Vulvar pruritus (pruritus vulvae) is a common itching symptom affecting the vulvar skin and mucous membranes. It can occur in all age groups, but is most common in women with lower genital tract infections, perimenopausal women, and older women. Severe itching can cause restlessness and even interfere with daily life and work. Patients are advised to seek medical attention and appropriate treatment promptly to alleviate the discomfort and minimize the impact on their daily lives.
symptom
Typical manifestations
1. Itchy area
Vulvar itching is mostly located in the clitoris, labia minora, labia majora, perineum, and even perianal skin lesions.
2. Characteristics of itching
Vulvar pruritus often occurs in paroxysmal episodes but can also be persistent, often worsening at night. The severity of the itching varies significantly depending on the disease and individual.
Associated symptoms
Some patients may experience symptoms such as vulvar burning, pain, increased vaginal discharge, leucorrhea odor, painful urination, and frequent urination.
complication
This symptom usually has no obvious complications.
reason
Overview
There are many causes of vulvar itching, mainly including local causes such as infection, chronic vulvar malnutrition, drug allergy or chemical irritation, poor hygiene habits, as well as systemic causes such as diabetes, intrahepatic cholestasis of pregnancy, and jaundice.
Cause of symptoms
1. Local causes
(1) Infection: Vaginitis such as vulvovaginal candidiasis, bacterial vaginosis, trichomonas vaginitis, and atrophic vaginitis are the most common causes of vulvar pruritus. Sexually transmitted diseases such as gonorrhea, chlamydia, mycoplasma, pubic lice infection, and scabies can also cause vulvar pruritus. Enterobiasis can cause itching around the anus and vulva in young girls.
(2) Chronic vulvar dystrophy (squamous cell hyperplasia): The main symptom is severe itching, accompanied by hypopigmentation of the vulvar skin.
(3) Drug allergy or chemical irritation: Soap, condoms, chlorhexidine, mercurochrome, etc. can cause contact dermatitis or allergic dermatitis due to direct irritation or allergy, resulting in vulvar itching.
(4) Bad hygiene habits: Not paying attention to the local cleanliness of the vulva, sebum, sweat, menstrual blood, vaginal secretions, and even urine and feces soaking in the vulva, long-term stimulation of the vulva can cause vulvar itching; improper menstrual hygiene products and wearing non-breathable synthetic underwear can induce vulvar itching.
(5) Others: Skin lesions, abrasions, common warts, herpes, eczema, and vulvar tumors can all cause vulvar itching.
2. Systemic causes
(1) Diabetes: Urine irritates the vulvar skin, causing vulvar itching, especially when accompanied by vulvovaginal candidiasis, the vulvar itching is particularly severe.
(2) Vulvar congestion during pregnancy and premenstrual period may occasionally cause vulvar itching.
(3) When patients with chronic diseases such as intrahepatic cholestasis of pregnancy, jaundice, vitamin A or vitamin B deficiency, anemia, leukemia, etc. experience vulvar pruritus, it is often part of systemic pruritus.
(4) Unexplained vulvar pruritus (psychogenic vulvar pruritus): Some patients experience severe vulvar pruritus without any obvious systemic or local cause, which is believed to be related to mental or psychological factors.
Common diseases
Vulvovaginal candidiasis, bacterial vaginosis, Trichomonas vaginitis, atrophic vaginitis, gonorrhea, chlamydia infection, mycoplasma infection, pubic lice infestation, scabies, enterobiasis, chronic vulvar dystrophy, contact dermatitis, allergic dermatitis, common warts, herpes, eczema, vulvar tumors, diabetes, intrahepatic cholestasis of pregnancy, jaundice, vitamin A deficiency, vitamin B deficiency, anemia, leukemia
Seeking medical treatment
Outpatient indications
1. Persistent or recurrent itching of the vulva, seriously affecting daily life;
2. Accompanied by burning and pain in the vulva;
3. Accompanied by increased leucorrhea and leucorrhea with odor;
4. Abnormal urination such as dysuria and frequent urination;
5. Accompanied by local redness of the vulva or papules, herpes, erosion, etc.;
6. Those with a history of high-risk sexual life and suspected sexually transmitted diseases;
7. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
1. For those with vulvar itching, the first choice is gynecology.
2. If you suspect that the disease is caused by genital warts, pubic lice, etc., you can go to the venereal disease department or dermatology department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. Pay attention to the cleanliness of the vulva, avoid using medicine to clean it yourself, and avoid sexual intercourse.
