Archives of Gynecology and Obstetrics

, Volume 272, Issue 2, pp 167–172 | Cite as

Vulvar susceptibility to contact irritants and allergens: a review

  • Miranda A. FarageEmail author
Original Article


Vulvar tissue differs from cutaneous epithelia in structure, morphology and biophysical characteristics. For example, the skin of the labia majora exhibits elevated hydration, occlusion and frictional properties, which may increase susceptibility to irritants and contact sensitizers. Furthermore, the nonkeratinized vulvar vestibule is likely to be more permeable than keratinized regions. These differences heighten vulvar susceptibility to topical agents. This reviews the structure and properties of vulvar tissue, emphasizing their impact on susceptibility contact irritants and allergens.


Vulvar epithelium Keratinization Permeability Irritant contact dermatitis Allergic contact dermatitis 



The author is grateful to H.I. Maibach, M.D. for his critical review and to Deborah Hutchins, Ph.D. of Hutchins & Associates, LLC (Cincinnati, OH, USA) for technical input and writing.


  1. 1.
    Agner T, Damm P, Skouby SO (1991) Menstrual cycle and skin reactivity. J Am Acad Dermatol 24:566–570PubMedGoogle Scholar
  2. 2.
    Allen-Davis JT, Beck A, Parker R, Ellis JL, Polley D (2002) Assessment of vulvovaginal complaints: Accuracy of telephone triage and in-office diagnosis. Obstet Gynecol 99:18–22CrossRefPubMedGoogle Scholar
  3. 3.
    Berardesca E, Maibach HI (1988) Contact dermatitis in blacks. Dermatol Clin 6:363–368PubMedGoogle Scholar
  4. 4.
    Berardesca E, Maibach H (1996) Racial differences in skin pathophysiology. J Am Acad Dermatol 34:667–672PubMedGoogle Scholar
  5. 5.
    Borgatta L (1978) Sensitivity to deodorant sanitary pads. JAMA 240:1239–1240CrossRefGoogle Scholar
  6. 6.
    Britz M, Maibach HI (1985) Normal vulvar skin: a model for specialized skin. In: Maibach H, Lowe N (eds), Models in dermatology, vol 1. Basel Karger, Basel, pp 83–88Google Scholar
  7. 7.
    Britz MB, Maibach HI (1979a) Human labia majora skin: Transepidermal water loss in vivo. Acta Derm Venereol Suppl (Stockh) 59:23–25Google Scholar
  8. 8.
    Britz MB, Maibach HI (1979b) Human cutaneous vulvar reactivity to irritants. Contact Dermatitis 5:375–377PubMedGoogle Scholar
  9. 9.
    Britz MB, Maibach HI, Anjo DM (1980) Human percutaneous penetration of hydrocortisone: The vulva. Arch Dermatol Res 267:313–316PubMedGoogle Scholar
  10. 10.
    Crone AM, Stewart EJ, Wojnarowska F, Powell SM (2000) Aetiological factors in vulvar dermatitis. J Eur Acad Dermatol Venereol 14:181–186PubMedGoogle Scholar
  11. 11.
    Du X, Squier CA, Kremer MJ, Wertz PW (2000) Penetration of n-nitrosonornicotine (nnn) across oral mucosa in the presence of ethanol and nicotine. J Oral Pathol Med 29:80–85PubMedGoogle Scholar
  12. 12.
    Eason EL, Feldman P (1996) Contact dermatitis associated with the use of always sanitary napkins. CMAJ 154:1173–1176PubMedGoogle Scholar
  13. 13.
    Edwards JN, Morris HB (1985) Langerhans’ cells and lymphocyte subsets in the female genital tract. Br J Obstet Gynaecol 92:974–982PubMedGoogle Scholar
  14. 14.
    Elsner P, Maibach HI (1990) The effect of prolonged drying on transepidermal water loss, capacitance and ph of human vulvar and forearm skin. Acta Derm Venereol 70:105–109PubMedGoogle Scholar
  15. 15.
    Elsner P, Wilhelm D, Maibach HI (1990a) Sodium lauryl sulfate-induced irritant contact dermatitis in vulvar and forearm skin of premenopausal and postmenopausal women. J Am Acad Dermatol 23:648–52PubMedGoogle Scholar
