Vulvar and Perineal Dermatoses Across the Female Life Course: An Integrative Review

Abstract

Vulvar and perineal dermatoses are prevalent disorders that often present with pruritus, burning, fissuring, dyspareunia, and dysuria, yet they remain under-recognised and frequently misdiagnosed. Diagnostic delay is driven by symptom overlap across inflammatory, infectious, neuropathic, and neoplastic pathways; discomfort with genital examination; and limited availability of clinicians trained in vulvar morphology and biopsy. A life-course perspective is essential because the vulvar–perineal unit undergoes marked physiologic transitions shaped by developmental stage, hormonal milieu, immune modulation, epithelial barrier maturation, microbiome shifts, and changing exposure patterns to irritants and allergens. These transitions influence disease susceptibility and phenotype expression, including irritant dermatitis in infancy, contact dermatitis and psoriasis in adolescence and reproductive years, pregnancy- and postpartum-associated symptom fluctuations, and the increased prominence of lichen sclerosus, genitourinary syndrome-related vulnerability, and neoplastic mimickers in peri- and postmenopause. This review synthesizes contemporary evidence on major vulvar and perineal inflammatory dermatoses—especially lichen sclerosus, lichen planus, psoriasis, and contact dermatitis—while emphasizing a structured diagnostic approach, appropriate indications for biopsy and patch testing, longitudinal management strategies, and surveillance principles for premalignant and malignant disease. The review concludes with an integrated framework that connects life stage, anatomy, exposures, morphology, and risk stratification to improve outcomes and reduce morbidity.