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A recent blog post discussed the importance of looking for skin dysfunctions near the vulva during pelvic muscle examinations. The logical question might be, "what would it look like if the tissue was unhealthy?" I was able to locate a very helpful article for illustrating some variances in tissues. Catherine Drummond, Australian dermatologist, has written a succinct article that includes excellent images to help the reader understand the various clinical presentations of vulvar skin disorders. (The article can be found by clicking here.) Specifically the article discusses inflammatory vulval dermatoses that present as rashes.

 

Presentations of vulvar dermatoses discussed include those that are erythematous, those with pallor, and those presenting as erosions or ulcers. Hopefully we are not the first person to notice an ulceration or disease process, yet many patients are referred for "pelvic pain" without having a thorough assessment or pelvic examination. In this article there is a chart listing common vulval irritants such as detergents, urinary or fecal discharge, hair removal, lubricants or condoms, pads, tight clothing (including thong underwear), cycling, and swimming. You will also find a list of common corticosteroids used for vulvar care. I found this list helpful as I had a patient last week asking me if she should be applying hydrocortisone cream to her vulvar area. (I deferred the question to her provider.) Keep in mind that unless you ask, you might not know what a patient is applying to the tissues. This same patient found another topical recommended "on the internet" that she started using, without first checking with her medical care providers.

 

Although some of the article is most relevant for the practicing gynecologist or dermatologist, much of the information is very helpful to us in our role of pelvic rehabilitation provider. The bottom line is that if we do not look, we won't see it. And if we do see something of concern, the more information that we can document, or provide to the provider and to the patient, the more we can be of value when working as part of a team.

 


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Finding the Driver in Pelvic Pain - Milwaukee, WI
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