Vulvar dysplasia is a pathology of the female genitals characterized by a change in the morphological structure of the multilayer flat epithelium of the external genitalia.
The content of the article:
Causes of vulvar dysplasia
Symptoms of vulvar dysplasia
Diagnosis of vulvar dysplasia
Treatment of vulvar dysplasia
Prognosis and prevention of vulvar dysplasia
Vulvar dysplasia
Causes of vulvar dysplasia
The main factor provoking the development of vulvar dysplasia is the human papillomavirus (especially its 16th and 18th species, which are considered oncogenic), which persists in the body for a long time. HPV-16 and HPV-18 are anogenital viruses that most often cause cervical cancer, so they are always under the close attention of gynecologists.
Often, vulvar dysplasia is a disease accompanying cervical dysplasia (cervical intraepithelial neoplasia). In addition, it becomes a consequence of chronic inflammatory processes occurring in the genitals:
vulvitis (inflammation of the external genitalia);
bartholinitis (inflammation of the gland of the vestibule of the vagina);
colpitis (inflammation of the vagina).
Neuroendocrine disorders against the background of age-related changes can also activate the division of squamous epithelial cells. Weakened immunity, as well as an imbalance of metabolic processes, can also play a role.
Finally, vulvar dysplasia can occur in women who have started an intimate life too early and have promiscuous sexual relations.
Symptoms of vulvar dysplasia
In some cases, this disease is asymptomatic and is detected only during a gynecological examination. The most obvious sign of vulvar dysplasia (especially caused by HPV) is a specific form of warts on the external genitalia, as well as on the anus. In this case, there may be several affected areas.
With moderate to severe degrees of vulvar dysplasia, the patient may experience itching in the area of the external genitalia, passing to the vagina or anus. Pain in these areas is not excluded. However, these signs do not directly indicate vulvar dysplasia: these may be symptoms of colpitis or vaginitis. Therefore, vulvar dysplasia is very difficult to recognize at the initial stages without a detailed examination.
Edema and discharge occur when vulvar dysplasia is accompanied by infections or bacteria that cause inflammation. There may also be symptoms of kraurosis (atrophy of the skin and mucosa) or leukoplakia (the appearance of dryness, whitish plaque or plaques, ulcers).
This is facilitated by an anomaly in the development of epithelial cells. This disease has other names:
atypical vulvar hyperplasia;
squamous vulvar intraepithelial neoplasia.
In a normal state, all epithelial cells are the same in shape and size. However, with dysplasia, they begin to differ. In addition, the nuclei of these cells undergo changes. There is an active cell division (proliferation). Because of this, there is a risk of degeneration of dysplasia into a more serious disease – vulvar cancer. As a rule, this pathology occurs in patients older than 40 years. However, recently, women of reproductive age also have such a violation.
There are three degrees of vulvar dysplasia:
Easy. Lesion of no more than 30% of the epithelial layer, insignificant changes in its lower layer.
Moderate. The defeat of 60% of the epithelial layer.
Heavy. The defeat of the entire epithelial layer with the transformation of the cell nucleus.
It is worth noting that with severe vulvar dysplasia, we are talking about a non-invasive tumor that does not affect the basement membrane and stroma.
Diagnosis of vulvar dysplasia
The study of vulvar dysplasia begins with a gynecological examination. Perhaps visual techniques will not be enough, then the doctor will use a colposcope, which will help to identify a more accurate picture of the disease. In addition, a Schiller test is often carried out, implying an iodine test that will show which areas have been affected. All three methods in a complex make it possible to diagnose with the greatest accuracy, because vulvar dysplasia due to asymptomatic course is often difficult to determine.
Since vulvar dysplasia is often caused by HPV, the examination may be aimed at establishing the presence of this virus. It is worth taking the appropriate analysis regularly after the age of 26: before that, the body has the opportunity to actively fight HPV. By the way, in the presence of diseases of the cervix, it is also recommended to undergo a study for the human papillomavirus.
If the doctor suspects vulvar dysplasia, he conducts a cytological examination of epithelial cells. When the diagnosis is confirmed, in order to exclude the development of cancer, a biopsy is performed, followed by a histological examination of the obtained material.
As a rule, in addition to the gynecologist, an oncologist, a venereologist and a dermatologist are connected to the diagnosis.
Treatment of vulvar dysplasia
The treatment of each individual case is an issue that can be solved on a purely individual basis. This disease belongs to the category of chronic, in addition, it can be accompanied by a number of other ailments. Thus, the treatment of vulvar dysplasia should be carried out comprehensively.
Conservative treatment is aimed at reducing the disease to remission and its further elimination. The following medications may be prescribed for these purposes:
desensitizing;
sedatives;
general strengthening;
hormonal;
antiviral (in case of HPV detection).
It may also require therapy aimed at stabilizing the reactions of the immune system. Doctors came to the conclusion that when signs of leukoplakia appear, it makes sense to stop conservative treatment, since it will no longer bring a lasting effect.
If the vulvar dysplasia has reached a severe form, surgical intervention is not excluded. Young patients may be offered an alternative:
removal of small foci by laser;
treatment with liquid nitrogen;
treatment by radio wave method.
The use of these methods is permissible with a mild form of the disease and small sizes of foci. If the lesions are large, then surgical excision of the damaged areas will be the way out.
Vulvectomy is prescribed if:
vulvar dysplasia has become severe;
the lesions are extensive;
there are relapses;
the patient has entered the age close to the onset of menopause (or it has already occurred).
After surgery, plastic surgery is prescribed to restore the normal appearance of the genitals.
Photodynamic therapy deserves attention as an organ-preserving method of treating vulvar dysplasia. As part of this therapy, the dysplastic cells of the vulva accumulate photosensitized dye. In the future, a light wave of a certain length will selectively destroy these cells.
Treatment is always carried out in a hospital setting. Upon its completion, a medical examination is required to monitor the results, including cytological examination.
Prognosis and prevention of vulvar dysplasia
Preventive measures include:
avoiding casual connections;
contact contraception;
compliance with intimate hygiene;
regular visits to the gynecologist;
periodic HPV testing.
Proper nutrition and rejection of bad habits also reduce the threat of developing this disease.
Patients who have been treated for vulvar dysplasia should strictly follow the recommendations of the attending physicians in order to avoid relapse. Chronically infected areas of the vulva should be treated regularly with prescribed remedies. If dysplasia has reached a severe degree, the patient must necessarily register with an oncologist.
Forecasts in the case of this disease can be very different. It happens that vulvar dysplasia regresses. Having received adequate treatment, the disease, as a rule, stabilizes and does not develop further. In more serious cases, there is a threat of developing cancer. Therefore, it is not necessary to refuse surgical intervention if the doctor saw the reasons for it.
