The so-called Pruritus Vulvae is an itching of the vulva, which can be triggered by various diseases. In addition to itching, pain or a burning sensation may also occur as symptoms. The itching should be clarified by a doctor.
What is pruritus vulvae?
Pruritus vulvae is the term used to describe itching of the external female genitalia, called the vulva. This itching (Latin “pruritus”) usually occurs episodically, that is, temporarily. The itching can be acute, as well as chronic. The vulva, where itching occurs, is the external part of the female genitalia. It includes the external, primary sexual organs of the woman. These include the mons veneris, labia majora, labia minora, clitoris, and vaginal vestibule with the outlets of the vagina, urethra, and vestibular glands.
Causes
Causes of vulvar itching (pruritus vulvae) include both primary and secondary causes. In primary causes, the pruritus of the vulva is in the foreground; in a secondary cause of disease, it occurs as a concomitant of a preexisting condition. In vulvitis, an inflammation of the vulva, itching is one of the main symptoms. Vulvitis is an inflammation of the external female genitals. Vulvitis can be caused by bacteria, viruses, fungi or parasites. In addition to the itching mentioned above, vulvitis causes redness, swelling and pain in the vulva area. Warmth in this area is also often felt. The female reproductive organ is limited in its ability to function due to the symptoms. Vulvitis can be primary, due to direct infection of the vulva with the pathogens, or secondary, due to spreading infection of neighboring organs, for example, the anus, urethra or vagina. In addition to vulvitis, other causes of pruritus vulvae are possible. For example, itching in the area of the vulva can occur in the context of various metabolic diseases. These include diabetes mellitus, estrogen deficiency, uremia (poisoning of the blood by urinary substances), obesity, liver disease and avitaminosis (the complete absence of certain vitamins). If pruritus vulvae occurs in the context of one of these metabolic diseases, there is a secondary cause. Other causes include allergic reactions, for example, to medications, soaps, or contact dermatitis from laundry and/or clothing. Lichen scelorsus et atrophicus vulvae (vulvar dystrophy), a degenerative disease of the skin of the vulva, also triggers itching. The disease occurs mainly in young women after puberty and is one of the possible precancerous conditions. Other possible causes include other precancerous lesions, vulvar carcinoma, leukemia, pernicious anemia, lack of or excessive hygiene, excessive sweating, and mechanical irritation, for example through masturbation. It is observed that different triggers of pruritus vulvae predominate in different age groups. In children, pruritus is often caused by fungal infections, allergies, diabetes mellitus or infections caused by pinworms (oxyuriasis). In the sexually mature age the main causes are fungal infections, contact eczema and infections. In older age, dysmorphia of the skin, neoplasia, and diabetes mellitus are the main causes of vulvar itching.
Symptoms, complaints and signs
The main symptom of pruritus vulvae (Latin: “itching of the vulva”) is itching of the labia majora pudendi, which is usually not persistent – it usually lasts only a short time. The itching may progress to a painful, burning condition. Furthermore, it can be observed that it is often intensified by warmth and is increasingly observed or noticed by patients after going to bed. Due to the itching, the patients tend to scratch, which, however, aggravates the condition. Furthermore, scratching usually leads to small tears and abrasions, which maintains or intensifies the painful condition. Medical diagnosis is also made more difficult by scratching, as any primary skin lesions that might be causing the pruritus can no longer be seen, or can only be seen with difficulty, due to the change caused by scratching.
Diagnosis and course of the disease
The diagnosis by the physician consists first of all of a thorough anamnesis as well as a physical examination. Here, special attention is paid to existing changes in the skin appearance of the vulva. Through the anamnesis and the physical examination, the physician arrives at a tentative diagnosis, which must be confirmed by suitable laboratory diagnostics. Depending on the suspected diagnosis, various methods are available for this purpose. These include, for example, a blood test in which the concentrations of glucose (suspected diabetes mellitus), urea, cholesterol or possible bacterial toxins (suspected bacterial vulvinitis) are determined. In addition, a vaginal smear is often taken. With the help of this smear, various causes can be tested and, if necessary, confirmed or ruled out. The course of the disease depends on the diagnosis determined and can therefore not be stated in general terms. It should be noted that pruritus vulvae is a symptom and not a disease. In most cases it is harmless, but a medical diagnosis and possibly therapy should take place in any case.
