Vulvar Complaints Research Articles

An Observational Study on Female Genital Dermatoses and the Impact of Chronic Genital Dermatoses on Quality of Life in Adult Females

Abstract Background: Female genital dermatoses (FGD) or vulvar dermatoses are a group of disorders that affect the vulva and contiguous parts. Most of the FGDs can be chronic or recurrent. Effects on Quality of life (QoL) in patients having dermatological conditions are well studied but this is not the case in vulvar dermatoses. Aims: We aimed to study the etiology of genital dermatoses in females attending the Dermatology Out Patient Department (OPD) and to assess QoL in females with chronic FGD (>6 weeks duration). Settings and Design: This was an observational study on female patients with vulvar complaints presenting to dermatology OPD. Both venereal and nonvenereal dermatoses were enrolled. QoL was assessed in females with chronic FGD using a self-administered Dermatological Life Quality Index (DLQI) questionnaire. Statistical Analysis: Sample size was calculated using the formula JOURNAL/ijod/04.03/00076423-202409000-00004/inline-graphic1/v/2024-10-29T111745Z/r/image-tiff Categorical variables were presented as numbers and percentages (%) and continuous variables were presented as mean ± standard deviation (SD) and median. The normality of the data was tested by the Kolmogorov-Smirnov test or non-parametric test. A t-test was used for the estimation of the mean. Results: Ninety-seven patients were included in our study; Vulvovaginal candidiasis was the most common dermatoses (22.6%); Lichen simplex chronicus (11.3%) the commonest non-venereal dermatoses. 57 (58.7%) had chronic FGD, among whom 43 (75.4%) had significant QoL impairment. Conclusions: Infectious etiologies predominated. There was significant impairment in QoL in females with chronic FGD.

Vulvodynia in prepubertal girls: diagnosis.

To identify specific features of vulvodynia in prepubertal girls, highlight potential triggers and concomitant diseases, outline diagnostic criteria is neglected problem in adolescent gynecology. A retrospective study, based on medical records of an outpatient clinic, a cohort of 54 vulvodynia cases was evaluated, aged 3-10 years, seen between January 2016 and July 2018. The study cohort presented with pain (61%), sometimes aggravated at night, pruritus (44%) and a range of other varied and unusual vulvar complaints (26%). Concomitant diseases and/or psychological problems were present in 61% of cases. Overactive pelvic muscles accompanying symptoms like urological or gastrological problems were noted in half of children. Several potential triggers were identified in a third of the cases that were emotionally stressful to the children. From the commencement of symptoms, 93% of the girls have consulted more than one doctor with 43% seeing more than three doctors, without receiving a diagnosis of vulvodynia. A diagnosis of vulvodynia needs to be considered in the absence of vulva pathology with wide range of vulvar pain, pruritus and discomfort. All persistent or recurrent vulvar discomfort must be taken into consideration as a vulvodynia symptom, also various non-specific, worrisome complaints. Comorbid urological and gastrological symptoms associated with overactive pelvic muscles should not be overlooked. Chronic pain can be triggered by the psychological distress in some prepubertal girls. Proper diagnosis may prevent long-term negative sequelae, what emphasizes the need for professional education of healthcare providers in adolescent vulvar pain and discomfort.

26420 Vulvar pain and pruritus secondary to dermatographism: An underrecognized etiology

Vulvar manifestations of dermatographism, which include itching, swelling, burning, and irritation, are not well-documented. Dermatographism is entirely excluded from current vulvar disease guidelines. We present a 23-patient series identified via retrospective chart review, alongside an illustrative case. From 2008-2020, 23 women presenting to a single provider for vulvovaginal complaints were dermatographic on physical examination. Presenting age averaged 42.76 years (range 17-75), with symptom duration of 32.53 months (range 10-72). Among eleven returning patients (M = 11.85 months follow-up; range 0.5-38), 91% (n = 10) reported symptomatic improvement with hydroxyzine treatment. A 35-year-old female presented with 10-month history of severe vulvar pruritus unresponsive to repeated antibiotic and topical steroid therapy. Symptoms impaired her concentration, daily activities, and sleep. Prior biopsies demonstrated mild dermal telangiectasias and attenuation of collagen possibly representing steroid atrophy but no evidence of active inflammatory process or atypia; periodic acid–Schiff stain was negative. Physical examination revealed no vulvar atrophy, erythema, or other dermatologic changes. Notably, the patient demonstrated marked dermatographism with wheal and flare response on her back. She reported improvement of vulvar symptoms within 1 week of initiating hydroxyzine treatment. Three years later, the patient maintains excellent control with hydroxyzine 10 mg nightly. Dermatologists and gynecologists alike should include dermatographism in the differential for vulvar complaints. The simple screening test (tic-tac-toe board drawn on the back) and high responsiveness to antihistamine treatment can prove gratifying to both patients and clinicians. Given the complexity of vulvar pain and itch, an etiology so easily screened and treated warrants consideration.

