Since the differential diagnoses according to the ICD 10 are partly not recorded, e.g. burning, vesicles or only unclear, and clinically not practicable to present, a differential diagnosis under clinically relevant aspects according to symptoms is presented under the item “Further”, whereby a strict separation between vulva and vagina is not possible and also not useful. Endocrine, nutritional, and metabolic diseases (E00-E90).
- Obesity
- Diabetes mellitus
- Estrogen deficiency (especially in children, postmenopausal, lactation).
- Thyroid disease (hyper-, hypothyroidism / hyperthyroidism or hypothyroidism).
Skin and subcutaneous (L00-L99).
- Abscess
- Acne conglobata – most severe form of acne; there are all efflorescences, some fistula comedones, especially on the back and neck.
- Acne inversa (also spelled acne inversa; synonyms: Acnetetrade; Hidradenitis suppurativa (misleading term, as the disease does not originate from the sweat glands, but from the sebaceous glands and terminal hair follicles), Pyodermia fistulans sinifica, sweat gland abscess) – chronic inflammatory and episodic skin disease; preferred sites of manifestation are submammary, genital and perianal; perifolliculitis (caused by bacteria (mostly Staphylococcus aureus)) especially in the axillae and groin and a pilonidal sinus lead to pronounced scarring overall.
- Allergies
- Allergic contact dermatitis – sensitization to contact allergens (e.g. fragrances, preservatives, ingredients of cosmetics and externals).
- Dermatitis (inflammatory reaction of the skin).
- Eczema: vulvar eczema (clinical picture: erythema (areal redness of the skin), lichenification (areal leathery change of the skin), itching; possibly also swelling and fissures).
- Lichen ruber/ planus (nodular lichen; clinical picture: streaky or reticular, whitish plaques (areal or squamous substance proliferation of the skin); the plaques may erode and itch or hurt frequently)).
- Lichen sclerosus et atrophicus – chronic disease of the connective tissue, which is probably to be counted among the autoimmune diseases; clinical picture: in addition to an erythema show depigmented spots; rarely also hyperkeratotic (“strongly keratinizing”) changes.
- Pemphigus vulgaris (blistering skin disease).
- Pemphigoid (blistering skin disease).
- Psoriasis (psoriasis)
- Toxic reaction
- Injury
Infectious and parasitic diseases (A00-B99).
- Bacteria
- Bartholinitis (esp. coliform bacteria, Neisseria gonorrhoeae, Staphylococcus aureus, anaerobes): Bartholinic abscess, or pseudoabscess of the Bartholinic gland due to obstruction of the excretory ducts.
- Lymphogranuloma venereum (inguinal) (Chlamydia trachomatis).
- Gonorrhea (Neisseria gonorrhoeae)
- Hidradenitis (Pyodermia fistulans) (bes. Staphylococcus epidermidis, streptococci).
- Pyoderma (purulent inflammation of the skin):
- Abscess (esp. Staphylococcus aureus).
- Erysipelas (bes. A streptococci).
- Erythrasma (Corynebacterium minutissimum).
- Folliculitis (Staphylococcus aureus)
- Boils and carbuncles (Staphylococcus aureus).
- Impetigo contagiosa (bork lichen; pus lichen) – by streptococci of serogroup A (GAS, group A streptococci) triggered highly infectious, not bound to the skin appendages (hair follicles, sweat glands), purulent infection of the skin (pyoderma).
- Vulvitis caused by A-streptococci (esp. in children).
- Vulvitis pustulosa (Staphylococcus aureus).
- Syphilis (Treponema pallidum)
- Ulcus molle (Haemophilus ducreyi)
- Vulvitis plasmacellularis (unknown bacterium).
- Mycoses/fungal diseases (esp. Candida).
- Parasites:
- Endoparasites:
- Oxyurans (pinworms).
- Trichomonads
- Ectoparasites:
- Crabs (Pediculi pubis).
