Vulvar disorders represent one of the more common gynecological problems in adolescent patients. However, this set of conditions can be evaluated and monitored with the aid of a quick, inexpensive, safe and readily available high-frequency ultrasound (HFUS) assessment.
First used to measure skin thickness in 1979, according to a review from the Journal of Ultrasound, this imaging technique was primarily used in research settings or by dermatologists, plastic surgeons and cosmetologists to plan surgery and follow the treatment of skin disorders.
Thanks to the advance of technological capabilities and decreases in price, HFUS has also become a useful tool for the evaluation of the vulva. Probes with frequencies in the range of 10 MHz and higher allow excellent evaluation of all the layers of the skin, including the epidermis, dermis and subcutaneous tissue.
What Causes Vulvar Complaints in Adolescents?
The majority of adolescent vulvar complaints fall into the broad category of symptomatic inflammatory conditions. Pubertal hormonal changes, poor perineal hygiene, obesity, tight-fitting non-cotton clothing, the use of oral contraceptives and sexual activity can all predispose adolescents to these conditions.
Common vulvar complaints that an OB/GYN may see in young patients include:
- Vulvovaginitis
- Lichen sclerosis
- Bartholin gland cysts
How Are Vulvar Disorders Treated in Young Patients?
Adolescents with vulvar complaints need to feel confident that their symptoms and concerns will be heard and dealt with quickly and confidentially. It is critical to reassure the patient that vulvar disorders are a common gynecological complaint and that the exam will not be painful.
A full bimanual pelvic exam is not always necessary for young patients. Instead, OB/GYNs should evaluate the vaginal canal on a case-by-case basis and carefully inspect the vulva after gathering appropriate information about the patient's complaint.
To lessen the discomfort of the exam, the patient may prefer to lie supine in the frog-leg position, with their head raised to allow direct communication with the examiner. Offer a handheld mirror as a way to empower patients to participate in the evaluation and give them a greater sense of control. Throughout the discussion, use proper terminology and diagrams to encourage communication with young patients and help build rapport for future office visits.
After inspecting the vulva, OB/GYNs should perform an ultrasound exam. Certain conditions that may cause an irregular vulvar appearance can easily be imaged in the office setting, including:
- Nevi
- Lipomas
- Hematomas
- Hemangiomas
- Abscesses
- Inflammatory dermatologic disorders
Diagnostic tests should be performed if an infection is suspected.
What Are the Advantages of High-Frequency Ultrasound for Gynecologists?
When it comes to using HFUS, the choice of equipment matters. Varying transducer frequencies are available, although 20 MHz transducers are the most common choice for performing dermatologic evaluations. The higher the transducer frequency, the greater the detail of the image — but the lower the depth of penetration. A 10 MHz transducer, for example, may be helpful when evaluating a Bartholin gland cyst.
On the other hand, ultra-high-frequency transducers in the range of 30-70 MHz will allow for better evaluation of the finer subcutaneous structures such as sebaceous, apocrine and eccrine glands. For example, a study published in Skin Research and Technology found that ultra-high-frequency ultrasound can be an effective tool for monitoring hidradenitis suppurativa. This skin condition most commonly affects the sweat glands of the axillary, genital and other areas, causing painful reddened nodules that sometimes lead to abscesses and fistulas.
HFUS provides objective data on vulvar disorders — including the dimensions and location of any lesions, the depth of involvement, and any associated findings — and allows medical teams to document and easily share that information with other physicians. Innovative software offers automatic measurements of the skin layers, increasing accuracy while reducing individual operator variance. The technology can even document tissue compliance and blood flow patterns.
In contrast to transabdominal or transvaginal ultrasound, which may also be used to help assess gynecological problems in adolescence, HFUS does not require a full bladder.
How Is Subepidermal Low-Echogenic Band Visualized?
Skin thickness and composition vary in different locations on the body. As a result, the echogenicity of the dermis changes in response to an accumulation of fluid or an increase in collagen fibers. Sun-damaged skin, atopic dermatitis and eczema all exhibit a characteristic pattern called subepidermal low echogenic band (SLEB) on ultrasound, according to research published in Advances in Dermatology and Allergology.
A groundbreaking study published in the Journal of Ultrasonography found that SLEB is also present with vulvar dermatoses. Since SLEB is an established marker of psoriasis, this may show promise for diagnosing and treating genital psoriasis.
How Can HFUS Assist With Vulvar Lichen Sclerosis?
According to research published in Frontiers in Physics, the use of high-intensity focused ultrasound shows promise as a treatment modality for vulvar lichen sclerosis (VLS). VLS may affect the labia, clitoris and genitocrural folds. Secondary infection, fusion of the labia and fragility of the tissue can lead to tearing. In the past, most medical therapy for VLS has focused on ameliorating the symptoms rather than treating the underlying cause. Ultrasound-based treatment may be a promising option for treating painful symptoms and supporting young patients' reproductive health.
Whether it occurs during a regular checkup or an appointment specifically meant to treat vulvar symptoms, the adolescent GYN exam is an excellent opportunity to build rapport, calm fears and share information. When indicated, ultrasound can act as an extension of the GYN exam that helps define the scope of vulvar disorders.