Dermatographism with vulvar symptoms.

Dermatographism (DG) is characterized by a localized, inducible, wheal-and-flare response along the distribution of mechanical pressure. We report an illustrative case of DG with vulvar symptoms (DG-VS) and review the literature on this rarely recognized but easily treated etiology of vulvar complaints. A 35-year-old woman presented with a 1-year history of vulvar pruritus unresponsive to antifungal, antibacterial, and steroid treatments. A prior punch biopsy was nondiagnostic. Vulvar examination revealed normal architecture and no cutaneous abnormalities. She was markedly dermatographic with a scratch test. DG-VS was diagnosed. The patient achieved complete symptomatic control on low-dose hydroxyzine. She maintains excellent control at 3.5 years. In the literature, a typical patient with DG-VS is of reproductive age, with several years’ history of vulvar symptoms (itching, burning, pain, or swelling) and repeated empiric treatment for infectious/inflammatory etiologies. Exacerbation with sexual activity, menstruation, or wearing tight clothing is characteristic and supports the role of mechanical pressure in inducing focal symptoms. Dermatologic changes to the vulvar skin are rarely noted. DG-VS is diagnosed based on clinical findings, symptom patterns, and a positive scratch test and is treated with antihistamines. DG-VS remains absent from current vulvar disease guidelines. In the complex world of vulvar pain and itch, an etiology so easily screened for and readily treated warrants consideration.

3. SWIFT Accurately Predicts Lichen Sclerosus among Premenarchal Girls

<h3>Background</h3> Prevalence of lichen sclerosus (LS) is 1 in 900 in premenarchal girls. Clinical presentation is elusive, and diagnosis can be challenging. Early identification of LS increases the likelihood of timely and effective treatment. We therefore sought to create a risk-stratification tool to help guide clinical diagnosis in cases of suspected LS in premenarchal girls presenting with vulvar complaints. <h3>Methods</h3> This study utilized retrospective chart review of patients seen at the pediatric and adolescent gynecology clinic in a tertiary hospital between July 2019 and September 2020. Patients were included if they were ≤ 13 years old, were premenarchal, and had vulvar complaints. History, physical exam, and genital culture results were documented across 26 variables. LS diagnosis was made based on history, physical exam and vulvar biopsy in few cases. A comprehensive logistic regression was constructed comprising all variables with LS diagnosis as a dichotomous outcome. Following a step-wise regression procedure on complete-records observations, surviving predictor variables were tuned so as to maximize accuracy in predicting LS status. Pursuant to this model discovery, the data were randomly partitioned into a separate training set and testing set (1:1 allocation). This prediction was iterated 500 times. Statistical analysis was completed using R (v.4.0.0). Study was approved by the institutional review board. <h3>Results</h3> In total, 81 patient visits met inclusion criteria with 69 unique patients. Among the 69 patients, 19 were diagnosed with LS and 50 were diagnosed with other diseases including but not limited to straddle injury, acute vulvovaginitis, sexual abuse, and vulvar irritation. Average age of patients was 6 years old (0-13 years old; Table 1). The optimal regression model included five predictors: Soreness/Pain (S), Whitening (W), Urinary Incontinence (I), Fissures (F), and Clitoral hood thickening (T). The most accurate model using predictive training-testing approach is logOdds(LS) = -71 + 47•S + 83•W + 48•I + 41•F + 30•T with a model accuracy of 96.6% (Figure 1). <h3>Conclusions</h3> Using statistical modeling, we identified five predictors for LS including soreness/pain (S), whitening of the skin (W), urinary incontinence (I), fissures (F), clitoral hood thickening (T; SWIFT). We developed a model for predicting LS with 96.6% accuracy among premenarchal patients presenting with vulvar complains. If future studies involving diverse population show replicability of this model, clinicians should consider using this model to stratify patients for risk of LS.

