Vulvar lesions are cutaneous lumps, nodules, papules, vesicles, or ulcers that result from benign or malignant tumors, dystrophies, dermatoses, or infection. They can appear anywhere on the vulva and may go undetected until a gynecologic examination. Usually, however, the patient notices lesions because of associated symptoms, such as pruritus, dysuria, or dyspareunia.
Ask the patient when she first noticed a vulvar lesion and find out about associated features, such as swelling, pain, tenderness, itching, or discharge. Does she have lesions elsewhere on her body? Ask about signs and symptoms of systemic illness, such as malaise, fever, or rash on other body areas. Is the patient sexually active? Ask whether she could have been exposed to sexually transmitted disease.
Examine the lesion, do a pelvic examination, and obtain cultures. (See Recognizing common vulvar lesions, page 640.)
Basal cell carcinoma.This nodular tumor has a central ulcer and a raised, poorly rolled border. Typically producing no symptoms, the tumor may occasionally cause pruritus, bleeding, discharge, and a burning sensation.
Benign cysts.Epidermal inclusion cysts, the most common vulvar cysts, appear primarily on the labia majora and are usually round and produces no symptoms. Occasionally, they become erythematous and tender.
Bartholin's duct cysts are usually unilateral, tense, nontender, and palpable; they appear on the posterior labia minora and may cause minor discomfort during intercourse or, when large, difficulty with intercourse or even walking. Bartholin's abscess, infection of a Bartholin's duct cyst, causes gradual pain and tenderness and possibly vulvar swelling, redness, and deformity.
Benign vulvar tumors.Cystic or solid, benign vulvar tumors usually produce no symptoms.
Chancroid.Chancroid causes painful vulvar lesions. Headache, malaise, and fever to 102.2° F (39° C) may occur, with enlarged, tender inguinal lymph nodes.
Genital warts.Genital warts are painless warts on the vulva, vagina, and cervix. They start as tiny red or pink swellings that grow and become pedunculated. Multiple swellings with a cauliflower appearance are common. Other findings include pruritus, erythema, and a profuse, mucopurulent vaginal discharge. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea.Vulvar lesions, which usually are confined to Bartholin's glands, may develop along with pruritus, a burning sensation, pain, and a green-yellow vaginal discharge, but most patients are asymptomatic. Other findings include dysuria and urinary incontinence; vaginal redness, swelling, bleeding, and engorgement; and severe pelvic and lower abdominal pain.
Granuloma inguinale.With granuloma inguinale, a single painless macule or papule initially appears on the vulva, ulcerating into a raised, beefy-red lesion with a granulated, friable border. Other painless and possibly foul-smelling lesions may occur on the labia, vagina, or cervix. These become infected and painful, and regional lymph nodes enlarge and may become tender. Systemic effects include fever, weight loss, and malaise.
Herpes simplex (genital).With herpes simplex, fluid-filled vesicles appear on the cervix, the vulva, labia, perianal skin, vagina, or mouth. The vesicles, which may initially be painless, may rupture and develop into extensive, shallow, painful ulcers, with redness, marked edema, and tender swollen inguinal lymph nodes. Other findings include fever, malaise, and dysuria. Secondary infections may also occur.
Lymphogranuloma venereum.Lymphogranuloma venereum is a bacterial infection commonly present with a single, painless papule or ulcer on the posterior vulva that heals in a few days. Painful, swollen lymph nodes, usually unilateral, develop 2 to 6 weeks later. Other findings include fever, chills, headache, anorexia, myalgias, arthralgias, weight loss, and perineal edema.
Squamous cell carcinoma.Invasive carcinoma occurs primarily in postmenopausal women and may produce vulvar pruritus, pain, and a vulvar lump. As the tumor enlarges, it may encroach on the vagina, anus, and urethra, causing bleeding, discharge, or dysuria. Carcinoma in situ is most common in premenopausal women, producing a vulvar lesion that may be white or red, raised, well defined, moist, crusted, and isolated.
Squamous cell hyperplasia.Formerly known as hyperplastic dystrophy, these vulvar lesions may be well delineated or poorly defined; localized or extensive; and red, brown, white, or both red and white. However, intense pruritus, possibly with vulvar pain, intense burning, and dyspareunia, is the cardinal symptom. With lichen sclerosis, a type of vulvar dystrophy, vulvar skin has a parchmentlike appearance. Fissures may develop between the clitoris and urethra or other vulvar areas.
Syphilis.Chancres, the primary vulvar lesions of syphilis, may appear on the vulva, vagina, or cervix 10 to 90 days after initial contact. Usually painless, they start as papules that then erode, with indurated, raised edges and clear bases. Condylomata lata, highly contagious secondary vulvar lesions, are raised, gray, flat topped, and commonly ulcerated. Other findings include a maculopapular, pustular, or nodular rash; headache; malaise; anorexia; weight loss; fever; nausea; vomiting; generalized lymphadenopathy; and a sore throat.
Viral disease (systemic).Varicella, measles, and other systemic viral diseases may produce vulvar lesions.
▪ Give a systemic antibiotic, antiviral, topical corticosteroid, topical testosterone, or an antipruritic, as ordered.
▪ Follow standard precautions.
▪ Teach the patient comfort measures, such as a sitz bath.
▪ Discuss safer sex practices with the patient.
▪ Tell the patient with a sexually transmitted disease that her sexual contacts will also need testing and treatment.
▪ Explain to the patient the cause of vulvar lesions and its treatment.
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Read the full text of these other book chapters:
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
|
More About This Book:
Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7 
|
|
What do you think about the features of this website? Take our user survey and have your say:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