Complications
Itching of the female genitals can be caused by certain diseases as well as by fragrances in cosmetics or by too much histamine in food. Depending on whether the cause of the itching can be found, complications such as inflammation or soreness can be prevented. If necessary, care should be taken to use fragrance-free cosmetics. If the vulva is sore from itching, bacteria, fungal infections, viruses or parasites can cause skin diseases that require treatment. In particular, a genital fungal infection is a complication that must be treated by a doctor. If treatment is not carried out promptly, the fungus may spread to the vagina. There is an increased risk of infection during sexual intercourse. Complications can also arise in the case of pruritus vulvae due to a skin disease called lichen sclerosus et degenerans. In this case, scarring, whitish hardening and spots can occur as a result of the constantly irritated skin. During sexual intercourse, skin cracking and pain occur. The risk of genital fungal infections is increased due to soreness and lowered immune defenses. With an increased risk of bladder problems, there may also be an increased risk of malignant cell development. Treatment with cortisone and estrogen ointments is usually given to prevent such complications.
When should you see a doctor?
Pruritus vulvae often indicates inflammation, so the symptom should usually be presented to a doctor. Sometimes pruritus vulvae can occur during puberty, and the cause there can be attributed to hormonal changes in the body rather than an infection. However, since itching can be irritating and unsettling for young girls, there is no reason why they should not consult a doctor for clarification. After all, even young women may already have various infections that need to be treated. In women with existing underlying diseases such as diabetes mellitus, pruritus vulvae may occur as a symptom or concomitant of the disease. Nevertheless, they should also have the itching clarified, because even if it turns out that there is no infection, something can be done about the unpleasant itching. Girls who have not yet reached puberty and experience itching in the vulva area may have a malformation that is not visible. For this reason, they should also be presented to the pediatrician outside of the regular U examinations. Girls at this age are also already susceptible to fungal infections, which should be treated in time to protect their immune system. As a sensitive reaction of the body, pruritus vulvae also occurs after frequent masturbation or irritation from sexual intercourse – in this case, it is possible to wait a few days to see if the symptoms improve on their own before consulting the doctor.
Treatment and therapy
Therapy depends on the cause of the itching. Therapy should be as causal as possible, that is, eliminate the causes of the underlying disease. Glucocorticoid ointments are primarily used against the symptom of pruritus. For allergic causes, anti-allergic drugs are used. Underlying infections are treated with a suitable drug depending on the type of pathogen.Thus, antibiotic treatment is given for bacterial vulvinitis, and antifungal treatment is given for fungal infection. In the case of estrogen deficiency, estrogens are administered. In summary, however, causal therapy should take place, for which a comprehensive medical diagnosis is necessary.
Prevention
Prevention is possible only to a limited extent. It is important here to pay attention to adequate hygiene, without overdoing it with this.
Aftercare
Pruritus vulvae, itching in the external genital area of women, can have various causes. Clarification of symptoms and diagnosis should therefore be left to an experienced gynecologist. Affected women must then consistently comply with the doctor’s prescriptions. To relieve the itching or burning sensation, the region should be kept as cool as possible. Loose clothing is therefore recommended, as heat only intensifies the discomfort unnecessarily. For daily body hygiene, cleansing with mild, ph-neutral products is recommended. Intimate washing lotions and special deodorants should not be used, as they can additionally irritate and dry out the area. The patient should also refrain from vigorous scratching of the region if itching is very severe. The skin of the vulva is very sensitive and therefore quickly injured or rubbed raw. Bacteria and viruses can penetrate through small injuries and make the infection even worse. During sexual intercourse, the woman should definitely protect herself with a condom during this time. This not only prevents reinfection, but also a possible infection of the partner. If fungi or bacteria are the trigger of pruritus vulvae, it is recommended to support the immune system. Balanced diet, adequate sleep and moderate exercise in the fresh air contribute to well-being and help to prevent such infections.
What you can do yourself
This itching can have the most diverse causes, so the affected girls and women should have the gynecologist clarify exactly what is behind the symptom. The corresponding prescriptions of the doctor should now be followed consistently. As long as the itching or burning sensation persists, the region should be kept cool, because heat unnecessarily intensifies the symptoms. Scratching would also aggravate the situation, because the delicate skin of the vulva is quickly injured or chafed. Scratches, tears and sores can quickly become infected with bacteria, fungi, viruses or parasites and should be avoided. Sexual intercourse during this time should only take place protected by a condom. This prevents reinfection as well as infection. pH-neutral cleansing products should be used for daily body hygiene. Intimate deodorants or perfumes are better taboo in the pubic area. Excessive hygiene is not indicated, because too much washing irritates the tissue unnecessarily. If the trigger for pruritus vulvae is not hormone-related, but rather fungi or bacteria, it is advisable to support the immune system. A perfectly functioning, active immune system accelerates healing and prevents the episode from recurring. A balanced diet rich in vitamins, plenty of exercise in the fresh air and some sports support the immune system as well as regular bedtimes and sufficient sleep.