- Scabies (scabies)
- Endoparasites:
- Viruses
- AIDS viruses
- HPV (human papillomaviruses)
- Condyloma
- Neoplasia/preneoplasia
- Herpes viruses
- Genital herpes
- Herpes zoster
- Smallpox virus (Molluscum contagiosum)
- Varicella zoster virus (chickenpox)
Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).
- Liver diseases
Musculoskeletal system and connective tissue (M00-M99).
- Behçet’s disease (synonym: Adamantiades-Behçet’s disease; Behçet’s disease; Behçet’s aphthae) – multisystem disease of the rheumatic type associated with recurrent, chronic vasculitis (vascular inflammation) of the small and large arteries and mucosal inflammation; The triad (the occurrence of three symptoms) of aphthae (painful, erosive mucosal lesions) in the mouth and aphthous genital ulcers (ulcers in the genital region), as well as uveitis (inflammation of the middle eye skin, which consists of the choroid (choroid), the corpus ciliary (corpus ciliare) and the iris) is stated as typical for the disease; a defect in cellular immunity is suspected
Neoplasms – tumor diseases (C00-D48).
- Clitoral carcinoma – malignant neoplasm of the clitoris.
- Bowen’s disease – skin disease that belongs to precancerous lesions (precancerous lesions).
- Hodgkin’s disease – malignant neoplasia (malignant neoplasm) of the lymphatic system.
- Vulvar intraepithelial neoplasia (VIN I, II, III) – precursor of vulvar carcinoma.
- Vulvar carcinoma – vulvar cancer; cancer of the external genital organs of women.
Psyche – nervous system (F00-F99; G00-G99).
- Depression
- Partner conflict
- Psychosomatic disorders – especially in sexual conflicts (sexual disorder).
- Vulvodynia – insensations and pain of the external primary sex organs, lasting longer than three months without identifiable cause; complaints are localized or generalized over the entire perineal area (tissue area between the anus and the external sex organs); possibly also present as a mixed form; prevalence (disease frequency) of essential vulvodynia: 1-3 %.
Pregnancy, childbirth and puerperium (O00-O99).
- Infections of the genital tract during pregnancy.
- Infections of the genital tract in the puerperium
- Infections following surgical obstetric procedures (e.g. episiotomy/perineal incision, perineal tear).
Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).
- Hyperhidrosis
- Fecal incontinence
Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99)
- Bladder-vaginal fistula
- Urinary incontinence
- Kidney disease
- Rectal-vaginal fistula
- Cystitis
Injuries, poisonings and other consequences of external causes (S00-T98).
- Foreign bodies in the vulva (e.g., piercing) and vagina.
- Sexual abuse
- Special sexual practices
- Trauma/injury to the genital area (e.g., defloration (deflowering), cohabitation (coitus), masturbation, pruritus sequelae/consequences of itching (scratching, rubbing, chafing), injuries (fall, impact, instruments, and others).
Further
- Vulvar Vestibulitis Syndrome (VVS) (Synonyms: Burning Vulva, Painful Vulva, Vestibulodynia, Vestibulitis, Vulvodynia, Vestibulitis Syndrome, Vestibulitis Vulvae Syndrome).
- A still largely unknown disorder with a prevalence (disease incidence) of about 9%, whose diagnosis is often made as a diagnosis of exclusion only after many years of unsuccessful different therapeutic attempts.
- Pathogenesis (disease development) unknown.
- Histology (fine tissue examination): chronic inflammation with plasma cells, lymphocytes, and histiocytes.
- a distinction is made between two forms
- Localized form
- Generalized form
- For diagnoses see under burning and pain
- A still largely unknown disorder with a prevalence (disease incidence) of about 9%, whose diagnosis is often made as a diagnosis of exclusion only after many years of unsuccessful different therapeutic attempts.
Medication
- Allergic or intolerance reactions to medications (local and/or systemic).
Environmental pollution – intoxications (poisonings).
- Epithelial damage caused by:
- Chemical effects e.g. deodorants, disinfectant solutions, intimate spray vaginal rinses, ablutions.