Candida Vajiniti Tedavisinde Umut: İbreksafungerp

Candida vaginitis (CV) is a neglected but growing public health problem. It is estimated that three out of four women have had at least one CV attack. The diagnosis and treatment of CV is often inadequate due to the tendency of women to self-diagnose and use over-the-counter drugs when they have vaginal or vulvar complaints, and clinicians plan treatment only according to clinical findings. There are limitations regarding the safety and efficacy of oral azoles, which are primarily preferred for the treatment of vaginitis, and these drugs have not revealed the desired levels of clinical or mycological cure. Also, there are a few options for current drugs used for treatment are not numerous the development of new antifungal drugs is thus urgently needed. Ibrexafungerp (IBX) is a semisynthetic triterpenoid glucan synthase inhibitor derived from enfumafungin. IBX has been shown to be a promising oral antifungal in the treatment of acute CV, and its use was approved on June 1, 2021. IBX is remarkable by it’s high oral bioavailability, low risk of side effects, few drug-drug interactions, good tissue penetration, increased activity at low pH in the vagina, and efficacy with regard to multi-drug-resistant fungi. In this review, in vitro and in vivo data on IBX were evaluated and compiled in light of current knowledge.

Comparison of Short-Duration and Chronic Premenarchal Vulvar Complaints.

To compare clinical characteristics, treatment histories, and microbiology of premenarchal girls who presented to a pediatric gynecology specialty clinic with short-duration and chronic vulvar symptoms. Retrospective cohort study. Pediatric and adolescent gynecology clinic at a tertiary care children's hospital. One hundred eighty-two premenarchal patients ages 2-14years who presented to a pediatric gynecology specialty clinic with vulvar complaints and who were evaluated with a yeast and/or bacterial culture. None. Chronic and short-duration vulvar symptoms, microbiology, and diagnosis. Patients with chronic symptoms were more likely to present with itching (59/102 (57.8%) vs 34/80 (42.5%); P=.04), redness or rash (53/102 (52.0%) vs 22/80 (27.5%); P=.0009), and discomfort (59/102 (57.8%) vs 30/80 (37.5%); P=.006), compared with patients with short-duration symptoms. Overall, 44.5% of patients had a history of antifungal treatment, with a greater proportion of patients with chronic symptoms having received antifungal treatment compared with those with short-duration symptoms (53/102 (52.0%) vs 28/80 (35.0%); P=.02). Despite a history of antifungal treatment in nearly half of the patients, Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were positive in 75/159 (47.2%), and there was no difference among the symptom duration groups (38/71 (53.5%) vs 37/88 (42.1%); P=.15). Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with short-duration and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely positive. Antifungal treatment should be avoided in toilet-trained prepubertal girls.

Vulvar Lesions in the Pediatric Patient

Vulvar lesions are a common complaint for which pediatric patients seek medical attention. Please refer to the chapter on Prepubertal Vulvovaginitis for more details. A careful history and physical exam, including full skin exam should be performed when pediatric and adolescent patients present with vulvar complaints. The chief complaint and chronicity of the symptoms can narrow the differential. The chronicity and areas of dermatologic involvement can also be key to diagnosing a systemic condition versus a primary vulvar dermatosis. When the latter is assumed, a referral to an appropriate specialist such as a Pediatric and Adolescent Gynecologist or Dermatologist should be considered. Treatment for vulvar dermatoses should be etiology dependent with consideration of systemic treatment as appropriately indicated. Vulvar hygiene should be considered in all patients as restoring the skin barrier and removing potential irritants is imperative to healing and preventing further irritation. This review contains 1 figure, 2 tables, and 25 references. Keywords: vulva, vulva dermatosis, vulvovaginitis, lichen sclerosus, atopic dermatitis, psoriasis, streptococcus vulvovaginitis, irritant dermatitis, contact dermatitis

