Painful fissures on perineum in fissuring candidiasis.

Red swollen excoriated labia majora in eczematous candidiasis.

Red, irritated vulva in recurrent candidiasis.

Candidiasis

Tinea Cruris. Annular, symmetric, red rash with a scaly border present on the inner thighs.

Acute intertrigo with erythema and fissuring in labiocrural fold.

A red-brown patch of erythrasma located on the inner thigh.

Red, macerated psoriasis extending from the vulva to the perianal area.

25 year old with inability to use tampons or tolerate speculum exams and severe dyspareunia with attempt at intercourse. Areas of pain were next to the hymen at 4-5:00 & 7-8:00. Other areas non-tender. In this case, pallor and mild erythema outside of Hart’s line was a normal finding.

Vulvodynia

Vulvovaginal Atrophy

Vulvovaginal Atrophy

Vulvovaginal Atrophy

Lichen Simplex Chronicus

Lichen Simplex Chronicus

Lichen Simplex Chronicus

Lichen Simplex Chronicus

Lichen Simplex Chronicus

Lichen Simplex Chronicus

From urinary incontinence and daily sanitary pads.

From witch hazel application.

From benzocaine application.

Contact Dermatitis

Contact Dermatitis

Contact Dermatitis

Contact Dermatitis

Contact Dermatitis

Contact Dermatitis

Subacute contact dermatitis resulting from perfume in a feminine deoderant spray.

Eczematous Dermatitis

Eczematous Dermatitis

Marked lichenification, erosions, and crusting in lichen simplex chronicus of left labium major.

Lichenification and swelling in a localized plaque of lichen simplex chronicus.

Subacute dermatitis of the vulva in an atopic individual with early lichen simplex chronicus.

Lichen Sclerosus

Extensive erosion of the vulva with loss of the clitoris and labia minora.

Lichen Planus

Lichen Planus

Lichen Planus

Lichen Planus

Lichen Planus

Diffuse painful cellulitis present on the lower abdomen, groin, and thigh.

Edema of labium as a result of recurrent streptococcal cellulitis.

Edema from Cellulitis

Chronic lymphedema from recurrent strep cellulitis.

Steroid Rosacea

Diffuse papular, fiery-red pattern of extensive rebound steroid dermatitis in an elderly woman with severe erosive vaginal lichen planus. Her vaginal erosive disease settled with 3 months of unavoidable intravaginal superpotent steroid (clobetasol), then her predictable rebound eruption was managed (see text for more information).

Steroid Rosacea

Diffuse bright red papular erythema in rebound steroid dermatitis caused by an amcinonide ointment for psoriasis.

HSIL (uVIN) on the patient’s lower right edge of the labium minus in a patient who presented with dyspareunia.

Vulvitis Plasma Cellularis

Vulvitis Plasma Cellularis

Fixed Drug Eruption

Fixed Drug Eruption

Recurrent red, swollen, burning lesion localized always to the same area of the labium minor caused by pyridium in a fixed drug reaction.

Ulcerated, irregularly outlined, itchy bleeding lesion in a 55-year old woman. The diagnosis of basal cell carcinoma is made on biopsy.

Asymptomatic, firm, cystic, slightly pigmented papule on labium major. This basal cell carcinoma in a 60 year old was found on routine pelvic exam.

Methicillin Resistant Staphylococcus Aureus

Progestogen Hypersensitivity

Progestogen Hypersensitivity

Large plaque of erythema and fissuring on the inner thigh and in groin folds is observed in benign familial pemphigus.

A 6-year-old girl who presented with scratching, pain, bleeding, and vaginal discharge showing intact red hymenal ring with tissue paper just inside opening. (Courtesy Dr. G.D. Oliver.)

A hematoma extending from the mons pubis and vulva to the left buttock area. (Courtesy Dr. P. Bryson.)

Chronic radiodermatitis of the vulva with extensive telangiectasia and marked scarring of the perineum.

Anus of a sexually abused little girl showing tears, bruising and laxity with normal hymen above. (Courtesy Dr. G.D. Oliver.)

Same child (supine position) 2 years later with a healed scar at the 6 o’clock position.

Perineal laceration through the hymen and posterior fossa with hematoma formation and surrounding bruising in a raped child. (Courtesy Dr. G.D. Oliver.)

Extensive, mildly eczematous erythematous plaque involving the labium major and extending up to the mons pubis. This case of Paget’s disease was mildly itchy and had been called “eczema.”

This case illustrates the difficulty in diagnosis. The patient is an obese diabetic. Her problem started as a small sore and started to drain.

Photos courtesy of Deborah Bartholomew, MD.

This case illustrates the difficulty in diagnosis. The patient is an obese diabetic. Her problem started as a small sore and started to drain.

Photos courtesy of Deborah Bartholomew, MD.

This case illustrates the need for aggressive debridement. The patient is an obese diabetic. Her problem started as a small sore and started to drain. This picture shows the need to resect until clean, bleeding tissue is obtained. Devitalized tissue is seen deep in the wound, as is bone.

Photos courtesy of Deborah Bartholomew, MD.

This case illustrates the need for aggressive debridement. The patient is an obese diabetic. Her problem started as a small sore and started to drain. This picture shows the final extent of the dissection required. She was in the ICU for quite some time, was treated with broad spectrum antibiotics and a wound vac. The wound retracted but eventually she got a split thickness skin graft.

Photos courtesy of Deborah Bartholomew, MD.

Deep debridement is necessary in the treatment of necrotizing fasciitis.

Photos courtesy of Deborah Bartholomew, MD.

Deep debridement is necessary in the treatment of necrotizing fasciitis.

Photos courtesy of Deborah Bartholomew, MD.