Fiona M. Lewis - Practical guide to vulval disease: diagnosis and management

1. Chapter 04
2. Chapter 06
3. Chapter 07
4. Chapter 08
5. Chapter 09
6. Chapter 13
7. Chapter 14
8. Chapter 15
9. Chapter 16
10. Chapter 17
11. Chapter 18
12. Chapter 19
13. Chapter 20
14. Chapter 23

1. Chapter 01
2. Chapter 02
3. Chapter 03
4. Chapter 04
5. Chapter 05
6. Chapter 06
7. Chapter 08
8. Chapter 09
9. Chapter 10
10. Chapter 11
11. Chapter 12
12. Chapter 13
13. Chapter 14
14. Chapter 15
15. Chapter 16
16. Chapter 17
17. Chapter 18
18. Chapter 19
19. Chapter 20
20. Chapter 21
21. Chapter 22
22. Chapter 23
23. Chapter 25

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Library of Congress CataloginginPublication Data

Names: Lewis, Fiona, 1963 author. | Bogliatto, Fabrizio, author. | Beurden, Marc van, author.
Title: Practical guide to vulval disease : diagnosis and management / Fiona Lewis, Fabrizio Bogliatto, Marc van Beurden.
Description: Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons, Inc., 2017. | Includes bibliographical references and index.
Identifiers: LCCN 2016040293 (print) | LCCN 2016040776 (ebook) | ISBN 9781119146056 (cloth) | ISBN 9781119146063 (pdf) | ISBN 9781119146070 (epub)
Subjects: | MESH: Vulvar Diseases | Vulvapathology
Classification: LCC RG261 (print) | LCC RG261 (ebook) | NLM WP 200 | DDC 618.1/6dc23
LC record available at https://lccn.loc.gov/2016040293

A catalogue record for this book is available from the British Library.

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Cover image: Pazhyna/Gettyimages

We would like to thank all those who have helped us with the preparation of this book particularly our trainees who inspired us to write it and our colleagues for their encouragement.

Our thanks to Dr Catherine Stefanato for supplying the immunofluorescence figures, .

We are grateful to our patients who have allowed us to use their clinical photographs and to our medical photography colleagues for their patience, advice and technical skills.

The vulva is a complex organ, due to its embryologic derivation from the three germ layers belonging to the embryonic disc:

• ectoderm (squamous epithelium);
• mesoderm (connective epithelium);
• endoderm (vulval vestibule).

This embryological derivation is responsible for the different variants in morphology that occur during the development of the vulva.

A correct and thorough knowledge of the normal vulva is vital for several reasons. Firstly, it is important in order to recognize some of the normal anatomical variants in order to differentiate them from pathological features. This will prevent unnecessary excision and treatment of normal areas. Secondly, it leads to a more specific and logical approach in treating vulval disorders. In some conditions, the normal anatomy of the vulva is altered and this can give diagnostic clues. It is important to note that the normal vulva modifies itself during a womans lifetime, depending on age, obstetrical and gynaecological history.

The vulva may be considered as the combination of the mucosal, cutaneous, muscular and connective tissue structures that compose the lower part of the female genital tract. The peculiarity of this localization means that the vulva is in close association with urological structures (urethra and bladder), gynaecological structures (vagina), and intestinal structures (rectum and anus).