Vulval conditions, in images

A variety of conditions can affect the female genital area. Jean Watkins describes some of the most common and discusses treatment options and outcomes.

Contact dermatitis

Nappy rash in babies is a common problem that is easily recognised by glazed, inflammed areas over the convex surfaces of the skin in the nappy area. It does not affect the deeper flexures. Scaling can develop with time. Changes are due to contact with irritants such as urine, faeces and friction. No testing is required unless the diagnosis is uncertain or there is concern about secondary infection or allergies. The problem should improve if nappies are left off as often as possible and/or the child is changed quickly after wetting or soiling. Mild cases are usually controlled by applying a barrier preparation, such as zinc and castor oil to the area, plus topical 0.1-1% hydrocortisone for up to a week, if the rash is uncomfortable or itchy. Adults, often with a history of atopic dermatitis, can also be incontinent, or develop allergies to soaps, detergents or other substances. If an allergy is identified by skin testing, the offending substance can be avoided. When examining the perineum or performing a vaginal examination, it is wise to offer the woman a chaperone.