Juvenile Vulva, Recessed Vulva, Episioplasty, Vulvoplasty
Excessive skin folds around the vulva can lead to the accumulation of urine and vaginal secretions. A moist, dark environment is created where bacteria and yeast can thrive, resulting in vulvar fold dermatitis (Figure 1). Episioplasty, also known as vulvoplasty, is a reconstructive surgical procedure performed to remove excess skin folds around the vulva to provide better ventilation of the area.
Signs and Symptoms:
- Licking or scooting
- Foul odor may be present
- Frequent or bloody urination may be noted
- Red irritated skin around the vulva
- Inappropriate urination
- Persistent urinary tract infections
- Physical examination
- Complete blood work
- Bacterial culture or the urine
- Ultrasound of the urinary bladder
Medical management of vulvar fold dermatitis with systemic antibiotics, topical antibiotics, cleansing, drying agents, or lotions may be successful, but is often unrewarding. For the majority of cases surgery is warranted.
Surgical treatment (episioplasty), is a reconstructive procedure aimed at removing the redundant skin folds around the vulva. The amount of perivulvar skin to be removed is determined by pinching the redundant skin between the thumb and forefingers. A crescent-shape incision is made around the vulva and the excessive skin and subcutaneous tissue is removed (Figure 2).