Vulvar lesions
Vulvar lesions: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
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.
History
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? Could she have been exposed to a sexually transmitted disease (STD)?
Physical assessment
Examine the lesion, perform a pelvic examination, and obtain cultures. (See Recognizing common vulvar lesions.) Examine the rest of the skin for rashes and lesions.
Medical causes
Basal cell carcinoma
Most common in postmenopausal women, basal cell carcinoma is a nodular tumor that has a central ulcer and a raised, poorly rolled border. Although it typically doesn’t produce symptoms, the tumor may occasionally cause pruritus, bleeding, discharge, and a burning sensation.
Benign cysts
Epidermal inclusion cysts, the most common benign vulvar cysts, appear primarily on the labia majora, are usually round, and typically produce 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.
Genital warts
Genital warts is an STD that produces painless warts on the vulva, vagina, and cervix. Genital warts 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
With 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 with gonorrhea are asymptomatic. Other findings include dysuria and urinary incontinence; vaginal redness, swelling, bleeding, and engorgement; and severe pelvic and lower abdominal pain.
Herpes simplex (genital)
With genital herpes simplex, fluid-filled vesicles appear on the cervix and, possibly, on the vulva, labia, perianal skin, vagina, or mouth. The vesicles, initially painless, may rupture and develop into extensive, shallow, painful ulcers, with redness, marked edema, and tender inguinal lymph nodes. Other findings include fever, malaise, and dysuria.
Molluscum contagiosum
Molluscum contagiosum is a viral infection that produces raised vulvar papules that are 1 to 2 mm in diameter and pearly or flesh colored with umbilicated centers, and that have a white core. Pruritic lesions may also appear on the face, eyelids, breasts, and inner thighs.
Pediculosis pubis
Infection with pediculosis pubis produces erythematous vulvar papules with pruritus and skin irritation. Adult pubic lice and nits are visible on pubic hair with magnification.
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
Squamous cell hyperplasia are vulvar lesions that 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 of squamous cell hyperplasia. 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. The characteristics of the lesions depend on the particular viral infection.
Special considerations
Expect to administer a systemic antibiotic, an antiviral, a topical corticosteroid, a topical testosterone, or an antipruritic.
Pediatric pointers
Vulvar lesions in children may result from congenital syphilis or gonorrhea. Evaluate for sexual abuse.
Geriatric pointers
Vulvar dystrophies and neoplasia increase in frequency with advancing age. All vulvar lesions must be suspected of being malignant until proven otherwise. Also, many women remain sexually active well into their older years and may come from a time when STDs weren’t openly discussed. These patients should be questioned about sexual activities and educated about safer sex practices.
Patient counseling
Show the patient how to give herself a sitz bath to promote healing and comfort. If she has an STD, encourage her to inform her sexual partners and persuade them to be treated. Advise her to avoid sexual contact until the lesions are no longer contagious. Provide information on safer sex practices.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
More About Vaginitis
More Medical Textbooks Online about Vaginitis
Review other book chapters online related to Vaginitis:
Medical Books Excerpts
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Vaginal bleeding, postmenopausal (Signs & Symptoms: A 2-in-1 Reference for Nurses)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
