Summary about Disease
Vulvar pruritus is characterized by persistent itching of the vulva, the external female genitalia. It is a common symptom with a wide range of potential causes, varying from infections and skin conditions to irritation from chemicals and, less commonly, underlying systemic diseases. The itching can be mild to severe and significantly impact a woman's quality of life, leading to discomfort, sleep disturbances, and psychological distress.
Symptoms
The primary symptom is itching of the vulva. Additional symptoms may include:
Burning sensation
Soreness
Redness or inflammation
Dryness
Thickened or leathery skin (lichenification) due to chronic scratching
Small bumps or blisters
Pain during urination or sexual intercourse (dysuria or dyspareunia)
Causes
The causes of vulvar pruritus are diverse. Common causes include:
Infections: Yeast infections (candidiasis), bacterial vaginosis, sexually transmitted infections (STIs) like trichomoniasis, herpes simplex virus (HSV), and human papillomavirus (HPV).
Skin Conditions: Eczema (atopic dermatitis), psoriasis, lichen sclerosus, lichen planus.
Irritants: Soaps, detergents, douches, perfumes, feminine hygiene products, tight clothing, chlorine in pools, spermicides.
Allergens: Latex (condoms), certain fabrics, fragrances.
Hormonal Changes: Menopause (due to decreased estrogen), pregnancy.
Other Medical Conditions: Diabetes, vulvar cancer (rare).
Idiopathic: Sometimes, no specific cause can be identified.
Medicine Used
Treatment depends on the underlying cause. Common medications include:
Antifungal Creams: For yeast infections (e.g., clotrimazole, miconazole).
Antibiotics: For bacterial infections (e.g., metronidazole, clindamycin).
Antiviral Medications: For herpes simplex virus (HSV) infections (e.g., acyclovir, valacyclovir).
Topical Corticosteroids: To reduce inflammation and itching (e.g., hydrocortisone, betamethasone).
Emollients/Moisturizers: To relieve dryness and protect the skin barrier.
Antihistamines: To reduce itching, especially at night.
Topical Calcineurin Inhibitors: For eczema and other inflammatory skin conditions (e.g., tacrolimus, pimecrolimus).
Hormone Therapy: For menopause-related pruritus (e.g., topical estrogen cream).
Is Communicable
Whether vulvar pruritus is communicable depends on the underlying cause. If the pruritus is caused by an STI or a fungal/bacterial infection, it can be communicable through sexual contact or, in some cases, close personal contact. Skin conditions or irritant-related causes are not communicable.
Precautions
General precautions to help prevent and manage vulvar pruritus include:
Good Hygiene: Gently wash the vulva with water and a mild, unscented soap. Avoid douching.
Avoid Irritants: Use fragrance-free products, avoid harsh soaps and detergents, and wear loose-fitting cotton underwear.
Proper Wiping Technique: Wipe from front to back after using the toilet.
Avoid Scratching: Scratching can worsen the itching and lead to skin damage and infection.
Safe Sex Practices: Use condoms to prevent STIs.
Manage Underlying Conditions: Control diabetes or other medical conditions that may contribute to vulvar pruritus.
Identify and Avoid Allergens: If an allergy is suspected, undergo allergy testing and avoid the identified allergens.
How long does an outbreak last?
The duration of vulvar pruritus depends on the cause and treatment. Infections can resolve within days to weeks with appropriate medication. Skin conditions may require ongoing management. Irritant-related pruritus often resolves quickly once the irritant is removed. Chronic conditions like lichen sclerosus may require long-term treatment to manage symptoms.
How is it diagnosed?
Diagnosis typically involves:
Medical History: A detailed discussion of symptoms, medical history, and potential irritants or allergens.
Physical Examination: Examination of the vulva and surrounding skin.
Microscopic Examination: Of vaginal discharge to identify yeast, bacteria, or trichomoniasis.
Skin Biopsy: In some cases, a skin biopsy may be necessary to diagnose skin conditions like lichen sclerosus or vulvar cancer.
Allergy Testing: If allergies are suspected.
STI Testing: If sexually transmitted infections are suspected.
Timeline of Symptoms
The timeline of symptoms varies widely depending on the cause:
Infections: Symptoms may appear suddenly and worsen over a few days.
Irritant Dermatitis: Symptoms may appear within hours or days of exposure to an irritant.
Allergic Dermatitis: Symptoms may appear within hours to days of exposure to an allergen.
Chronic Skin Conditions: Symptoms may develop gradually over months or years.
Hormonal Changes (Menopause): Symptoms may develop gradually over months or years.
Important Considerations
Persistent vulvar pruritus should be evaluated by a healthcare provider to determine the underlying cause and receive appropriate treatment.
Self-treating without a diagnosis can delay proper treatment and potentially worsen the condition.
Vulvar pruritus can have a significant impact on a woman's quality of life, so seeking medical care is essential.
Chronic itching can lead to a cycle of itch-scratch-itch, which can be difficult to break. Behavioral strategies, such as stress management and distraction techniques, may be helpful.
Vulvar self-examination is important to monitor for any changes in the skin, such as new lumps, bumps, or sores.