Vulvar and Vaginal Disorders

• Bacterial vaginosis occurs when your bacteria levels are out of balance.
• Symptoms include white, gray or green discharge, a fishy odor, itching and burning during urination. It’s also possible to have BV and not experience any symptoms.
• Avoid using scented products or douching to reduce the risk of BV.
• Treatment often includes an antibiotic medication – which can be a pill, gel, cream or suppository.

• Pain during intercourse can feel like burning or aching. It can also continue after intercourse.
• You may be at more risk for experiencing dyspareunia if you’re experiencing menopause, have a vulvar, vaginal or bladder infection, or have neurologic changes.
• Treatment can include physical therapy as well as oral and topical medications.
• Learn more about dyspareunia.

• Genital warts are a sexually transmitted infection. They are caused by human papillomavirus (HPV) and spread through sexual contact.
• Genital warts can look like small, smooth bumps or they can be textured lesions. Sometimes they are too small to be seen.
• You may experience itching or discomfort from warts. There can also be bleeding with intercourse.
• Treatment can include removing the warts or topical medication.

• Lichen planus is one of several vulvar and vaginal diseases that occurs when the immune system is overactive and attacks mucous membranes.
• Skin affected by lichen planus can either be white or have shallow sores. The genital areas that are white are usually itchy, whereas those areas with superficial ulcerations are usually sore and painful.
• Untreated or severe lichen planus sometimes produces scarring. When the vagina is involved, the vaginal walls can scar together so that intercourse is no longer possible.
• Treatment may include topical medication, suppositories or pills.

• Lichen sclerosus is a skin disease that occurs most often on the vulva. This autoimmune condition occurs when the immune system becomes overactive and attacks the skin.
• Skin affected by lichen sclerosus is usually white, and sometimes there is a fine, crinkled texture.
• It causes itching. As the disease progresses it leads to easy bruising, tearing and pain. If untreated, lichen sclerosus often causes scarring, and the opening of the vagina can narrow.
• Most people need 4-8 weeks of daily ultrapotent topical steroid treatment. This usually restores the texture and color, although it does not always reverse scarring.

• Lichen simplex chronicus (LSC) is also called atopic dermatitis, eczema, neurodermatitis and dermatitis. It is an itchy skin rash that occurs in people who have sensitive skin. It is often caused by irritations of daily living such as contact with certain soaps, perspiration, stress or rubbing from clothes. It can also be provoked by prolonged contact with body fluids like urine, blood or vaginal discharge.
• Because people with LSC have skin that is easily irritated, there is no cure for LSC. However, steroid medication and very careful skin care to minimize irritation usually can control the problem.

• Burning that occurs with touch or pressure only at the opening of the vagina, called the “vestibule”, is called vestibulodynia. It is a form of vulvodynia.
• It is diagnosed when you’ve experienced pain for at least 6 months and any other conditions – like a yeast infection – have been treated but the pain persists.
• Vestibulodynia most likely is caused by a combination of a nerve abnormality (neuritis, neuralgia), pelvic floor muscle weakness and irritability, irritation from previous treatments, overwashing and anxiety/depression.
• Vestibulodynia does not affect fertility or the ability to carry pregnancy to term and have a normal delivery. Vestibulodynia is not an early sign of any disease that affects overall health.
• Treatment includes avoiding any products that may irritate the skin. There are topical medications that can be used for numbing any time you feel burning or 15-20 minutes before sexual activity to help you avoid some of the pain.
• Medication for neuropathic pain is often beneficial. These include medications that were originally developed for depression but have been found to have specific benefits for neuropathic pain.
• Topical medications and experimental treatments – like Botox, acupuncture and hypnosis – may be used depending on your specific symptoms, age and response to other treatments.
• A surgical option for vestibulodynia is to remove the painful vestibule. However, success of this surgery (vestibulectomy) is dependent upon the location of the pain being strictly and always limited to the opening of the vagina.
• Pelvic floor therapy can also be beneficial.

• This is when abnormal cells develop in the top layer of skin covering the vulva. It is not cancer but is considered precancerous.
• The symptoms of VIN are itching, burning, tingling or soreness in the vulvar area. There may be red or white areas on the skin or raised skin bumps that can be darker. Pain during intercourse can also be a symptom.
• Some people with VIN do not have any symptoms. Your gynecologist will do a careful skin exam, and may recommend further testing if your skin appears abnormal.
• VIN can be caused by a previous infection, like HPV, immunosuppression or chronic irritation.
• Diagnosis usually includes a colposcopy or looking at the skin with a microscope. Sometimes a biopsy is also needed.
• Treatments may include steroid creams, surgery, laser therapy and topical chemotherapy.

• Vulvar dermatitis is a common chronic skin condition of the vulva. It typically presents with dry, very itchy skin on the vulva, the outside genitalia.
• Estrogen levels can affect your likelihood to have vulvar dermatitis. It can also flare up in response to products that irritate the vulva, like scented soap, detergent, medications and period products.
• It is treated with topical corticosteroids and barrier emollients. Lifestyle changes, like following good skin care recommendations, can help prevent it from returning.

• Vulvodynia is defined as sensations of burning, rawness, stinging, stabbing, tearing, aching, or irritation that have been present for at least 6 months, and are not caused by any specific disease – no infection, skin disease or specific neurologic disorder.
• Vulvodynia can be caused by hormonal factors, inflammation, weakened pelvic muscles and nerve injury, among other things. It’s commonly experienced by people who menstruate.
• It can be treated with numbing medications, nerve blocks, oral medications – including antidepressants – pelvic floor physical therapy and even surgery.

• This is a type of fungal infection that occurs when you have a candida overgrowth. It is also a type of vaginitis and may be called vulvovaginal candidiasis or vaginal candidiasis.
• The symptoms of a yeast infection include burning, itching and redness on your vulva. You may also notice changes in the texture of your vaginal discharge.
• Yeast infections are very common. Your risk of getting one increases with using antibiotics, taking birth control pills, being pregnant, having a weakened immune system or having diabetes.
• Treatment often includes antifungal medications that are taken by mouth or applied to your skin. Talk to your doctor about over-the-counter medications that may be used.

No, a referral is not required. However, patients have usually sought treatment through their primary care physician or OB-GYN first and not gotten sufficient relief of their symptoms.

Whether you are referred or not, please bring your outside medical records with you to the appointment.

If you have tried other treatments without success, a consultation would be a good place to start. Also, you may be referred by another gynecologist to get care from us.

Yes. Call 913-588-1227 to schedule a virtual visit.

At The University of Kansas Health System Quivira Medical Pavilion office in Overland Park, Kansas.

Most of the time surgery is not necessary. However, your doctor will review your history, examine your condition and discuss treatment options if surgery may be required.