too, may have also noticed.  The next time you are intimate, or after you are intimate, you may want to let her know that you have noticed a change in her vaginal scent.

Secondly, all menstruating women's vaginas go through monthly changes wherein their vagina's smell or scent changes from one day to the next, and throughout her monthly menstrual cycle. Also, the amount of vaginal secretions, cervical mucous and vaginal moisture, changes from one day to the next, and throughout the monthly menstrual cycle.  This is due to the flow of hormones that produce these changes throughout her cycle and also the reason for her monthly menstruation, if she has not conceived. 

Next, a woman that has a vaginal odor problem, probably already knows she has a problem, and can be related to many things related to her menstrual hygiene, vaginal hygiene, and/or feminine hygiene, but may also be an indication of a medical condition that may need immediate treatment.  Because you are concerned about her health, you may want to let her know that you suspect that there may be a problem and that you would like her to go see her ob-gyn to make sure that there is nothing serious.

Here are some of the signs and symptoms related and possible causes of V.O. (vaginal odor):

Vaginal odor may be the result of an inflammation of her vagina.  The vaginal inflammation is often a result of infection in or around the vagina or vulva, called the vulvovaginal area. Sometimes this condition is referred to as vulvovaginitis.

Causes of Vaginal Odor

Bacterial Vaginosis 
Chlamydia  
Genital Herpes  
Gonorrhea 
Lymphogranuloma Venereum ("LGV") 
Pelvic Inflammatory Disease ("PID")
Sexually Transmitted Diseases
Syphilis 
Trichomonas
Vaginal Yeast Infection (candida)
Vulvovaginitis 


Bacterial Vaginosis leads to vaginal odor, what causes it?

Bacterial Vaginosis (BV) is a type of vulvovaginitis. Bacterial Vaginosis occurs due to an overgrowth of one or more organisms that are normally present in your/your wife's vagina. 

Many times, when a woman begins taking antibiotics, these antibiotics kill off the natural organisms in her vagina.  This may cause some organisms in her vagina to multiply, and these organisms produce chemicals that cause a fish-like odor characteristic of BV. Vaginal odor may be more acute, and stronger after sexual intercourse. 

Many times, while a woman may believe that vaginal douching prevents or helps prevent vaginal odor, especially after menstruation, douching actually disrupts the normal flora, or naturally occurring organisms that normally live in the vagina.  Vaginal douching, therefore,  may actually increase the risk of vaginal infection.

Signs and symptoms of Bacterial Vaginosis include(s): 

*  Grayish-white vaginal discharge
*  Vaginal itching or irritation
*  Vulva/labial redness, irritation, swelling and redness

Treating Bacterial Vaginosis is normally started after a visit to the ob-gyn who may  prescribe medication(s) - usually antibiotics.

Other causes of vaginal odor include the following:

Poor vaginal, menstrual or feminine hygiene methods.

Not changing tampons, or menstrual pads frequently enough.

"Losing" or forgetting a tampon in the vagina, which may lead to a vaginal infection. 

Rarely, an advanced tumor of the cervix or vagina will cause a vaginal odor problem.

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