  16. 16.
    Elsner P, Wilhelm D, Maibach HI (1990b) Multiple parameter assessment of vulvar irritant contact dermatitis. Contact Dermatitis 23:20–26PubMedGoogle Scholar
  17. 17.
    Elsner P, Wilhelm D, Maibach HI (1990c) Irritant effect of a model surfactant on the human vulva and forearm. Age-related differences. J Reprod Med 35:1035–1039PubMedGoogle Scholar
  18. 18.
    Elsner P, Wilhelm D, Maibach HI (1990d) Frictional properties of human forearm and vulvar skin: Influence of age and correlation with transepidermal water loss and capacitance. Dermatologica 181:88–91PubMedGoogle Scholar
  19. 19.
    Elsner P, Wilhelm D, Maibach HI (1990e) Physiological skin surface water loss dynamics of human vulvar and forearm skin. Acta Derm Venereol 70:141–144PubMedGoogle Scholar
  20. 20.
    Elsner P, Wilhelm D, Maibach HI (1991) Effect of low-concentration sodium lauryl sulfate on human vulvar and forearm skin. Age-related differences. J Reprod Med 36:77–81PubMedGoogle Scholar
  21. 21.
    Feldmann RJ, Maibach HI (1967) Regional variation in percutaneous absorption of [14c] cortisol in man. J Invest Dermatol 48:181–183PubMedGoogle Scholar
  22. 22.
    Fischer GO (1996) The commonest causes of symptomatic vulvar disease: A dermatologist’s perspective. Australas J Dermatol 37:12–18PubMedGoogle Scholar
  23. 23.
    Fisher AA (1973) Allergic reaction to feminine hygiene sprays. Arch Dermatol 108:801–802PubMedGoogle Scholar
  24. 24.
    Guy RH, Potts RO (1992) Structure-permeability relationships in percutaneous penetration. J Pharm Sci 81:603–604PubMedGoogle Scholar
  25. 25.
    Guy RH, Potts RO, Francoeur ML (1992) Skin barrier function and the mechanism(s) of percutaneous penetration. Acta Pharm Nord 4:115Google Scholar
  26. 26.
    Hansen A, Carr K, Jensen JT (2002) Characteristics and initial diagnoses in women presenting to a referral center for vulvovaginal disorders in 1996–2000. J Reprod Med 47:854–860PubMedGoogle Scholar
  27. 27.
    Harper WF, McNicol EM (1977) A histological study of normal vulval skin from infancy to old age. Br J Dermatol 96:249–253PubMedGoogle Scholar
  28. 28.
    Harris D, Robinson JR (1992) Drug delivery via the mucous membranes of the oral cavity. J Pharm Sci 81:1–10PubMedGoogle Scholar
  29. 29.
    Harvell J, Hussona-Saeed I, Maibach HI (1992) Changes in transepidermal water loss and cutaneous blood flow during the menstrual cycle. Contact Dermatitis 27:294–301PubMedGoogle Scholar
  30. 30.
    Jones IS (1983) A histological assessment of normal vulval skin. Clin Exp Dermatol 8:513–521PubMedGoogle Scholar
  31. 31.
    Law S, Wertz PW, Swartzendruber DC, Squier CA (1995) Regional variation in content, composition and organization of porcine epithelial barrier lipids revealed by thin-layer chromatography and transmission electron microscopy. Arch Oral Biol 40:1085–1091PubMedGoogle Scholar
  32. 32.
    Lesch CA, Squier CA, Cruchley A, Williams DM, Speight P (1989) The permeability of human oral mucosa and skin to water. J Dent Res 68:1345–9PubMedGoogle Scholar
  33. 33.
    Margesson LJ (2004) Contact dermatitis of the vulva. Dermatol Ther 17:20–27PubMedGoogle Scholar
  34. 34.
    Marren P, Wojnarowska F, Powell S (1992) Allergic contact dermatitis and vulvar dermatoses. Br J Dermatol 126:52–56PubMedGoogle Scholar
  35. 35.
    Miller CJ, McChesney M, Moore PF (1992) Langerhans cells, macrophages and lymphocyte subsets in the cervix and vagina of rhesus macaques. Lab Invest 67:628–34PubMedGoogle Scholar
