Vulvar Lichen Sclerosus: It’s Not Just Itching

Vulvar Lichen Sclerosus: It’s Not Just Itching

by jillkrapfmd

Let’s talk about symptoms of vulvar lichen sclerosus.
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Changes in vulvar appearance- loss or resorption of the labia minora, covering of the clitoris with the clitoral hood (clitoral phimosis), narrowing of the vaginal opening.
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Fissures- small cuts, especially on the clitoral hood, between the labia minora and majora, and at the base of the vaginal opening (often with intercourse).
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Tightening or Discomfort- feeling of the vulvar skin being stretched or tight leading to discomfort.
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Itching- may not be present if estrogen levels are normal (premenopausal women).
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Pain with Sex- narrowing of the vaginal opening can occur leading to pain with insertion, there can be tearing at the top or bottom of the vaginal opening.
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Loss of Skin Pigment- white patches on the vulva, called hypopigmentation. Of note, chronic inflammation of LS can also lead to darkened areas, called hyperpigmentation.
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The “Other” Type of Pelvic Floor Muscle Weakness

The “Other” Type of Pelvic Floor Muscle Weakness

by jillkrapfmd

🌱Many women with vulvar pain have hypertonic (overactive) pelvic floor muscle dysfunction.
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🌱The muscles that make up the “floor of the pelvis” (the pubococcygeus, puborectalis, and the transverse perinei muscles), which come together at the bottom of the vestibule (4-8 o’clock on the vaginal opening), can become tight and tender.
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🌱It is one of the most common contributors to vestibulodynia and often occurs with other forms of vulvar and pelvic pain.
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🌱These muscles affect the bowel, bladder, hips, lower back, and vulva. Women often blame symptoms of tight pelvic floor on infections, like chronic yeast or urinary tract infections, even interstitial cystitis. Often the cultures are all negative and this causes increased anxiety, increased discomfort, and increased tightness.
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🌱It is possible to break the pain cycle of tight pelvic floor muscles… but it involves a proper diagnosis and identifying contributing factors.
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🌸 I feel that evaluation of the pelvic floor should be standard in a gynecologic exam, and essential in women with pelvic and vulvar pain.

Let’s Talk About Female Sexual Pain Conditions

Let’s Talk About Female Sexual Pain Conditions

by jillkrapfmd

The more we talk about it, the more we make it acceptable to discuss with others, including our doctors/NPs and those we rely upon for support.
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These conditions are real. They have causes, symptoms, and treatment options. The time for suffering in silence is over.
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🌷Vestibulodynia- persistent pain located at the vulvar vestibule (vaginal opening) that may be related to conditions that affect the tissue or nerves in that area.
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🌷Painful Bladder Syndrome- formerly called Interstitial Cystitis (IC), this describes chronic bladder pain without an identified cause, but may be related to the lining of the bladder or the muscles surrounding the bladder.
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🌷Lichen Sclerosus and Lichen Planus- two likely autoimmune skin conditions that affect the vulva (LS) and the vestibule and vagina (LP) leading skin changes, itching, and narrowing of the vaginal opening.
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🌷Pudendal neuralgia- pain located in the distribution of the pudendal nerve, can be a cause of generalized vulvodynia (persistent pain of the vulva), including clitorodynia (pain of the clitoris).
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🌷Chronic vaginitis/vaginosis- recurrent or persistent vulvovaginal infections such as yeast infections or bacterial vaginosis.
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🌷Endometriosis- the presence of endometrial (uterine lining) glands and stroma outside the utuerus, leading to pelvic pain and infertility.
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🌷Overactive Pelvic Floor Dysfunction- increased tone of the pelvic floor muscles, leading to genito-pelvic pain, as well as urinary and bowel symptoms.