Itching Of The Vulva : Causes, Symptoms, Diagnosis & Treatment

• The Reasons
• Pathogenesis
• Symptoms Of Itching Of The Vulva
• Complications
• Diagnostics
• Vulvar Itching Treatment
• Forecast And Prevention

Itching of the vulva is a pathological condition that is usually a symptom of other diseases, accompanied by burning, tingling, and other uncomfortable sensations in the vulvar region. The examination includes vulvoscopy, cytological examination of vulvar tissues, microbiological analysis of possible secretions, consultations of specialized specialists. The treatment is complex conservative with the appointment of etiotropic drugs, detoxification therapy, antihistamines, sedatives, physiotherapeutic methods. In persistent cases, blockade with anesthetics and resection of the pudendal nerves are performed.

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. Very rarely, a violation is regarded as an independent disease. To date, more than 30 diseases are known, accompanied by itching in the genital area. Often the reasons for its development are directly related to the age of the patient. In girls, adolescents and girls, itching is provoked by inflammatory processes, in women older than 3 years - gynecological, somatic and endocrine diseases, during menopause - hypoestrogenism and associated involutive changes in the mucous membranes of the genital organs.

The reasons

Unpleasant itchy sensations in the vulva appear due to adverse external influences, genital and extragenital diseases. In some cases, the factors that provoke the occurrence of itching remain unidentified. Specialists in the field of obstetrics and gynecology identify five main groups of reasons 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. In case of inflammation, the mucosa constantly irritated by secretions.
• Non-inflammatory diseases of the vulva . Usually they are the result of age-related involutive changes caused by a decrease in estrogen levels. Itching due to dryness of the mucous membranes is accompanied by kraurosis (lichen sclerosus), 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 with mechanical irritations of coarse tissue, contaminated linen, parasites (scabies mites, pinworms, other pathogens of helminthic invasions). Itching of the vulva can be provoked by thermal effects (especially hypothermia), chemical agents, allergens, observed 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 failure, leukemia, lymphogranulomatosis, gout, thyroid dysfunction, Sjögren's syndrome and other autoimmune processes. Complaints also appear in skin diseases - lichen planus, lichen pink, eczema.
• Mental and neurological disorders . According to many obstetrician-gynecologists, the sensation of itching in the external genitalia and the degree of its severity largely depend on the state of the peripheral and central nervous system. Provoking factors are psychological and sexual trauma, neurosis, depression, prolonged or severe stress. These disorders are highly resistant to treatment.

Itching of the vulva

Pathogenesis

The mechanism of formation of itching of the vulva is based on the characteristics of the innervation of the perineum, small and large labia. Branches of the iliac, pudendal, femoral and rectal nerves approach this area. Under the influence of various stimuli on the endings of unmyelinated C-fibers through the conducting tracts of the spinal cord, undifferentiated impulses, perceived as itching, tingling, burning, and even pain, enter the sensitive zone of the cerebral cortex.

The nature of the stimulus is usually determined by the direct cause of the pathology. These can be drying secretions, local changes in the mucosa, metabolites, thermal, mechanical and chemical factors. Sometimes the action of irritants leads to the release of histamine, which causes swelling and itching at 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 itching of the vulva

A woman complains of burning, tingling, itching, and other uncomfortable sensations that constantly bother her or occur paroxysmal, more often in the evening or at night. With a long course of the underlying disease, areas of redness, scratching, cracks, and ulcerative defects appear on the genital mucosa. Often itching spreads from the perineum and labia to the skin near the anus and inner thighs. With the development of the inflammatory process, pain, light yellow, greenish, grayish-white, curdled or abundant liquid discharge with an unpleasant odor are noted.

Complications

To get rid of intense discomfort, women often rub or scratch itchy areas. Mechanical effects increase irritation, which leads to the formation of scratching, erosion, ulceration. Infection of the mucosa aggravates the course of the underlying pathology due to the addition of vulvitis. In chronic somatic, endocrine and inflammatory genital diseases against the background of prolonged irritation of the vulvar mucosa, dysplastic and neoplastic processes may occur. Constant discomfort in the genital area causes the development of anxiety-depressive, hypochondriacal 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, the gynecologist examines the external genitalia and perineum. On examination, a change in the color and condition of the mucous membranes (redness, areas of hyperkeratosis, damage due to friction and scratching), condylomas, other formations, and discharge in the vestibule of the vagina are revealed. 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 mucous membranes. If necessary, the procedure is carried out in an extended version with surface treatment with various medications.
• Histological examination . In the presence of local changes in the tissues of the vulva, it is recommended to take a biopsy specimen with subsequent examination of the material obtained. The method makes it possible to accurately determine the nature of changes in the external genital organs and timely identify oncopathology.
• Microscopy and culture of secretions . Microbiological examination allows to detect possible pathogens of infectious and inflammatory processes, to clarify their sensitivity to antibiotics. According to indications, microbial antigens and antibody titers are additionally determined (RIF, ELISA, PCR).

To establish the genital causes of itching, examination in the mirrors, bimanual examination, cervicoscopy, hysteroscopy, and other special methods for diagnosing gynecological diseases are used. Analyzes and studies to identify extragenital pathology are prescribed by specialized specialists - urologists, therapists, gastroenterologists, dermatologists, venereologists, infectious disease specialists and allergologists-immunologists. In the absence of morphological prerequisites for the occurrence of vulvar itching, the patient is examined by a neuropathologist and a psychiatrist. Differential diagnosis is carried out with vulvodynia, as well as between diseases and conditions, about which discomfort is observed in the vulvar zone.

Vulvar itching treatment

Therapeutic tactics are aimed at eliminating the causes of the disorder, reducing its severity or completely eliminating it. 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 pathologies. With intense itching, which significantly reduces the quality of life of a woman, the following are effective:

• Detoxification therapy . Means for the active, rapid excretion of pathological metabolites are usually used in the form of droppers, if necessary supplemented with forced diuresis. Use of enterosorbents is possible.
• Antihistamines . Part of the symptoms in inflammatory, allergic and autoimmune reactions is due to the effects of histamine. Drug blocking of histamine receptors can reduce itching and swelling of tissues.
• Novocaine blockade of the pudendal nerve . For patients with persistent, painful sensations, the affected area is chipped with anesthetic solutions. Although this method provides only a temporary effect, it is chosen when it is important to ensure normal sleep.
• Sedatives . With an unspecified etiology of a disorder or emotional disorders, herbal sedatives, tranquilizers and mild antidepressants are used. According to indications, psychotherapy is carried out.

Drug therapy is usually combined with physiotherapeutic methods, the most effective of which are laser therapy and calcium electrophoresis. The patient is recommended gentle care for the vulvar area using mild pH-neutral hygiene products, sitz baths with decoctions of string, calendula and chamomile, the use of moisturizers, wearing cotton underwear with its frequent change. Diet correction 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, in severe cases, surgical resection of the pudendal nerves is performed.

Forecast 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, neoprocesses, mental etiology of the disorder. As a preventive measure, timely treatment of extragenital and gynecological diseases, giving up bad habits, proper care of the genitals, and the use of soft linen made of cotton fabrics are recommended. It is important to observe the sleep and rest regimen, eat rationally, avoid significant psycho-emotional stress and exposure to harmful environmental factors.