Itching of the vulva
Itching of the vulva
Vulvar itching is a pathological condition that is usually a symptom of other diseases, accompanied by burning, tingling, and other uncomfortable sensations in the vulvar area. The examination includes vulvoscopy, cytological examination of vulva tissues, microbiological analysis of possible secretions, consultations of specialized specialists. Treatment is complex conservative with the appointment of etiotropic agents, detoxification therapy, antihistamines, sedatives, physiotherapy methods. In persistent cases, anesthetic blockade and resection of the sacral nerves are performed.
Reasons
Pathogenesis
Symptoms of vulvar itching
Complications
Diagnostics
Treatment of vulvar itching
Prognosis and prevention
Prices for treatment
Itching of the vulva
Itching of the vulva is one of the most common complaints in gynecological practice. Usually, the disorder occurs against the background of another pathology or under the influence of external factors. Extremely rarely, a violation is regarded as an independent disease. To date, more than 300 diseases are known, accompanied by itching in the genital area. Often, the causes of its development are directly related to the age of the patient. In girls, adolescents and girls, itching provokes inflammatory processes, in women over 30 years of age — gynecological, somatic and endocrine diseases, during menopause — hypoestrogenism and associated involutive changes in the mucous membranes of the genitals.
Reasons
Unpleasant itchy sensations in the area of the external genitals appear due to adverse external influences, genital and extragenital diseases. In some cases, the factors provoking the occurrence of itching remain unidentified. Specialists in the field of obstetrics and gynecology identify five main groups of causes for which this disorder develops:
Inflammatory urogenital pathology. Burning and itching in the genital area are a characteristic symptom of vulvitis, vaginitis, bacterial vaginosis, endocervicitis, urethritis, cystitis caused by opportunistic flora or pathogens of specific infections – chlamydia, genital herpes, candidiasis, mycoplasmosis, gonorrhea, trichomoniasis, etc. With inflammation, the mucous membrane is constantly irritated by secretions.
Non-inflammatory diseases of the vulva. They usually result from age-related involutive changes caused by a decrease in estrogen levels. Itching due to dryness of the mucous membranes is accompanied by kraurosis (scleroatrophic lichen), leukoplakia (squamous cell hyperplasia), post-castration syndrome after removal of the ovaries. Itchy sensations are also characteristic of vulvar cancer and genital psoriasis.
External factors. The disorder occurs when mechanical irritations are caused by coarse cloth, contaminated underwear, parasites (scabies mite, pinworms, other pathogens of worm infestations). Itching of the vulva can be provoked by thermal effects (especially hypothermia), chemical agents, allergens, noted when taking phenothiazine derivatives, hormonal contraceptives, erythromycin, aspirin, etc.
Extragenital diseases. Burning in the vulva is observed with an increase in the concentration of certain metabolites in patients suffering from diabetes mellitus, hepatitis, renal insufficiency, leukemia, lymphogranulomatosis, gout, thyroid dysfunction, Sjogren’s syndrome and other autoimmune processes. Complaints also appear in skin diseases — red lichen planus, pink lichen, eczema.
Mental and neurological disorders. According to many obstetricians and gynecologists, the sensation of itching in the external genitals and the degree of its severity largely depend on the state of the peripheral and central nervous system. Psychological and sexual traumas, neuroses, depression, prolonged or severe stress become provoking factors. Such disorders have increased resistance to treatment.
Itching of the vulva
Itching of the vulva
Pathogenesis
The mechanism of vulvar itching formation is based on the features of the innervation of the perineum, labia minora and labia majora. Branches of the iliac, sacral, femoral and rectal nerves are suitable for this area. When exposed to various stimuli on the ends of unmyelinated C-fibers, poorly differentiated impulses, perceived as itching, tingling, burning and even pain, enter the sensitive area of the cerebral cortex through the conductive tracts of the spinal cord.
The nature of the stimulus is usually determined by the immediate cause of the pathology. These may be drying secretions, local mucosal changes, metabolites, thermal, mechanical and chemical factors. Sometimes the action of stimuli leads to the release of histamine, which causes swelling and itching in the affected area. The pathogenesis of the disorder in mental disorders seems to be associated with a decrease in the threshold of sensitivity and increased excitability of brain structures.
Symptoms of vulvar itching
A woman complains of burning, tingling, itching, and other uncomfortable sensations that bother her constantly or occur paroxysmally, more often in the evening or at night. With a prolonged course of the underlying disease, areas of redness, scratching, cracks, ulcerative defects appear on the genital mucosa. Often, itching spreads from the perineum and labia to the skin near the anus and the inner surface of the thighs. With the development of the inflammatory process, there are pains, light yellow, greenish, grayish-white, curd or abundant liquid discharge with an unpleasant odor.
