VULVAR
DYSTROPHY
Vulvar dystrophy is a condition found in older women
thatcauses dry, thickened skin on the vulva or slightly raised, whitish
papules, fissures, or macules. Symptoms usually consist of varying degrees of
itching, but some patients have no symptoms. A few patients with vulvar cancer
have associated dystrophy. Biopsy with careful follow-up is the standard
intervention. Benign dystrophies include lichen planus, simplex chronicus, lichen sclerosus, squamous cell hyper-plasia, vulvar vestibulitis, and other
dermatoses (Chart 47-5).
Topical
corticosteroids (ie, hydrocortisone suppositories) are the usual treatment for
lichen planus. Petrolatum jelly may relieve pruritus. Use is decreased as
symptoms abate. Topical cortico-steroids are effective in treating squamous
cell hyperplasia. Treat-ment is often complete in 2 to 3 weeks; this condition
is not likely to recur after treatment is complete.
If
malignant cells are detected on biopsy, local excision, laser therapy, local
chemotherapy, and immunologic treatment are used. Vulvectomy is avoided, if
possible, to spare the patient from the stress of disfigurement and possible
sexual dysfunction.
Key
nursing responsibilities for patients with vulvar dystrophies focus on
teaching. Important topics include hygiene and self-monitoring for signs and
symptoms of complications.
Instructions for patients with be-nign vulvar dystrophies include the importance of maintaining good personal hygiene and keeping the vulva dry. Lanolin or hy-drogenated vegetable oil is recommended for relief of dryness. Sitz baths may help but should not be overused because drynessmay result or increase.
The patient is instructed to notify her pri-mary health
care provider about any change or ulceration because biopsy may be necessary to
rule out squamous cell carcinoma.
By
encouraging all patients to perform genital self-examinations regularly and
have any itching, lesions, or unusual symptoms assessed by a health care
provider, nurses can help prevent com-plications and progression of vulvar
lesions.
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