Vulvar Conditions: Answers to FAQs
Frederick R. Jelovsek MD
   
Growth on vulvar lips that swells up
Can't tell without actually seeing it but it sounds like a polyp of the vagina, a skin tag or gland infection of the hymen or labia minora or maybe even a condyloma accuminata.
The periodic swelling may represent a gland in the skin tag in which the duct gets periodically blocked. If you see a gynecologist, that should be easily removed if it is on a stalk. I don't think there is any cream you can use or anything you can do yourself to get rid of it.
Try not to be embarrassed. This isn't something you caused. It's probably just the way your skin and anatomy is and it could get irritated by just tampon or pad use. I don't think your mother would think badly of you and would probably be more supportive than you think.
No. Most women do not have this problem.
Probably not if you don't get worsening symptoms and it doesn't start swelling and hurting more and more frequently.
Since it is at the entrance to the vagina I suspect sex will irritate it and make it swell more. You would be the one to answer that. Try to get it looked at so you will know and not worry.
Enlarging tissue below the urethral opening
Without seeing it, making a diagnosis is difficult. However, several possibilities exist which include NORMAL hymen, urethral diverticulum or blocked/infected Skene's gland. The Skene's gland cyst is the most likely from your description and will need to be opened or excised if it keeps swelling up.
Infection or possibly irritation with intercourse
If you are concerned, see your doctor so he/she can obtain a history (which would include things like how long "the tissue" has been present, the presence of any discharge, fever, redness, painful urination etc) and do a physical exam.
Tear or cut near clitoris
It sounds as if there was some direct mechanical irritation of the clitoral area or possibly even a contact dermatitis. Did you use any lubricants, deodorants, creams etc., on the area? Treatment usually is to abstain from relations for about 5-7 days, use petrolatum as a coating to prevent further contact irritation (use about twice per day apply thin coat) and avoid other creams or soaps directly. Tub bath with just soap in water but not directly on affected area is ok.
Fear of pain can decrease libido. Was desire a problem before this came up? Are you on any meds? Need some more info.
I would just treat it as a tear for right now and see if it clears up with a week of using Neosporin® ointment on it twice a day. If it doesn't clear up with that, then you need to have it checked out.
Morning vulvar irritation and burning urination
It is difficult to say for sure without examining the urine microscopically and examining you in the vulvar area when you are having symptoms. If
this is happening primarily on the mornings after sexual relations, urethral syndrome comes to mind. This is a direct irritation of the
urethra due to sexual relations (often referred to as "honeymoon cystitis" although it can happen long after the initial relations with a new
partner). Usually the urine culture is negative but sometimes there are blood cells in the microscopic urinalysis.
If this is happening everyday regardless of sexual relations, it may represent an active urine infection that has not been well treated or just
keeps coming back.
If you think it is just burning because the urine hits an irritated vulva, try to void when you get up in the morning by sitting in a bath tub
and void in the water. If the burning is not present then, it is because of vulvar irritation and that is what needs to be checked out. If the
burning is still present, it is urethral in origin and that should be the focus of diagnosis.
Clitoral pain - is surgery needed?
This is a female circumcision procedure. It is not recommended or necessary and there are world wide efforts being made to ban it's use.
Disfigurement mostly. Sometimes it just exposes sensitive tissue to more constant irritation especially if a woman wears pads during
menstruation.
Yes it can. This often affects self-image and might make a women more self-conscious during sexual relations.
In the rare case of pthimosis (narrowing, stricture) of the clitoral hood, only a small incision needs to be made so the hood can retract. Then
keep something like petrolatum gel or vegetable oil on the cut surfaces until it heals (about 7-10 days). The entire hood does not need to be removed.
Varicose veins of the vulva
5 1/2 weeks is too soon to tell about the varicosities. They may still improve as swelling in the pelvis subsides. It's difficult to say
at this point how bad they will be. It won't be until about 3 months after surgery that you can tell their baseline rate. In your case it might
be a month to 6 weeks longer because of the post operative complication you had.
This unlikely to be due to anything you have done. You can help though, by wearing good support hose during the recovery process.
You have to get fitted panty hose to help the vulvar ones but any support of any of the veins makes less stretching of the veins.
Itching after sex using condoms
Yes. You are probably having a contact allergy. Most often it is the lubricant and not the latex. You have to be your own detective to determine which brand is the problem. There are unlubricated condoms you can try and then add Replens as a lubricant. You may want to try the Replens first to make sure you don't react to it but it is one of the least reactive ones to try.
