Diagnosis and Management of Vulvar Skin Disorders

doi:10.1097/aog.0000000000003944

Cited by 26 publications

(4 citation statements)

References 66 publications

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“…Any dermatologic vulvar condition, such as hidradenitis suppurativa, vulvar psoriasis, and atopic dermatitis, that presents premenopausally, may persist in menopause. Lichen planus is relatively rare but occurs most often in women in their 50s and 60s 159 . Lichen sclerosus is by far the most common vulvar dystrophy in postmenopausal women.…”

Section: Approach To Specific Conditions and Treatment Optionsmentioning

confidence: 99%

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Diagnosis, causes, and treatment of dyspareunia in postmenopausal women

Streicher

2023

Menopause

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Importance and Objectives: Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women.Methods: This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia.Findings: Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO 2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists.Conclusions: Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.

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Section: Approach To Specific Conditions and Treatment Optionsmentioning

confidence: 99%

“…Treatment is based on the specific diagnosis 159 . In most postmenopausal women, both the dermatologic condition and the atrophy must be treated.…”

Section: Approach To Specific Conditions and Treatment Optionsmentioning

confidence: 99%

Diagnosis, causes, and treatment of dyspareunia in postmenopausal women

Streicher

2023

Menopause

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“…Lichen sclerosus and lichen planus should be treated according to American College of Obstetricians and Gynecologists guidelines, with a topical, ultra-potent steroid ointment 7 . People with lichen sclerosus who use steroids regularly have a lower risk of vulvar squamous-cell carcinoma than those whose use is more intermittent 8 .…”

Section: Treatment Of Vulvar Itchingmentioning

confidence: 99%

Evaluation and treatment of vulvovaginal itching in postmenopausal women

Mitchell

2023

Menopause

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Vulvovaginal itching, a commonly reported symptom in postmenopausal women, may be because of the genitourinary syndrome of menopause but has a broad differential including dermatologic, infectious, and autoimmune causes. Comprehensive evaluation is important to avoid inappropriate treatments that may delay the correct diagnosis. In many cases, no clear cause can be identified, and the goal of management is simply to control symptoms.

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“…For patients who do not show improvement with this treatment, several other options may be tried: calcineurin inhibitors, topical and oral retinoids, steroid injections, ciclosporin, and methotrexate. The level of evidence is low for most of these agents, with the exception of the calcineurin inhibitors, which are considered second-line treatments for vulvar LS [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Mid-term symptomatic relief after platelet-rich plasma infiltration in vulvar lichen sclerosus

et al. 2023

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Purpose Vulvar lichen sclerosus (LS) is a chronic, progressive, autoimmune dermatologic condition that causes cutaneous changes accompanied by pruritus and pain. There remains a small population with vulvar LS refractory to topical corticosteroids. Injection of platelet-rich plasma (PRP) has been reported to have positive effects on tissue repair. The aim of this pilot study was to evaluate changes in symptom scores during and after PRP vulvar infiltration. Methods Three PRP infiltrations were administered to 28 female postmenopausal patients with biopsy-proved LS with unsatisfactory response to steroid therapy. Change in score according to the Clinical Scoring System for Vulvar Lichen Sclerosus (CSS) was measured on six occasions over the course of a year. We used growth curve modeling to measure change over the period of the study. Results Women in our study experienced a statistically significant improvement in auto-assessed symptoms of vulvar lichen sclerosus, and this improvement appears to be maintained throughout the monitoring year. Conclusion Platelet-rich plasma may have a role in symptom relief in certain cases of patients with LS that do not respond to first-line therapy.

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Diagnosis and Management of Vulvar Skin Disorders

Cited by 26 publications

References 66 publications

Diagnosis, causes, and treatment of dyspareunia in postmenopausal women

Diagnosis, causes, and treatment of dyspareunia in postmenopausal women

Evaluation and treatment of vulvovaginal itching in postmenopausal women

Mid-term symptomatic relief after platelet-rich plasma infiltration in vulvar lichen sclerosus

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