Common benign chronic vulvar conditions include genitourinary syndrome of menopause (formerly called vulvovaginal
atrophy),
lichen sclerosus,
lichen planus,
lichen simplex chronicus, and
vulvodynia. Genitourinary syndrome of menopause results from the hypoestrogenic state that leads to
atrophy of normal vulvar and vaginal tissues. It is typically treated with
lubricants, moisturizers, and intravaginal
estrogen.
Lichen sclerosus is an inflammatory condition characterized by intense vulvar
itching. It is treated with topical
steroids or, in some cases, topical
calcineurin inhibitors. Patients with
lichen sclerosus are at risk of vulvar
squamous cell carcinoma and should be monitored closely for
malignancy.
Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and vagina in addition to other skin and mucosal surfaces. The first-line treatment is topical
steroids, and significant
scarring can occur if left untreated.
Lichen simplex chronicus manifests as persistent
itching and scratching of the vulvar skin that leads to thickened epithelium. Breaking the itch-scratch cycle, often with topical
steroids, is the key to treatment.
Vulvodynia is a common vulvar
pain disorder and is a diagnosis of exclusion. A
multimodal treatment approach typically includes vulvar hygiene,
physical therapy, psychosocial interventions, and antineuropathy medications.