3. It is recommended to wear a skirt of appropriate length or loose pants on the day of consultation to facilitate the doctor’s gynecological examination.
4. Patients can organize their medical history and onset conditions in advance so that they can answer the doctor’s questions accurately.
5. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
6. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
7. Arrange for family members or friends to accompany you to the hospital.
8. Prepare a list of questions you want to ask in advance.
What questions might a doctor ask a patient?
1. When did you start experiencing vulvar itching? Can you describe the location of the itching?
2. Does your vulvar itching occur intermittently or continuously?
3. Under what circumstances will your vulvar itching be relieved?
4. Under what circumstances will your vulvar itching become more severe?
5. Have you ever had vulvar itching? What caused it? How was it treated?
6. Have you ever had vaginitis?
7. Do you have diabetes?
8. Have you recently had any diseases originating in the vulva, such as genital warts, vulvar eczema, or pubic lice?
9. Do you often wear tight pants or non-breathable synthetic underwear?
10. Are you sexually active? Do you have a history of sexually explicit intercourse?
11. Do you pay attention to vulvar hygiene?
12. Have you ever used medication on your own? What medication did you use?
What questions can patients ask their doctor?
What is the most likely cause of my vulvar itching? Are there other possible causes?
2. What tests do I need to do?
3. What treatments do I need? Are there any risks associated with treatment?
4. How long will I need treatment? Can it be cured? Will it recur?
5. Is there any harm if I don’t get treatment? Does my sexual partner need to be treated at the same time?
6. How should I care for myself during treatment? What precautions should I take?
7. If medication is needed, what are the usage, dosage, and precautions?
8. Do I need follow-up examinations? How often should I do so?
examine
Scheduled inspection
Patients usually need to undergo a gynecological examination and vaginal discharge examination. If necessary, patients may also need to undergo blood sugar testing, liver function tests, kidney function tests, and pathological examinations to further clarify the cause of the disease.
Physical examination
1. Vulvar examination
Vulvar examination mainly involves observing the appearance of the vulvar skin and mucous membranes to see if there is redness, swelling, papules, erosion or other abnormalities.
2. Vaginal examination
The doctor will use a vaginal speculum to open the vaginal wall and observe whether there are any abnormal changes in the vaginal wall and cervix, as well as the color and texture of vaginal secretions.
Laboratory tests
1. Vaginal secretion examination
It can help us understand the cleanliness of the vagina and whether there are pathogens such as Trichomonas and Candida (Candida), so as to determine whether there is vaginitis and the type of vaginitis.
2. Others
Laboratory tests such as blood sugar, liver function, and kidney function were performed to rule out systemic diseases that cause vulvar itching.
Pathological examination
In cases where vulvar skin lesions are suspected, the doctor may recommend a skin scraping or biopsy for pathological analysis to understand the nature and severity of the lesion and make an accurate diagnosis.
diagnosis
Diagnostic principles
In clinical practice, doctors usually make an accurate diagnosis based on a comprehensive analysis of the patient’s medical history, symptom characteristics, gynecological examination and vaginal secretion examination, blood sugar test, liver function test and other auxiliary examination results.
Differential diagnosis
1. Trichomonas vaginitis
The main symptoms are increased vaginal discharge and vulvar itching, occasionally accompanied by burning, pain, and dyspareunia. The itching primarily occurs at the vaginal opening and vulva. The discharge is typically thin, purulent, frothy, and has an odor. The discharge is grayish-yellow or yellowish-white and purulent, and may also be yellow-green if associated with other infections. Microscopic examination of vaginal discharge may reveal wavy movements of Trichomonas.
