Pruritus vulvae
Definition: Intense desire to scratch the vulva and may be associated with anal pruritus.
Incidence: difficult to be estimated as it is a symptom not a disease.
Aetiology:
♦ With vaginal discharge: infections 80 % (trichomonas, monilia & bacterial vaginosis).
♦ Without vaginal discharge: 20 %
A. General systemic causes:
♦ Endocrinal: DM & hyperthyroidism.
♦ Metabolic: LCF & CRF.
♦ Neoplastic: lymphoma & leukemia.
♦ Allergy: to food, drugs & local clothes.
♦ Psychological: e.g. sexual dissatisfaction.
♦ Miscellaneous: achlorhydria, vitamin deficiency & menopause.
B. Local causes:
♦ All causes of vulvitis(1ry & 2ry)
♦ Early stages of vulval dystrophies.
♦ Cancer vulva.
♦ Oxyrius infection: cause both vulval & anal pruritus.
♦ Idiopathic:
• No detectable cause.
• Usually in neurotic or hysterical causes.
• Sometimes part of generalized pruritus.
• Diagnosed by exclusion.
Diagnosis:
History:
• Of the cause e.g. DM.
• To reach a cause e.g. polyuria for DM.
• Age.
• Relation to menses.
• Vaginal discharge (amount, colour, odour, character & consistency).
Examination:
• General: jaundice, uremia & leukemia.
• Local: vaginitis, vulvitis, vulval dystrophy & vulval mass.
Investigations:
• For infections: smear & culture for organisms.
• For endocrinal causes: urine analysis, FBS for DM.
• For metabolic causes: LFT & KFT.
• For neoplastic causes: CBC & BM examination for leukemia.
• For allergy: skin sensitivity test.
• For local causes: – Biopsy of suspicious lesions.
– Stool analysis for oxyrius.
Treatment:
A. Treatment of the cause: e.g. proper control of DM.
B. General treatment:
1) Sedatives e.g. phenobarbitone.
2) Antihistaminics.
3) Vitamins: A, B & minerals e.g. iron.
C. Local treatment:
1) Local hygiene: shaving pubic hair.
2) Antipruritic agents: calamine lotion & cortisone ointment.
3) Anaesthetic agents: NaHCO3 solution(warm alkaline bath).
4) Local estrogen in children & post-menopausal female ointment or pessaries.
D. Treatment of resistant cases:
♦♦♦ UV rays exposure to the vulva treatment of undiagnosed fungal infection.
1) S.C. injection of hydrocortisone.
2) S.C. injection of alcohol 95 % painful with good effect for several months.
3) Mering operation: circular incision around vulva to cut nerve fibers.
4) Simple vulvectomy: in some cases.
Obstetrics and Gynecology – Vaginal Discharge / Pruritus vulvae : By Kate Pulman M.D.
Obstetrics and Gynecology – Vaginal Discharge / Vulvar Pruritus Whiteboard Animation Transcript with Kate Pulman, MD
Vulvar pruritus and vaginal discharge are two common gynecologic symptoms that may present simultaneously or independently. Most etiologies will fall into the following 3 categories:
1. Infectious: such as bacterial vaginosis, trichomoniasis, and candidiasis.
2. Neoplastic diseases: such as vulvar cancer, and it’s precursor vulvar dysplasia.
3. Dermatologic conditions: such as lichen sclerosus, contact dermatitis, or eczema. After completing a thorough history, the following steps of your physical exam will help lead you to your diagnosis:
Step 1: Visual inspection of the vulva Look for single or multifocal lesions that may be raised or discolored. These may represent VIN, or a vulvar carcinoma, that you would not want to miss. Diffuse erythema may lead you to diagnose vulvar candidiasis or contact dermatitis. Diffuse symmetric whitening of the vulva is associated with lichen sclerosus. In this condition, you may see a loss of vulvar architecture, narrowing of the introitus, and fissuring may occur. You must biopsy any suspicious lesion for diagnosis.
Step 2: Speculum examination of the vagina and cervix Evaluate the discharge for colour, odor, and consistency. Copious thin grayish discharge suggests bacterial vaginosis. Frothy yellow-green discharge or a “strawberry” cervix suggests trichomoniasis. Chunky white discharge suggests candidiasis.
Step 3: Bimanual pelvic examination Cervical motion tenderness, uterine, or adnexal tenderness in association with vaginal discharge may be a sign of pelvic inflammatory disease.
Step 4: Special tests Vaginal and cervical swabs can be done for culture. Wet mount microscopy may allow you to detect hyphae to indicate candidiasis, trichomonads, or clue cells in bacterial vaginosis. The KOH whiff test: bacterial vaginosis can be diagnosed by a “fishy” odor.
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