Vulvar Lesions in the Pediatric Patient

Vulvar lesions are a common complaint for which pediatric patients seek medical attention. Please refer to the chapter on Prepubertal Vulvovaginitis for more details. A careful history and physical exam, including full skin exam should be performed when pediatric and adolescent patients present with vulvar complaints. The chief complaint and chronicity of the symptoms can narrow the differential. The chronicity and areas of dermatologic involvement can also be key to diagnosing a systemic condition versus a primary vulvar dermatosis. When the latter is assumed, a referral to an appropriate specialist such as a Pediatric and Adolescent Gynecologist or Dermatologist should be considered. Treatment for vulvar dermatoses should be etiology dependent with consideration of systemic treatment as appropriately indicated. Vulvar hygiene should be considered in all patients as restoring the skin barrier and removing potential irritants is imperative to healing and preventing further irritation. This review contains 1 figure, 2 tables, and 25 references. Keywords: vulva, vulva dermatosis, vulvovaginitis, lichen sclerosus, atopic dermatitis, psoriasis, streptococcus vulvovaginitis, irritant dermatitis, contact dermatitis

No. 385-Indications for Pelvic Examination.

No. 385-Indications for Pelvic Examination.

Prepubertal Vulvovaginitis

Vulvar and vaginal irritation/redness and vaginal discharge are common referrals to the pediatric and adolescent gynecologist. In nearly 75% of cases the etiology of the pre-pubertal patient’s signs and symptoms is non-specific and resolves with proper vulvar hygiene. Infections, ulcerations, labial adhesions, foreign bodies, constipation, voiding dysfunction, and trauma are other causes of vulvar and vaginal complaints. Gathering a detailed history and performing a thorough physical exam help to determine the etiology and best treatment. Staphylococcal aureus and Streptococcus pyogenes infections are frequently isolated on vaginal cultures and treated with organism specific antibiotics. Ulcerations are usually from a self-limiting viral infection (EBV, CMV, influenza) and heal with supportive cares—acetaminophen and sitz baths. Labial adhesions recede with topical estrogen cream in up to 89% of cases and rarely need surgical separation. When vulvovaginitis persists despite hygiene measures and no evidence of infectious etiology assessment and treatment of constipation and voiding dysfunction can provide relief of symptoms. This review contains 1 table and 28 references. Key words: Vulvovaginitis, vulvar hygiene, vagina hygiene, vaginal infection, labial adhesions, vulvar trauma, genital ulcer, vaginal foreign body, constipation, pre-pubertal voiding dysfunction

Clinical and epidemiological profile of patients attended in a vulvar clinic of the dermatology outpatient unit of a tertiary hospital during a 4-year period.

Vulvar complaints are among the most frequent causes for a woman to visit a healthcare provider. The diseases of this area of the body may be a challenge to diagnose. In this study, we assess epidemiologic and clinical data of patients in an outpatient vulvar clinic in the dermatology department of a tertiary hospital. We performed an observational retrospective study of patients who attended our consultation service for vulvar diseases at the Dermatology Division at Hospital das Clínicas da Faculdade de Medicina da USP during a 4-year period. Data were obtained by patient medical records and by phone. During the 4-year period under study, a total of 136 patients were treated in the outpatient service specialized in vulvar care. All patients were included in the study. The most frequent diagnoses were lichen sclerosus et atrophicus (64.7%), lichen planus (8.8%), and vitiligo (8%). We registered that 26.7% of the patients showed extravulvar involvement. Women with vulvar diseases need specific care, considering not only genital aspects but also all skin changes. In this context, the dermatologist is a very well trained professional to take good and complete care of these patients. However, ideally vulvar clinics should have a multidisciplinary team.

Allergic Contact Dermatitis of the Vulva.

Allergic contact dermatitis is an important diagnostic consideration in the evaluation of patients presenting with vulvar complaints. The high prevalence of contact sensitization in the vulvar region is likely multifactorial. We review the extant literature regarding key predisposing factors in the pathogenesis of vulvar allergic contact dermatitis, as well as the most commonly implicated allergens as identified by a number of retrospective studies and case series. On the basis of our findings, we provide diagnostic and therapeutic recommendations for practicing clinicians.

