Dermatological conditions of the female genitalia

Abstract

Introduction Disorders of the skin in the vulval area can present at any stage of life. A young child may be unable to describe changes in skin sensation and a pubertal child may not be sure what is normal and what is abnormal at a time when so many bodily changes are occurring. Vulval disease in children and adolescents may, therefore, present late and hence be diagnosed slowly. There may be misconceptions that vulval disease is a result of poor hygiene and hence a feeling of shame or embarrassment, which can result in a further delay to presentation. The causes are multiple (Table 35.1). As in adults, the most common symptoms of vulval disease are itch and pain. In children, these may mainly be noticed by parents as a change in behaviour, for instance a reluctance to go to the toilet, as that produces pain, a wish for certain clothes that do not press on the vulval skin, or rubbing and scratching. Careful examination of the vulval skin, the vagina, where possible, the oral mucosa and the rest of the skin and appendages can give many clues to the possible diagnosis of vulval skin disease. Common and some rare causes of vulval symptoms are listed in Table 35.2 and the signs of vulval disease shown in Table 35.3. Infections Streptococcal infection Definition, epidemiology and aetiology Streptococcal infection of the vulval area is not uncommon and can present at any age, but most commonly prepubertally (Dhar et al., 1993).