Ridley's The Vulva - 4th Edition
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Ridley’s The Vulva
Edited by
Fiona M. Lewis, MD, FRCP
Consultant Dermatologist
St John’s Institute of Dermatology
Guy’s & St Thomas’ NHS Foundation Trust
Guy’s Hospital
London
UK
Fourth Edition
This fourth edition first published 2022
© 2022 John Wiley & Sons Ltd
Edition History
Churchill Livingstone (1e, 1975); Blackwell Publishing Ltd (2e, 1999, 3e, 2009)
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The right of Fiona M. Lewis to be identified as the author of the editorial material in this work has been asserted in accordance with law.
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Library of Congress Cataloging-in-Publication Data
Names: Lewis, Fiona M., 1963– editor.
Title: Ridley’s the vulva / edited by Fiona M. Lewis.
Other titles: Vulva
Description: Fourth edition. | Hoboken, NJ : Wiley-Blackwell, 2022. |
Includes bibliographical references and index.
Identifiers: LCCN 2021056436 (print) | LCCN 2021056437 (ebook) | ISBN
9781119755111 (cloth) | ISBN 9781119755159 (epub) | ISBN 9781119755166 (epub)
Subjects: MESH: Vulva | Vulvar Diseases
Classification: LCC RG261 (print) | LCC RG261 (ebook) | NLM WP 200 | DDC
618.1/6–dc23/eng/20211124
LC record available at https://lccn.loc.gov/2021056436
LC ebook record available at https://lccn.loc.gov/2021056437
Cover Image: © traffic_analyzer/Getty Images
Cover Design: Wiley
Set in 9.5/12.5pt STIXTwoText by Straive, Pondicherry, India
I would like to dedicate this edition to two true experts in vulval disease whom I have been privileged to work
with and who continue to teach me
Sallie Neill, my mentor in this subject and good friend, for continuous support and encouragement in clinical
scenarios, teaching and publication.
Micheline Moyal-Barracco, my friend, teaching colleague, and collaborator, who always challenges me to think,
learn, and develop new concepts.
vii
Contents
List of Contributors xi
Preface xiii
Acknowledgements xiv
About the Companion Website xv
Section 1 The Basics of Vulval Disease 1
1 Vulval Embryology and Developmental Abnormalities 3
Fiona M. Lewis
2 The Normal Vulva 19
Fiona M. Lewis
3 Vulval Physiology and Changes Through Life 36
Fiona M. Lewis
4 Normal Microbiology of the Vulva 42
Fiona M. Lewis
5 The Vulval Clinic, History, and Examination 45
Fiona M. Lewis
6 Symptoms and Signs in Vulval Disease 51
Fiona M. Lewis
7 Investigations in Vulval Disease 56
Fiona M. Lewis
8 Topical and Non-Surgical Treatments 63
Fiona M. Lewis
Section 2 Infection and the Vulva 69
9 Bacterial Vaginosis 71
Gulshan Sethi
10 Vulvovaginal Candidiasis 74
Gulshan Sethi
11 Syphilis 78
Gulshan Sethi
12 Gonorrhoea 83
Gulshan Sethi
viii Contents
13 Chlamydial Infection 87
Gulshan Sethi
14 Trichomoniasis 91
Gulshan Sethi
15 Genital Herpes 94
Gulshan Sethi
16 Human Papillomavirus Infections 99
Gulshan Sethi
17 Other Sexually Transmitted Infections 105
Gulshan Sethi
18 Tropical Infections 110
Fiona M. Lewis
19 Non-Sexually Transmitted Infections 117
Fiona M. Lewis
20 HIV Infection and Vulval Disease 129
Gulshan Sethi
Section 3 Inflammatory Dermatoses 131
21 Vulval Psoriasis 133
Shireen Velangi
22 Eczema and Allergic Reactions 139
Fiona M. Lewis
23 Lichen Sclerosus 147
Fiona M. Lewis
24 Lichen Planus 161
Fiona M. Lewis
25 Hidradenitis Suppurativa 171
Ellie Rashidghamat
26 Immunobullous Disease 180
Elisabet Nylander
27 Other Inflammatory Dermatoses 186
Fiona M. Lewis
Section 4 Other Dermatological Conditions 197
28 Genetic Conditions 199
Fiona M. Lewis
29 Disorders of Pigmentation 206
Fiona M. Lewis
Contents ix
30 Disorders of Skin Appendages and Hair 213
Fiona M. Lewis
31 Drug Reactions and the Vulva 217
Fiona M. Lewis
32 Conditions Associated with Systemic Disease 223
Fiona M. Lewis
33 Lymphatic Abnormalities and the Vulva 234
Kristiana Gordon
34 Vascular Abnormalities and the Vulva 240
Fiona M. Lewis
Section 5 Vulvodynia 243
35 Vulvodynia – History, Classification, and Terminology 245
Nina Bohm-Starke and Ulrika Johannesson
36 Vulvodynia – Pathophysiology and Clinical Features 248
Nina Bohm-Starke and Ulrika Johannesson
37 Vulvodynia – Management 260
Nina Bohm-Starke and Ulrika Johannesson
Section 6 Benign Tumours of the Vulva 269
38 Benign Vulval Tumours 271
Zlatko Marusic and Eduardo Calonje
39 Benign Vulval Naevi 287
Zlatko Marusic and Eduardo Calonje
Section 7 Intraepithelial Lesions 291
40 High-Grade Squamous Intraepithelial Lesions 293
Fabrizio Bogliatto and Fiona M. Lewis
41 Differentiated Vulval Epithelial Neoplasia 301
Fiona M. Lewis
42 Vulval Paget’s Disease 306
Michelle van der Linden
Section 8 Vulval Cancer 313
43 Vulval Squamous Cell Carcinoma 315
Marc van Beurden
44 Malignant Melanoma of the Vulva 327
Fiona M. Lewis
x Contents
45 Other Malignant Vulval Tumours 333
Zlatko Marusic and Eduardo Calonje
