There are many causes of skin irritation in the female vulvar tissues. Bacterial or yeast infections, skin pH imbalances, diseases, contact dermatitis, and many others. How often are we as pelvic rehabilitation providers really looking for these issues? Do you take extra care to gently open the labia so that you can view the vulvar area including the vestibular tissues? It was impressed upon me while I listened to a lecture by Holly Herman, one of the founders of the Herman & Wallace Pelvic Rehabilitation Institute, that I could do a much better job of really investigating these tissues.
During lectures Holly describes her methods of examination that include use of a bright light along with careful inspection of the perineal skin and tissues leading into the vaginal opening. A proper referral may then be made if it appears that some medical intervention is warranted. So how do we know what is "normal?" As a physical therapist, how did I learn what a "normal" knee joint ligament felt like? You have to test a lot of knees to build the experience of learning a range of knee joints. Similarly, you have to begin inspecting the area to develop your own database of healthy-appearing skin versus tissue that leads you to be concerned. In addition, I have included in this post some resources that I found informational.
Do you have a dermatologist to whom you can refer a patient with pelvic pain? I found this "Skin Therapy Letter" helpful in identifying the role of the dermatologist in pelvic rehabilitation. Vulvar lichen planus and vulvar lichen sclerosus are 2 conditions that a provider needs to be looking for, here is an image from a family practice article of a patient who has lichen sclerosus. The International Society for the Study of Vulvovaginal Disease (ISSVD) is also a helpful resource for some basic information about lichen sclerosus and lichen planus. There are many skin conditions other than these that a patient may seek treatment for, yet these are conditions about which I often hear questions from students and therapists. The message to take to the clinic is that it is very important to inspect for healthy, pink, uniform-appearing tissues that are pliable and non-painful to touch or stretch. The more we are aware of the possibility of such skin conditions, the better we can serve as part of a team in caring for our patients.