  36. 36.
    Nauth H (1993) Anatomy and physiology of the vulva. In: Elsner P, Marius J (eds), Vulvovaginitis. Marcel Dekker, New York, pp 1–18Google Scholar
  37. 37.
    Nauth HF, Haas M (1985) Cytologic and histologic observations on the sex hormone dependence of the vulva. J Reprod Med 30:667–674PubMedGoogle Scholar
  38. 38.
    O’Hare PM, Sherertz EF (2000) Vulvodynia: A dermatologist’s perspective with emphasis on an irritant contact dermatitis component. J Womens Health Gend Based Med 9:565–569PubMedGoogle Scholar
  39. 39.
    Oriba HA, Bucks DA, Maibach HI (1996) Percutaneous absorption of hydrocortisone and testosterone on the vulva and forearm: Effect of the menopause and site. Br J Dermatol 134:229–233PubMedGoogle Scholar
  40. 40.
    Patton DL, Thwin SS, Meier A, Hooton TM, Stapleton AE, Eschenbach DA (2000) Epithelial cell layer thickness and immune cell populations in the normal human vagina at different stages of the menstrual cycle. Am J Obstet Gynecol 183:967–973PubMedGoogle Scholar
  41. 41.
    Potts RO, Guy RH (1992) Predicting skin permeability. Pharm Res 9:663–669PubMedGoogle Scholar
  42. 42.
    Sargeant P, Moate R, Harris JE, Morrison GD (1996) Ultrastructural study of the epithelium of the normal human vulva. J Submicrosc Cytol Pathol 28:161–170PubMedGoogle Scholar
  43. 43.
    Sayani AP, Chien YW (1996) Systemic delivery of peptides and proteins across absorptive mucosae. Crit Rev Ther Drug Carrier Syst 13:85–184PubMedGoogle Scholar
  44. 44.
    Sihvo S, Ahonen R, Mikander H, Hemminki E (2000) Self-medication with vaginal antifungal drugs: physicians’ experiences and women’s utilization patterns. Fam Pract 17:145–149PubMedGoogle Scholar
  45. 45.
    Squier CA, Hall BK (1985) The permeability of skin and oral mucosa to water and horseradish peroxidase as related to the thickness of the permeability barrier. J Invest Dermatol 84:176–179PubMedGoogle Scholar
  46. 46.
    Squier CA (1986) Penetration of nicotine and nitrosonornicotine across porcine oral mucosa. J Appl Toxicol 6:123–128PubMedGoogle Scholar
  47. 47.
    Squier CA, Cox P, Wertz PW (1991) Lipid content and water permeability of skin and oral mucosa. J Invest Dermatol 96:123–126PubMedGoogle Scholar
  48. 48.
    Thompson IO, van der Bijl P, van Wyk CW, van Eyk AD (2001) A comparative light-microscopic, electron-microscopic and chemical study of human vaginal and buccal epithelium. Arch Oral Biol 46:1091–1098PubMedGoogle Scholar
  49. 49.
    van der Bijl P, Thompson IO, Squier CA (1997) Comparative permeability of human vaginal and buccal mucosa to water. Eur J Oral Sci 105:571–575PubMedGoogle Scholar
  50. 50.
    van der Bijl P, van Eyk AD, Thompson IO (1998a) Penetration of human vaginal and buccal mucosa by 4.4-kd and 12-kd fluorescein-isothiocyanate-labeled dextrans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:686–691PubMedGoogle Scholar
  51. 51.
    van der Bijl P, van Eyk AD, Thompson IO (1998b) Permeation of 17beta-estradiol through human vaginal and buccal mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:393–398PubMedGoogle Scholar
  52. 52.
    van der Bijl P, van Eyk AD, Thompson IO, Stander IA (1998c) Diffusion rates of vasopressin through human vaginal and buccal mucosa. Eur J Oral Sci 106:958–962PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Feminine Care and Family Care Research and DevelopmentThe Procter & Gamble CompanyCincinnatiUSA

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