Vulvar Cases: A Comprehensive Review of Mucous Membrane Pemphigoid and Genitourinary Syndrome of Menopause

This comprehensive review discusses two significant cases related to vulvar conditions: mucous membrane pemphigoid (MMP) and genitourinary syndrome of menopause (GSM). The first case involves an 84-year-old woman with extensive scarring, blisters, and erosions, diagnosed with MMP. Important diagnostic clues emphasized include the need to check other mucosal surfaces like the eyes and mouth, as MMP can affect various areas and manifestations may be subtle. The diagnosis often poses challenges due to frequently negative test results, necessitating thorough patient history and symptom review. Treatment primarily involves rituximab, with careful monitoring for disease progression. The second case features a 31-year-old non-binary individual experiencing discomfort following gender-affirming surgery, diagnosed with GSM, which can occur even without oophorectomy. This highlights the impact of declining estrogen levels on individuals with female anatomy, causing symptoms like vaginal dryness and discomfort. Treatment strategies for GSM include topical estradiol, particularly for trans individuals who may be hesitant about systemic hormones. Key takeaways from the session stress the importance of examining all mucosal surfaces, recognizing subtle symptoms of vulvar diseases, and understanding the specific risks for transgender individuals in relation to vulvar health.