Crohn's Disease of the Vulva
In the last few articles (What Women Should Know About Living with IBD, and Crohn's Disease in Your Where?), we've talked about the complications that the female reproductive system can endure, such as vulvar inflammation. In this article, we'll dig a little deeper into how Crohn's can manifest in the vulva, how to identify symptoms, and how it can be diagnosed. It's not talked about enough, and far too many women suffer in silence, not knowing where they can find support.
The pain of vulvar Crohn's
It can be extremely hard to diagnose and additionally, hard to treat. Often, some of these complications can be misdiagnosed due to symptoms presenting without bowel issues or problems. My care team involves a high-risk OBGYN and a Urologist as well as my most important team member, my GI.
But there are some things that GI's might not specialize in, like vulvar Crohn's, that may require multiple team members. This will ensure they are providing the best care for patients who struggle with vaginal symptoms.
What are the symptoms of Crohn's in/around the vulva?
Swelling of the labia, ulcers in/around the vulva and topical lesions may be some of your first clues. Painful swelling, bumps, and ulcers can become a very serious issue and in some cases, surgery might be necessary if the patient fails different courses of antibiotics and immunosuppressants.
Why is vulvar Crohn's so hard to diagnose?
First, there is a stigma surrounding these symptoms and many women are embarrassed to deal with these issues. Sex is impacted, there is a lot of pain involved and if you've ever had a fistula, you know the pain an open wound or impacted wound can bring. Unfortunately, some of these abscesses and other symptoms can appear like an STD. Many gynecologists will screen for a sexually transmitted disease to rule it out, especially if they're unaware of your Crohn's. Some doctors may use a pelvic MRI to help determine the specific diagnosis in addition to finding the right course of treatment.
Again, this is why it's so important to be completely open and honest regarding your sexual health, including any pain or symptoms you may have. The worst thing you can do is ignore the issue, as it may become incredibly painful, infected and even result in an abscess requiring surgery.
What types of complications are observed in the vulva with this type of Crohn's?
Edema or swelling of the vulva may occur. Ulcers may also be present. Some ulcers may be completely asymptomatic, with no pain at all, but can wreak havoc long-term. Some may actually appear as small knife-like cuts in the perianal and vulvar regions, or in the folds of the vagina. The most common symptom of vulvar Crohn's is slow-to-heal labial swelling on only one side. Some ulcers or abscesses may require drainage if they do not respond to traditional therapy.
Have you had experiences with vulvar inflammatory bowel disease? How did it affect your physical or mental health?
What is your comfort level disclosing your IBD to your employer?