2. Vulvovaginal candidiasis
The main symptoms are vulvovaginal itching and increased vaginal discharge. The itching is pronounced and long-lasting, and in severe cases, can cause restlessness, which is more pronounced at night. Some patients experience burning pain in the vulva, dyspareunia, and dysuria during urination. The vaginal discharge is characteristically thick and white, with a curd-like or tofu-like consistency. Smears of vaginal discharge may reveal blastospores or pseudohyphae of Candida species.
3. Bacterial vaginosis
The clinical hallmark of this condition is an increased, thin vaginal discharge with a fishy odor. The discharge is grayish-white, uniform, and thin. Mild vulvar itching or burning may occur, and symptoms worsen after sexual intercourse. A vaginal smear may reveal clue cells accounting for greater than 20% of the squamous epithelial cells.
4. Vulvar eczema
Vulvar eczema is an inflammatory skin disease affecting the vulva. In addition to vulvar itching, patients may experience burning and pain, as well as lesions such as papules, blisters, and erosions, or thickening, roughening, and lichenification of the vulvar skin. Physical examination may reveal signs of vulvar redness and edema.
5. Diabetes
Diabetic pruritus can be caused by diabetes, which can also trigger Candida infection, leading to severe itching. Therefore, patients with vulvar pruritus should be carefully questioned about whether they have symptoms such as increased drinking, eating, urinating, or weight loss, especially those who have not been treated for a long time or have recurrent Candida infection. Blood sugar testing can help diagnose this condition.
treat
Expected treatment
For patients with vulvar itching, individualized treatment is needed based on the cause, with medication being the main treatment. At the same time, patients should pay attention to personal hygiene and keep the vulva clean.
Treatment of the cause
The following describes the treatment of common diseases that cause vulvar itching.
1. Trichomonas vaginitis
Patients with trichomoniasis may be infected with Trichomonas vaginalis in multiple locations, including the urethra, paraurethral glands, and Bartholin’s glands. To ensure complete eradication of Trichomonas vaginalis, oral medications such as metronidazole or tinidazole are generally recommended. For patients with more persistent disease, the use of metronidazole or tinidazole suppositories is recommended to enhance the effectiveness of treatment.
2. Vulvovaginal candidiasis
Patients with this condition often require topical antifungal medications, such as clotrimazole suppositories and nystatin vaginal suppositories. Compound antifungal preparations, such as compound zedoary oil suppositories (999 Kangfute), can also be used. For those who are not suitable for topical medications, oral medications are an option, with fluconazole capsules being the most common.
3. Bacterial vaginosis
The treatment of bacterial vaginosis is mainly based on the use of anti-anaerobic drugs, which can be taken orally or used as suppositories or ointments in the vagina. Commonly used drugs include metronidazole, tinidazole, clindamycin, etc.
4. Vulvar eczema
Under a doctor’s guidance, patients with vulvar eczema can use topical glucocorticoid preparations (such as hydrocortisone cream and clobetasol propionate ointment) or calcineurin inhibitors (such as tacrolimus ointment and pimecrolimus cream) to help relieve itching and control inflammation. If necessary, oral antihistamines (such as loratadine tablets) and glucocorticoids (such as prednisone tablets) can be used.
General treatment
1. Wear loose, breathable cotton underwear, wash, change and dry it frequently, and pay attention to the cleanliness of the vulva.
2. Avoid eating spicy and irritating foods, quit smoking and limit alcohol consumption, and avoid using irritating soaps, soaps, and shower gels.
Drug treatment
There is generally no specific medicine, and treatment is mainly targeted at the cause of the disease.
Related drugs
Metronidazole tablets, tinidazole tablets, metronidazole suppositories, tinidazole suppositories, clotrimazole suppositories, nystatin vaginal suppositories, compound zedoary turmeric oil suppositories (999 Kangfute), fluconazole capsules, hydrocortisone cream, clobetasol propionate ointment, tacrolimus ointment, pimecrolimus cream, loratadine tablets, prednisone tablets
Surgical treatment
This symptom usually does not require surgical treatment.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Estimated treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.