Vulvar disorders: the uncomfortable questions, answered.

Written by: Ms Pushpakala Maharajan
Edited by: Lauren Dempsey

What are vulvar disorders and how are they treated? Leading consultant obstetrician and gynaecologist, based in Harpenden and Milton Keynes, Ms Pushpakala Maharajan, answers the questions that many women feel uncomfortable asking. Ms Maharajan explains what these disorders are, what causes them, and the symptoms, treatments, and methods of prevention.


What are vulvar disorders? 

Common benign chronic vulvar conditions include:

  • vulvovaginal atrophy, a condition causing the drying and inflammation of the vaginal walls.
  • lichen sclerosus, a long-term skin condition that causes skin to be thin, white and causes soreness in that area.
  • lichen planus, a skin condition causing swelling and irritation.
  • lichen simplex chronicus, a skin condition caused by repeated friction.
  • vulvodynia, chronic and unexplained pain in the vulva
  • vulval eczema/ dematitis
  • vulval psoriasis
  • vulval intraepithelial neoplasia, a precancer condition, whereby cells change and could potentially become cancerous later.
  • vulval pain syndromes


What causes vulvar disorders? 

Vulval atrophy is due to the hypoestrogenic state following menopause. Lichen sclerosis is an autoimmune condition characterized by vulva skin thinning and changes in the skin architecture. Lichen planus is an inflammatory /autoimmune disorder that can affect the vulva and the mucosal surfaces leading to skin lesions. Lichen simplex chronicus manifests due to persistent itching and scratching of the vulvar skin that leads to thickening of the skin and irritation. Vulvodynia is a condition diagnosed by exclusion of other conditions


What are the symptoms of vulvar disorders? 

Many women, of any age, experience symptoms. Symptoms include vulval skin dryness, ongoing pain, pain during sex, bladder problems, recurrent urinary tract infections (UTIs), burning sensation, itching, rashes, and irritation. These symptoms may be caused by a condition that only affects the vulva, but they can sometimes be a sign of a more general medical problem or other skin diseases.


How can vulvar disorders be treated?

Treatment is based on the diagnosis and this could include steroids, emollients, oestrogen pessaries, etc. A vulval biopsy is indicated if the symptoms are not improving with routine medical treatments. Multidisciplinary input from dermatologists, gynaecologists, and physicians may help to identify and diagnose conditions at an earlier stage and treat them accordingly. Conditions like vulvodynia may cause different types of pain. This pain is often described as burning, stinging, irritation, and rawness over the entire vulva or only in one place, such as the clitoris or vestibule. Treatment includes antidepressants and surgical interventions in resistant cases.


Can vulvar disorders be prevented?

Self-care measures help prevent or alleviate certain vulvar problems. They include:

  • a focus on general hygiene and local care
  • avoiding wearing tight-fitting pants or underwear that may irritate the skin
  • avoiding using pads or tampons that contain a deodorant or a plastic coating
  • avoiding using perfumed soap or scented toilet paper
  • avoiding douching or use of feminine sprays or talcum powders locally.

More information on vulval health care can be found here.


If you are interested in booking a consultation with Ms Pushpakala Maharajan, you can do so directly by visiting her Top Doctors profile.

By Ms Pushpakala Maharajan
Obstetrics & gynaecology

Ms Pushpakala Maharajan is an established consultant obstetrician and gynaecologist practising in Harpenden and Milton Keynes. Her speciality focus is colposcopy, menopause, menstrual disorders and abnormal bleeding, as well as minimal access surgery and benign gynaecological conditions. Presently, Ms Maharajan practices at two private clinics along with her work at the Luton and Dunstable University Hospital NHS Trust.

She received her primary medical qualification in 1995 before completing her post-graduate degree in obstetrics and gynaecology at Madras Medical College. While doing her specialist training in the Oxford deanery, Mr Maharajan worked in various teaching hospitals.

Ms Maharajan has dedicated herself to work beyond the clinic hours by being committed to college tutoring and being an educational supervisor for future obstetricians and gynaecologists, in addition to her involvement with her NHS practice. Not only is she the clinical director for obstetrics and gynaecology, but she also runs the post-menopausal bleeding one-stop clinic. Her innovative procedures in the clinic have reduced the number of hospital admissions due to the reduced need for general anaesthesia.

One of Ms Maharajan's passions in her field is ensuring that women are treated in a holistic manner, giving them high-quality care by considering their opinions and views. She approaches her work in an evidence-based fashion and offers tailored care to each patient. Communication between patient and healthcare professionals is a foundation point of Ms Maharajan's healthcare beliefs.

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