Vulva, Vagina and Perineum

Abstract

The vulva and vagina are involved by trauma, primary and secondary infections, dermatoses and neoplasia. Poor personal hygiene, chemical irritation and the spread of disease from the perineum and anus can all give rise to pain. The vulva is prone to be a site of irritation, which is in essence subliminal pain. In addition the vulval skin and vaginal mucosa are hormone sensitive and undergo the maturation changes of puberty, cyclical menstrual changes and atrophic changes after the menopause. The vulva is particularly sensitive to touch and pain, the vagina is less so, and the cervix is virtually insensitive. The possibility of direct inspection and examination of discharges and of tissues permits accurate diagnosis of pain. Conditions in which vaginal discharge is the predominant problem are more difficult to diagnose and resolve, in part because they are likely to be recurrent.