Non venereal benign dermatoses of vulva in sexually active women: a clinical study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Vulvar complaints are usually an uncomfortable discussion not only for the patient but also for the health care provider. Vulva remains one of the most covered regions of the body and seems truly to be a forgotten pelvic organ. Any genital lesion or related symptoms are erroneously considered to be sexually transmitted. Hence this study was conducted to emphasize on the fact that all genital lesions are not sexually transmitted. Objective of the study was to determine the clinical pattern and relative frequency of non-venereal benign dermatoses of vulva in sexually active women at a tertiary health care centre.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a prospective, observational study. All sexually active women attending the outpatient department of Dermatology and Gynecology, who presented either with vulvar complaints or with vulvar dermatoses on routine clinical examination were included in the study. Women with six classical venereal diseases or with vulvar malignancies were excluded from the study. After detailed history &amp;amp; examination, results were tabulated and analysed by SPSS software.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 70 sexually active women were observed. Majority of women were from rural background (54.28%), were housewives (81.42%) and were illiterate (42.85%). The commonest presenting feature was itching. Labia majora was the most common site of involvement and Tinea cruris was the most common dermatoses involved.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; All vulvar dermatoses are not sexually transmitted.

Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?

Topical remedies based on botanical ingredients are popular. To assess: (i) the usage of botanical substances in subjects affected with itching and chronic vulvar complaints; (ii) the incidence of side-effects associated with their use and the frequency of contact allergy; (iii) the diagnostic usefulness of patch testing. Sixty-six patients were provided with a questionnaire to assess the prevalence and type of topical botanical preparations used and the occurrence of adverse reactions. Patients were patch tested with (i) the Italian baseline series, (ii) a topical medicament series, and (iii) a botanical series. Forty-two patients (63.6%) reported the use of natural topical products on the vulva. Seven (16.7%) noted adverse reactions; 27 showed positive reactions with the baseline series; 14 (21.2%) had at least one relevant reaction, mainly to allergens in topical products and cosmetics; and 2 (3%) showed positive reactions to the botanical series. Of the 7 patients complaining of adverse effects of botanical products, 3 (42.8%) showed relevant sensitization. The use of natural topical products is widespread among women affected with itching vulvar diseases. Contact dermatitis is a possible adverse effect. Botanical series are of questionable usefulness, owing to the wide variety of botanical ingredients.

Comparison of Short and Chronic Duration Premenarchal Vulvar Complaints

Abstract Study Objective To compare clinical characteristics, treatment histories, and microbiology of premenarchal girls presenting to a pediatric gynecology specialty clinic with short-duration and chronic vulvar symptoms. Design Retrospective cohort study Setting Pediatric and adolescent gynecology clinic at a tertiary care children’s hospital Participants One hundred eighty two premenarchal patients ages 2-14 years presenting to a pediatric gynecology specialty clinic with vulvar complaints and evaluated with a yeast and/or bacterial culture Interventions None Main Outcome Measures: Chronic and short duration vulvar symptoms, microbiology, and diagnosis. Results Patients with chronic symptoms were more likely to present with itching (57.8% v 42.5%, p=0.04), redness or rash (52.0% v 27.5%, p=0.0009), and discomfort (57.8% v 37.5%, p=0.006), compared to patients with short-duration symptoms. Overall 44.5% of patients had a history of antifungal treatment, with a greater proportion of patients with chronic symptoms having received antifungal treatment compared to those with short-duration symptoms (52.0% v 35.0%, p=0.02). Despite a history of antifungal treatment in nearly half of patients, Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were positive in 75/159 (47.2%), and there was no difference among the symptom duration groups (53.5% v 42.1%, p=0.15). Conclusions Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with both short-duration and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely positive. Antifungal treatment should be avoided in toilet trained prepubertal girls.