- Maceration (softening of the tissue) of the skin e.g. fluorine, fistulas, menstrual blood, sweat, secretion (urinary, fecal incontinence (inability to hold urine or stool), carcinoma secretion).
- Mechanical irritation: z.B. tight pants, sanitary napkins, underwear.
Differential diagnoses by symptoms
Vesicles:
- Infections
- Genital herpes
- Herpes zoster
- Varicella
- Dermatoses (skin diseases)
- Herpes gestationis
- Pemphigus vulgaris
- Toxic allergic dermatitis (e.g., drugs, detergents, insecticides, cosmetics, oils, conditioners, detergents).
Burning:
- Infections
- Genital herpes
- Herpes zoster
- Streptococcus group A
- Trichomonads
- Vulvitis plasmacellularis
- Dermatoses
- Behçet’s disease
- Lichen ruber/ planus erosivus
- Lichen sclerosus
- Pemphigus vulgaris
- Other
- Skin injury
- Irritative (allergic) dermatitis
- Toxic contact dermatitis (e.g., drugs, detergents, insecticides, cosmetics, oils, rinses, washovers, detergents).
- Vulvar Vestibulitis Syndrome (VVS) (Synonyms: Burning Vulva, Painful Vulva, Vestibulodynia, Vestibulitis, Vulvodynia, Vestibulitis Syndrome, Vestibulitis Vulvae Syndrome).
- Burning and pain
- When touching the vestibule (“vaginal entrance“) (e.g., fingers, tampon, intercourse),
- When pressure is applied, e.g. cycling, sitting.
- Redness none, low
- Exclusion of infections
- Duration of complaints > 3 months
Areal redness:
- Infections
- Mycoses (fungi)
- Streptococcus group A
- Trichomonads
- Vulvitis plasmacellularis
- Dermatoses (skin diseases)
- Lichen ruber/ planus erosivus
- Lichen sclerosus (scratch marks)
- Pemphigus vulgaris
- Psoriasis
- Other
- Irritative (allergic) dermatitis
- Toxic contact dermatitis (e.g., drugs, detergents, insecticides, cosmetics, oils, conditioners, detergents).
Fluor vaginalis (vaginal discharge): see colpitis (vaginitis).
Nodules:
- Infections
- Acne inversa
- Folliculitis
- Genital herpes
- Molluscum contagiosum
- Mycosis (fungi)
- Syphilis
Without (hardly) any symptoms:
- Infections
- Erythrasma
- Condyloma
- Molluscum contagiosum
- Syphilis
Pruritus (itching):
- Infections
- Candida
- Crabs (Pediculi pubis)
- Scabies (scabies)
- Trichomonads
- Dermatoses (skin diseases)
- Lichen ruber/planus
- Lichen sclerosus
- Lichen simplex
- Psoriasis
- Other
- Irritative (allergic) dermatitis
- Scratch marks
- Toxic contact dermatitis (e.g., drugs, detergents, insecticides, cosmetics, oils, rinses, washovers, detergents)Injuries
Pustules:
- Infections
- Folliculitis
- Genital herpes
- Herpes zoster
- Fungi
- Varicella
Pain:
- Infections
- Abscess (Bartholinian pseudoabscess)
- Acne inversa
- Folliculitis
- Genital herpes
- Dermatoses (skin diseases)
- Behçet’s disease
- Other
- Skin lesion/scratch marks
- Irritative (allergic) dermatitis
- Toxic contact dermatitis (e.g., drugs, detergents, insecticides, cosmetics, oils, rinses, washovers, detergents).
- Vulvar Vestibulitis Syndrome (VVS) (Synonyms: Burning Vulva, painful vulva, vestibulodynia, vestibulitis, vulvodynia, vestibulitis syndrome, vestibulitis vulvae syndrome) (pinpoint, circumscribed pain, esp. after touch) see burning above.
Ulcers (ulcers):
- Infections
- Genital herpes
- Syphilis
- Ulcus molle
- Dermatoses
- Behçet’s disease
- Lichen ruber/planus
- Lichen sclerosus (scratch marks)
- Other
- Sexual abuse
- Special sexual practices
