Report Prevalences of and risk factors for vulvar diseases in Nepal: a hospital-based study Deeptara Pathak, MD, Sudha Agrawal, MD, MPhil, and Tapan K. Dhali, MD Department of Dermatology and Venereology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal Correspondence Dr Sudha Agrawal, MD, MPhil Professor and Head Department of Dermatology and Venereology B. P. Koirala Institute of Health Sciences Dharan Nepal E-mail: sudha92@yahoo.com Funding sources: None. Conflicts of Interest: None. Abstract Background The vulvar diseases are common skin conditions, but their frequency and importance are often underestimated. Objectives This study is aimed to investigate the frequency and clinical patterns of vulvar diseases and the risk factors associated with these diseases in patients attending a tertiary care hospital in eastern Nepal. Methods Patients with vulval symptoms or cutaneous lesions on the vulva were enrolled in the study. Laboratory investigations were carried out according to need. Equal numbers of age-matched females without vulval lesions or symptoms were selected from the outpatient department as controls. Results Of 5521 female patients attending the Dermatology Department’s outpatient clinic during the study period, 105 (1.9%) had vulval symptoms and/or lesions. The most com- mon types of vulvar disease were vulvar dermatoses (62.85%), pruritus vulvae (36.19%) and vulvodynia (0.95%). In vulvar dermatoses, infection was the most common (33.4%) manifestation, with a predominance of vulvovaginal candidiasis. Other dermatoses included: cysts and tumors (5.6%); pigmentary changes (vitiligo) (5.6%); inflammatory dermatoses (6.6%); atrophic vaginitis (1.8%); erosive disease (0.9%); and dermatosis caused by sexual abuse (1.9%). Use of nylon undergarments, occasional detergent use for washing clothes, and an irregular menstrual history were found to be associated with vulvar diseases. Conclusions Our study findings indicate that the known frequency of vulvar diseases may represent only a small proportion of actual frequency. Further clinical and population-based research should be carried out with respect to the treatment, follow-up, and true prevalence of these diseases in the community. Introduction The vulva is the most visible female genital structure, but it has been referred to as ‘‘the forgotten pelvic organ’’. 1 The keratinized skin and mucocutaneous surfaces of the vulva differ from the skin on the rest of the human body, where epitheliums from all three embryological layers coalesce. In addition, this area of the body has a unique immunological response because the vulvovaginal tract, which contains foreign proteins and antigens necessary for reproduction, 2 and the loose subcutaneous tissue of the labia majora allow for the formation of considerable edema. 3 Although vulvar diseases are common skin conditions, their frequency and importance are often underesti- mated. 4 Vulvar diseases may present in a variety of ways ranging from the asymptomatic to chronic disabling con- ditions. The associated symptoms include dyspareunia, pain, itching, fissuring, and bleeding after intercourse. The multifactorial nature of the symptoms and physical expressions of vulvar diseases complicates their manage- ment. 5 The other major difficulty involved in managing such diseases relates to the confusion over the terminol- ogy used to describe vulvar diseases. The International Society for the Study of Vulvovaginal Diseases recently devised a new method of classifying vulvar diseases as either ‘‘vulvar dermatoses’’ (for conditions that cause visi- ble skin changes) or ‘‘vulvar dysesthesia’’ (vulvodynia) (for conditions that cause vulval pain). 6 However, some dermatologists and gynecologists continue to use their own systems of categorizing vulvar diseases. 7 The detailed study of vulvar diseases is a relatively new field, and it is only in recent years that vulval symptoms have been related to definitions of disease status. 4 In some European countries and in the USA, interdisciplinary vul- var disease clinics in which dermatologists, gynecologists, 161 ª 2011 The International Society of Dermatology International Journal of Dermatology 2011, 50, 161–167