Vulvar Dystrophy

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).

Medical Management

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.

Nursing Management

Key nursing responsibilities for patients with vulvar dystrophies focus on teaching. Important topics include hygiene and self-monitoring for signs and symptoms of complications.

PROMOTING HOME AND COMMUNITY-BASED CARE

Teaching Patients Self-Care. 

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.