Section 9 Surgical Procedures and Management of Other Conditions 347
46 Female Genital Mutilation 349
Refaat Karim
47 Transgender Surgery and the Neovulva 355
Fiona M. Lewis
Section 10 Psychological Aspects of Vulval Disease 359
48 Psychological Aspects of Vulval Disorders 361
Alia Ahmed and Fiona M. Lewis
Section 11 Vulval Disease in Children 373
49 Inflammatory Dermatoses of the Vulva in Children 375
Fiona M. Lewis
50 Vulval Infection in Children 385
Fiona M. Lewis
51 Anatomical Abnormalities in Children 391
Fiona M. Lewis
52 Vulval Trauma in Children 396
Fiona M. Lewis
53 Vulval Lesions in Children 400
Fiona M. Lewis
Section 12 Other Topics 403
54 Vulval Trauma 405
Fiona M. Lewis
55 Cosmetic Procedures and Complications 412
Fiona M. Lewis
Glossary of Terms 416
Index 417
xi
List of Contributors
Alia Ahmed Fiona M. Lewis
Consultant Dermatologist Consultant Dermatologist
Frimley Health NHS Trust St John’s Institute of Dermatology
UK Guy’s & St. Thomas’ NHS Foundation Trust
Guy’s Hospital
Fabrizio Bogliatto London
Department of Obstetrics and Gynaecology UK
Ivrea Hospital
Italy
Zlatko Marusic
Clinical Department of Pathology and Cytology
Nina Bohm-Starke
University Hospital Centre Zagreb
Department of Obstetrics and Gynaecology
Zagreb
Danderyd Hospital
Croatia
Stockholm
Sweden
Elisabet Nylander
Eduardo Calonje Department of Public Health and Clinical Medicine
Director of Dermatopathology Dermatology and Venereology
St John’s Institute of Dermatology Umeå University
Guy’s & St Thomas’ Hospital Sweden
London
UK
Ellie Rashidghamat
Kristiana Gordon St John’s Institute of Dermatology
Department of Dermatology Guy’s & St Thomas’ NHS Foundation Trust
St George’s Hospital London
London UK
UK
Gulshan Sethi
Ulrika Johannesson
Consultant Genito-urinary Physician
Department of Obstetrics and Gynaecology
Guy’s & St Thomas’ NHS Foundation Trust
Danderyd Hospital
London
Stockholm
UK
Sweden
Refaat Karim Marc van Beurden
Plastic Surgeon Department of Gynaecological Oncology
Medical Director National Cancer Institute
Aklinieken Amsterdam
The Netherlands The Netherlands
xii List of Contributors
Michelle van der Linden Shireen Velangi
Department of Obstetrics and Gynaecology Department of Dermatology
Radboud University Medical Center University Hospitals Birmingham NHS Trust
Nijmegen Birmingham
The Netherlands UK
xiii
Preface
It is now over 10 years since the 3rd edition of Ridley’s a ddition of an online edition, it is possible to provide
The Vulva was published. Since that time, my co-editor for additional references, clinical and histological images,
that book, Dr Sallie Neill, has retired but has trusted me to and other resources.
continue with this new edition. It aims to provide a com- Despite all these changes, the aim of the book has not
prehensive update but also to include more topics now changed from Marjorie Ridley’s original vision, and it will
encompassed by the field of vulval disease. keep her name to acknowledge her pioneering work in
Significant changes have been made to this 4th edition, this field. I hope it will therefore be a useful resource for
with a more contemporary feel and a format that is easier all those involved in the management of patients with vul-
to navigate. The number of chapters has therefore been val disease and hence ultimately improve care for this
increased to include new and emerging subjects. There patient group.
are several new authors, all experts in their fields, who
help to discuss old subjects in new ways. With the Fiona M. Lewis
xiv
Acknowledgements
I would like to thank all the contributors for their hard The staff at Wiley have provided great support, especially
work in revising the old and writing the new chapters. I am Rajalaxmi Rajendra Singh, who took on the administration
especially grateful to my dermatopathology colleague, of this edition with great skill. Jennifer Seward, the
Dr Eduardo Calonje, not only for providing histology slides Managing Editor at Wiley, has been a constant help and
but also for his superb dedication to clinicopathological guide and has tolerated my many queries with great
correlation and for teaching me so much in our weekly patience. For this, I thank her.
meetings to review vulval pathology. Dr Ágnes Pekár- Lastly, enormous thanks to my brother, Jeff Lewis, for
Lukacs has scanned most of the new histology slides to ongoing help with grammar and spelling, and for being
provide excellent-quality images, and her contribution to a good opinion in my attempts to make things
this book has been enormous. understandable!
xv
About the Companion Website
This book is accompanied by a companion website.
www.wiley.com/go/thevulva4e
This website includes:
●● Downloadable PDFs of the complete reference lists from the book.
●● Downloadable PowerPoint slides of over 100 extra figures.
1
Section 1
The Basics of Vulval Disease
