Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa; and Florida Hospital for Women, Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida.
Obstet Gynecol. 2018 Feb;131(2):371-386. doi: 10.1097/AOG.0000000000002460.
Vulvar symptoms of pain, dyspareunia, and pruritus are common and may significantly affect a woman's sense of well-being and sexual function. Despite this, vulvar symptoms are often underreported by women. When identified, however, vulvovaginal symptoms should be addressed by health care providers to optimize care. The evaluation of patients with vulvovaginal complaints begins with a thorough history and physical examination. Biopsy is indicated when concern exists for malignancy or the diagnosis is uncertain. Treatment, if possible, should be evidence-based, although for many vulvar disorders including vulvar dermatoses, treatment is based on limited evidence and anecdotal experience. Although many vulvar dermatoses represent chronic conditions and thus cannot be simply cured, control is possible for the majority of women. Patient education regarding vulvar hygiene and skin care is the foundation for optimal management of inflammatory vulvar dermatoses. These conditions may be triggered or worsened by aggressive hygiene. Additionally, patients should be counseled regarding the need for individually tailored long-term maintenance to achieve optimal outcomes.
外阴疼痛、性交困难和瘙痒是常见症状，可能会严重影响女性的幸福感和性功能。尽管如此，女性常常对外阴症状的报告不足。然而，当出现外阴症状时，医护人员应予以处理，以优化护理。外阴阴道症状患者的评估从详细的病史和体格检查开始。当怀疑恶性肿瘤或诊断不确定时，应进行活检。如果可能，治疗应基于证据，尽管对于许多外阴疾病，包括外阴皮肤病，治疗是基于有限的证据和经验。尽管许多外阴皮肤病是慢性疾病，因此不能简单治愈，但大多数女性的病情可以得到控制。向患者提供有关外阴卫生和皮肤护理的教育是最佳管理炎症性外阴皮肤病的基础。这些情况可能会因过度清洁而被触发或加重。此外，应告知患者需要进行个体化的长期维持治疗，以获得最佳效果。