Spectrum of Vulvar Lesions in an Obstetrics and Gynecology Outpatient Clinic

Wide range lesions may occur in the vulvar region. The aim of the present study is to have an insight into the diverse morphologic spectrum of vulvar lesions. Total of 263 patients with primary vulvar complaints seen in Ankara Numune Training and Research Hospital Gynecology and Obstetrics Outpatient Clinic were recruited into study. The present retrospective study was carried out by compiling the data from archival records from January 2010 to May 2014. The vulvar biopsies specimens were studied for histomorphological features. The lesions were categorized as non-neoplastic, neoplastic and inconclusive; neoplastic ones were further divided into benign, malignant and premalignant.The age of the women ranged from 11 to 85 years (mean 46.27±14.32) with the maximum number of patients between 41 to 50 years of age. Most common clinical presentation was itching (126 cases; 47.9%). The commonest site of vulvar lesions was labia majora (145 cases, 55.1%). Non neoplastic lesions were more common (n = 172; 65.4%) than the neoplastic lesions (n =91; 34.6%). There were 81 (30.8%) benign lesions while 10 cases (3,8%) were malignant or premalignant ones. Amongst the non-neoplastic lesions, the most common histopathologic diagnosis was of lichen sclerosus et atrophicus (46 cases; 17,5%). Early recognition of vulvar lesions and a prompt biopsy diagnosis for all lesions with suspicious changes is of great significance.

Benign vulvar tumors

In the last few decades, gynecological visits for vulvar conditions have increased, often for symptoms of vulvar itching and burning. Although benign vulvar tumors are an uncommon condition of the lower genital tract, it is important to consider these tumors in the differential diagnosis of vulvar complaints. To date, there is no accepted classification for benign tumors. However, these tumors can be differentiated by clinical criteria, such as benign cystic and solid tumors. Common benign tumors of the vulva include the Bartholin gland cyst or abscess, epidermoid inclusion cysts, and angiomas. Many benign vulvar tumors are asymptomatic and are found only on self-examination. Depending on the type of lesion, most do not require excisional treatment. It is important for the gynecologist to differentiate between benign and malignant lesions as malignant tumors require proper treatment.

Cutaneous Vulvar Streptococcal Infection

This study aimed to determine the etiology of fine superficial fissures in women with vulvar pain. The charts of women with vulvar complaints seen in the Mucosal Disorders Clinic at Northwestern University between April 2006 and May 2008 were reviewed. Outcome measures included mucocutaneous examination findings and results of microbiological swab cultures in the presence of fine, superficial, vulvar and/or perianal fissures. The presence of concomitant vulvar disorders was noted. Sixteen women who presented with vulvar pain were found to have fine, superficial, vulvar and/or perianal fissures with minimal or no erythema on examination. None had inflammatory vaginitis. Group B β-hemolytic streptococcus (Streptococcus agalactiae) was recovered in 6 (37.5%) patients. All women with group B β-hemolytic streptococcus-positive cultures had a concomitant vulvar disorder; however, fissures were present despite appropriate treatment directed at the concomitant vulvar dermatosis. Three patients reported improvement in vulvar pain after treatment with antibiotics, and fissures had resolved by the time of follow-up examination in these 3 patients. Group B β-hemolytic streptococcus may cause painful fine superficial fissures and minimal erythema of vulvar skin. Obtaining microbiological cultures should be considered in the evaluation of vulvar pain even in the absence of purulent inflammatory vaginitis. The search for documentation and treatment of this relevant pathogen is a departure from published recommendations.

Role of Vulvar Care Guidelines in the Initial Management of Vulvar Complaints

This study aimed to determine the effectiveness of vulvar care guidelines as the initial treatment of vulvar complaints. A chart review was conducted at the Saint Louis University Vulvar and Vaginal Disease Center. Women with vulvar symptoms in the absence of specific identifiable causes were evaluated and given guidelines for vulvar care. An 11-point Likert scale was used to rate symptoms at the initial and follow-up visits. Compliance level was determined. A decrease in mean scores was shown for dyspareunia (7.5 ± 2.0 to 4.6 ± 3.1, p < .001), burning after intercourse (6.8 ± 2.7 to 3.4 ± 2.4, p = .10), vulvar burning (5.7 ± 2.6 to 2.1 ± 1.9, p < .001), vulvar itching (4.9 ± 2.8 to 2.5 ± 2.6, p < .001), and vulvar pain (5.8 ± 2.8 to 2.2 ± 3.0, p < .01). The mean dyspareunia difference scores were significant between the low- and high-compliance groups. Vulvar care guidelines are successful for the management of vulvar complaints.