Let us know.
Primary Vulvodynia, vestibulitis and HPV
While it has been suspected that HPV may play a role in vulvar vestibulitis, recent controlled studies are against HPV as an etiology.
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There is such a condition of primary vulvar vestibulitis that occurs from the time of the first intercourse. Not much is known about this but it responds the same as a secondary vulvar vestibulitis.
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I suspect that many times it is just a direct trauma to the skin at the vaginal opening due to several factors such as involuntary muscle spasm (vaginismus), lack of good lubrication at the opening and sometimes just the physical anatomy of tightness at the introitus. Women who never used tampons for menses (which seem to slowly dilate the vaginal tissues and make them more elastic) before starting intercourse seem to have more problems with this. On the other hand maybe using tampons was too painful from the start indicating anatomy tightness.
If a male does not have any visible venereal warts on the glands or shaft of the penis then it is very difficult to know if HPV is present. The virus can be in the skin cells inactive for a long time. Anyhow, I doubt HPV is playing a role here.
Categories of vulvodynia
Vulvodynia refers not to a
specific disease, but rather to a symptom - vulvar
pain. In this case the pain is chronic and either
recurrent or almost constant. Vulvodynia can be primary, i.e., starting from the first episode of intercourse, or secondary, starting after a specific event.
There are 4 main categories of vulvodynia:
- vulvar dermatoses
- cyclic vulvovaginitis
- vulvar vestibulitis syndrome
- dysesthetic vulvodynia
Again, these four categories are not diseases
themselves but rather clusters of different
diseases or descriptive syndromes whose etiology
is unknown.
Vulvar dermatoses often require a biopsy for
diagnosis. Examples might include psoriasis, seborrheic dermatitis, tinea cruris, contact dermatitis, lichen simplex chronicus, lichen planus, lichen sclerosis, pemphigus, and erythema multiforme. Sometimes a dermatologist is the person
to see for this rather than a gynecologist
especially if the vulva seems to have a chronic
redness or scaliness.
Cyclic vulvovaginitis is frequently due to a
recurrent yeast infection but it can also be
bacterial in origin commonly from E.Coli and Group D or B streptococcus. In this instance, secretions
from the vagina are the skin irritants and if use
of a tampon eases the burning, it is very likely
that cyclic vulvovaginitis is the major factor.
The remaining two subcategories, vulvar
vestibulitis and dysesthetic vulvodynia are
totally unknown as to their etiology. Vulvar
vestibulitis shows inflammation of the vestibular
glands on biopsy but what causes the inflammation
is unknown. It does not respond to antibiotics. HPV virus was postulated as a possible
cause but current concepts are that HPV is not the
cause.
Dysethetic vulvodynia tends to be found in
postmenopausal women and is postulated to be an
inflammation of the nerves similar to a herpetic
vulvitis. There are no histological changes on
biopsy so it is really just the existence of
vulvar pain in the absence of inflammation on
biopsy. Primary vulvodynia may also fall under this category. In this case it is young women who have the problem and vaginismus, involuntary contraction of the pelvic floor muscles plays a big role. Pelvic floor therapy with microelectrical stimulation may be helpful for this.
All categories of vulvodynia may be associated with a secondary vaginismus. If a woman fears pain with vaginal intercourse, there is almost always an involuntary muscle contraction that narrows the vaginal opening and continues to cause vulvar pain because of direct friction. thus the primary cause can be cured (the dermatosis, the vaginitis, the vestibulitis, the atrophic vulvitis) but the pain continues because of fear of pain and involuntary muscle spasms.
Irritant vulvitis or vulvodynia?
With a recurrent or secondary yeast infection of the vagina, the yeast metabolizes glycogen (sugar) in the vaginal cells to alcohol. When alcohol gets on the vulvar skin, it burns and irritates it. If you wear tampons to prevent the discharge from getting on to the vulva and the pain lessens or goes away, then the main problem is a recurrent yeast infection. Also, vaginal yeast cultures will show heavy growth.
With an irritant vulvitis, vaginal yeast cultures are generally negative, and pain does not improve with tampon use. If the vulvitis is constant, it is by definition vulvodynia which merely means vulvar pain. Vulvodynia is a constant, chronic condition which has different etiologies such as chronic yeast infections, a contact dermatitis (irritant vulvitis) but a large category is unknown cause. Vulvar vestibulitis which is an inflammation or the glands of the vestibule skin is actually a very less common cause of vulvodynia but an important one because it is a persistant disease refractory to treatment.
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