Vaginal Lumps and Bumps - What to Know

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We have talked about the common lumps and bumps we get on our labial and vaginal area in recent blogs, but I want to talk about the difference and describe for you the sores and rashes that can be a sign of something worse.

As background, the vulva is the general name given to the external parts of the female genitals. It includes: the mons pubis (the pad of fatty tissue covered with pubic hair); the clitoris; labia majora (the outer lips); labia minora (the inner lips); the vestibule (area immediately surrounding the vaginal opening); the urinary opening; vaginal opening; and the perineum (area of skin between the anus and vagina). The appearance of the vulva can vary greatly between women. For example, although the labia minora are referred to as the 'inner lips', it is quite normal for them to extend outside the labia majora.

Dermatitis is the most common cause of chronic vulvar symptoms, such as painful intercourse, increased or foul-smelling vaginal discharge and painful urination. In some cases, vulva dermatitis can be caused by a genetic predisposition to allergies and hypersensitivity. This can be so embarrassing and frustrating because it causes a lumpy, bumpy feel and intense redness and rashes. This can take away all the fun and enjoyment from intimacy.

The following are good rules of thumb to follow to help with prevention and healing:

☛Wear cotton underwear for daily use (save the lace and G-strings for your intimate occasions)

☛Watch for allergies or sensitivities, especially latex in condoms or diaphragms, over-the-counter vaginal medications or soaps, laundry detergents, and lotions

Some of the most common, non-cancerous reasons for vulvar bumps are Genital herpes, Genital warts, Granuloma inguinale, Chancroid, Bechet's, Pagets of the vulva, Lichen Sclerosis (now known as Vulvar Hyperplasia) along with leukoplakia, neurodermatitis, Bowen's disease, hyperplastic vulvitis, Kraurosis vulva and erythroplasia of Queyrat.

Genital herpes is caused by the herpes simplex virus (HSV). It is transmissible through vaginal, anal or oral sex. Symptoms appear within 2-14 days of exposure and include flu-like symptoms and painful blisters in the genital area. Some people only experience one outbreak while others will have several. A minority of those infected experience frequent recurrences. There is no cure for genital herpes, but antiviral medications can help reduce the duration and severity of an outbreak and prevent transmission to a partner. Keeping the area clean and dry and bathing with a saline solution will help relieve discomfort and assist healing.

Genital warts are caused by particular types of the human papilloma virus (genital HPV). Genital HPV is also transmissible through vaginal, anal or oral sex. Warts can be found on the vulva, clitoris, cervix, inside the vagina or urethra and in or around the anus. They can be flesh colored or pink and come in a variety of sizes and shapes, occurring singularly or in clusters. Warts do not usually cause pain. Warts can be treated with chemical applications, ablation (freezing, burning or use of a laser to remove warts) or a cream that enhances the body's immune response to the viral infection. Warts DO NOT come and go. Once there, they stay until removed.

Psoriasis on the Vulva may or may not be itchy, and does not affect the vaginal mucosa. Symptoms include a scaly, silvery or red plaque. Women with psoriasis of the vulva often have the skin condition elsewhere on their body as it is an autoimmune system disorder. Treatment includes the use of topical steroids and a low dose of coal tar cream.

Beh├žet's syndrome is a disease characterized by recurrent aphthous ulcers, possibly ulcers of the vulva. These usually occur on a cyclical basis related to the menstrual cycle.

Paget's disease of the vulva is a rare skin disease but can cause extreme itching along with red or white patches.

A common benign condition which can occur at any age, but that is more common in the post-menopausal patient, is lichen sclerosis. Now called squamous cell hyperplasia, it presents with intensive itching. White patches are frequently seen along with evidence of excoriation from scratching. Biopsy reveals an increase in the thickness of the top layer of the epidermis (hyperkeratosis) and irregular thickening of the Malpighian layer (acanthosis). This latter process produces a thickened Vulvar skin. It responds to the use of high strength topical cortical therapy - Clobetasol ointment appears to be the treatment of choice. If you stop the treatment, it will reoccur, as it is a lifelong treatment. If left untreated, lichen sclerosus can cause severe scarring of the vulva (including the shrinking of the labia and narrowing of the vaginal entrance). Lichen Sclerosis is known as Vulvar dystrophy or vulvar intraepithelial neoplasia (VIN).

Neoplasia (VIN) can develop in women of any age. Its frequency appears to be increasing among younger women. Today, the average age for VIN is said to be about 50 years of age. The presence of a distinct mass, bleeding or discharge, strongly suggests invasive cancer and not VIN. VIN is often asymptomatic and presents as whitening or hyperpigmentation of what appears to be normal vulvar skin. Over half of the women have multiple lesions all thought to be related to HPV virus infection. The lesions are located in the non-hairy portion of the vulva in 85-95% of cases. A biopsy is essential to confirm the diagnosis and distinguish it from the benign lesions described above and surgical excision has been the mainstay of therapy. Symptoms of VIN may include itching and burning in a specific area of the vulva, raised brown, red, pink or white lesions, warty lesions or persistent erosions or ulcers.

The vulva can also develop skin cancers such as melanoma and basal cell and squamous cell carcinomas. HPV seems to be the main culprit in many female cancers. Treatment for vulvar cancer depends on how advanced the cancer is when diagnosed. Early detection of vulval cancer is important as it improves the chances of successful treatment. Once again, surgery is the most common treatment for vulval cancer. Radiation therapy and/or chemotherapy may also be used.

I hope this helps you. The most important thing is if you feel something is wrong or have non-healing sores, go see your doctor.
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