Complications
To get rid of intense unpleasant sensations, women often rub or scratch itchy areas. Mechanical effects increase irritation, which leads to the formation of scratches, erosions, ulceration. Infection of the mucosa aggravates the course of the underlying pathology due to the addition of vulvitis. With chronic somatic, endocrine and inflammatory genital diseases, dysplastic and neoplastic processes may occur against the background of prolonged irritation of the vulvar mucosa. Constant discomfort in the genital area causes the development of anxiety-depressive, hypochondriac and other neurotic disorders.
Vulvoscopy
Diagnostics
The main diagnostic task for complaints of itching of the vulva is to determine the cause that caused it. At the first stage of the examination, a gynecologist examines the external genitalia and perineum. Examination reveals changes in the color and condition of the mucous membranes (redness, areas of hyperkeratosis, damage due to friction and combing), warts, other formations, discharge in the vestibule of the vagina. Next, a comprehensive laboratory and instrumental examination is prescribed. The most informative methods are:
Vulvoscopy. The study of the vulva and perineum under a colposcope is performed to detect local inflammation, dysplasia, hyperproliferation, atrophy, malignant degeneration of the skin and mucosa. If necessary, the procedure is carried out in an expanded version with surface treatment with various medications.
Histological examination. In the presence of local changes in vulva tissues, biopsy sampling is recommended with subsequent examination of the obtained material. The method makes it possible to accurately determine the nature of changes in the external genitalia and timely identify oncopathology.
Microscopy and back-seeding of secretions. Microbiological examination makes it possible to detect possible pathogens of infectious and inflammatory processes, to clarify their sensitivity to antibiotics. According to the indications, microbial antigens and antibody titers (RIF, ELISA, PCR) are additionally determined.
To determine the genital causes of itching, mirror examination, bimanual examination, cervicoscopy, hysteroscopy, and other special methods of diagnosing gynecological diseases are used. Tests and studies to identify extragenital pathology are prescribed by specialized specialists — urologists, therapists, gastroenterologists, dermatologists, venereologists, infectious diseases and allergologists-immunologists. In the absence of morphological prerequisites for the occurrence of vulvar itching, the patient is examined by a neurologist and a psychiatrist. Differential diagnosis is carried out with vulvodynia, as well as between diseases and conditions about which uncomfortable sensations are observed in the vulvar zone.
Treatment of vulvar itching
Therapeutic tactics are aimed at eliminating the causes of the disorder, reducing its severity or eliminating it completely. Depending on the etiology, the patient is prescribed antibacterial, antifungal, anti-inflammatory drugs, eubiotics, estrogens, immunomodulators, drugs for the treatment of somatic, endocrine, and other extragenital pathology. With intense itching, which significantly reduces the quality of a woman’s life, effective:
Detoxification therapy. Means for active, rapid elimination of pathological metabolites are usually used in the form of droppers, if necessary, supplemented with forced diuresis. It is possible to use enterosorbents.
Antihistamines. Some of the symptoms of inflammatory, allergic and autoimmune reactions are caused by histamine exposure. Drug blocking of histamine receptors can reduce itching and swelling of tissues.
Novocaine blockade of the sacral nerve. For patients with persistent, painful sensations, the affected area is punctured with solutions of anesthetic agents. Although this method provides only a temporary effect, it is chosen when it is important to ensure normal sleep.
Sedatives. For unspecified etiology of the disorder or emotional disorders, herbal sedatives, tranquilizers and mild antidepressants are used. According to the indications, psychotherapy is carried out.
Drug therapy is usually combined with physiotherapy techniques, the most effective of which are laser therapy and calcium electrophoresis. The patient is recommended gentle care of the vulvar area with the use of soft pH-neutral hygiene products, sedentary baths with decoctions of turn, calendula and chamomile, the use of moisturizers, wearing cotton underwear with its frequent change. The correction of the diet provides for the rejection of fried foods, canned food, smoked meats, sweets and muffins. As a rule, complex conservative therapy allows you to completely eliminate itching, only in extreme cases, with severe course, surgical resection of the sacral nerves is performed.
Prognosis and prevention
With adequate diagnosis and therapy, in most cases it is possible to completely get rid of itching of the vulva or significantly reduce its manifestations. Longer treatment is required for atrophic diseases of the vulvar region, neoprocess, mental etiology of the disorder. For preventive purposes, timely treatment of extragenital and gynecological diseases, rejection of bad habits, proper care of the genitals, the use of soft linen made of cotton fabrics is recommended. It is important to observe the sleep and rest regime, eat rationally, avoid significant psycho-emotional stress and exposure to harmful environmental factors.
