The vulva is the area of the female external genitals extending from the pubis to the perineum. Included in the area are the mons pubis, labia majora, labia minora, clitoris, urethral opening, vaginal opening, the vestibule, glands of the vulva, and vascular structures.

Disease of or injury to the vulva has multiple causes. Among the factors included are: changes in the normal vaginal pH, vaginal infections, hormone replacement therapy, antibiotic therapy, multiple sexual partners, sexually transmitted diseases, foreign objects (such as a pessary) left in place for a prolonged period, and chronic skin disorders. Infection due to poor hygiene; use of hygiene sprays or perfumes; bath water additives; laundry chemicals; tight underclothing; sensitivity to contraceptives; as well as frequent douching with irritants, such as iodine, may also be contributing causes. Deficiencies in estrogen due to surgery, radiation or chemotherapy may increase the chance of trauma or infection. Other causes may be fistulas, viruses, polyps, cysts, cancer, lice, pinworms, or biologic conditions (such as diabetes mellitus).

Signs and symptoms may include: itching, burning, pain, redness, swelling, excoriation, vaginal tenderness, dryness, blisters, abnormal and malodorous discharge, fever, dysuria, or watery or bloody discharge. There may be lesions, such as warts, cysts, or lumps. Pain with intercourse may be present depending on the cause of inflammation or infection. A foreign object or pinworms may be evident.

A complete history, physical and pelvic examinations, biopsy of lesions, measurement of the pH, wet mounts for microscopic examination, cultures, laboratory studies, and papanicolaou (PAP) smear may be included in the testing.

Topical corticosteroids may be used in the absence of infection. Other oral or topical medications may be given for the specific organism, and to treat symptoms. Hormone replacement therapy (HRT) may be offered for postmenopausal patients. Occasional warm water douching, sitz baths, and re-education regarding personal hygiene may be indicated. Warts may require cryotherapy, electrocautery or laser therapy if topical therapy fails. In the event of cancer, radical removal of the tumor and radiation therapy may be indicated.

Depending on the specific cause, there may be re-infection, social isolation, sexual dysfunction, infertility, and self-esteem issues. Long-term oral drug therapy may be needed for chronic infections. There may be resistance to topical treatments. Outcomes may depend on the patient's compliance relating to treatments. With certain cancer types, the rate of malignancy may be high. Counseling, psychotherapy, and support groups may be indicated to assist the patient in dealing with the diagnosis.

• None.

• Natural menopause, primary amenorrhea, and pregnancy and childbirth are not disabilities for rating purposes. Chronic residuals of medical or surgical complications of pregnancy may be disabilities for rating purposes.
• When evaluating any claim involving loss or loss of use of one or more creative organs or anatomical loss of one or both breasts, refer to 38 CFR 3.350 to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, almost any condition in 38 CFR 4.116 might, under certain circumstances, establish entitlement to special monthly compensation.