The Vulva in Pregnancy and Delivery
The vulva and vagina undergo profound anatomic and physiologic changes in pregnancy. The following chapter describes these changes. It also elaborates on a few unique conditions: vulvar varicose veins, pain, genital herpes in pregnancy, condylomata acumin
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The Vulva in Pregnancy and Delivery Maya Wolf
The pregnant woman undergoes profound anatomic and physiologic changes in almost every organ system. These adaptations to the pregnant state begin just after conception and evolve through delivery, after which they almost completely revert back to the nonpregnant state over a period of weeks. Pregnancy may be associated with changes resulting in many common symptoms and signs of pregnancy. The changes include general symptoms such as amenorrhea, weight gain, sleep alterations, fatigue, and other changes that are more specific to various physiologic systems/organs [1]. These symptoms are usually self-limited and can be treated to provide relief. Skin changes may include linea nigra, stretch marks, chloasma, and various vascular changes [2]. It may also include hyperpigmentation— darkening of linea alba (linea nigra), axillae, areola, perineum, and inner thighs due to melanocytic stimulation by estrogen and progesterone [3]. Pruritus in pregnant women may be physiologic, related to a flare of disorder present prior to conception, or related to pregnancy-specific dermatoses. Pruritus without any underlying pathologic process affects up to 20% of pregnant woman. Common pruritic locations are the scalp, anus, vulva, and, during the third trimester, the
M. Wolf (*) Maternal-Fetal Unit, Department of Obstetrics and Gynecology, Galilee Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel e-mail: [email protected]
abdominal skin. Patients with more generalized pruritus should be evaluated for intrahepatic cholestasis of pregnancy [2]. Skin vascular changes attributed to physiologic changes in estrogen and increased blood volume include spider telangiectasias, palmar erythema, and non-pitting edema. Vulvar, saphenous, or hemorrhoidal varicosities are reported in about 40% of pregnant women.
9.1
ulvar Varicose Veins V (Figs. 9.1 and 9.2)
Reported incidence is 8% of pregnant women and up to 23% of pregnant women with varicose veins. Although rare in nonpregnant women, in pregnancy it may appear as lobulated, purplish-colored lesions involving the labia majora. Symptoms include tenderness and discomfort during sexual intercourse. The etiology is partly hemodynamic, due to increased blood volume and venous pressure in femoral and pelvic vessels from the enlarging uterus. Genetic predisposition also plays a role. Vulvar varicose veins may persist or worsen in subsequent pregnancies and cannot be prevented [4]. Jacquemier’s sign refers to venous distention in the vestibule and vagina and is associated with vulvar varicosities, which are particularly difficult to treat [5]. They usually regress, at least partially, postpartum. During pregnancy, they are managed conservatively by vulvar support and compression and by avoiding prolonged standing.
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_9
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Fig. 9.1 Vulvar large varicosities du
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