Vaginal Itching (Pruritus Vulvae): Causes

Pathogenesis (development of disease)

There are many different causes of pruritus vulvae. The pathomechanism lies in the activation of free nerve endings in the corium and epidermis and serves as a protective function and indication of a possible noxious agent or disease. Messenger substances such as histamine and cytokines transmit sensory excitation to the brain.

Etiology (causes)

Biographic causes

  • Age of life – senium
  • Hormonal factors
    • Lactation phase (breastfeeding phase)
    • Menopause (menopause)/Senium

Behavioral causes

  • Nutrition
  • Physical activity
    • Mechanical stress e.g. tight clothing, cycling, horse riding, etc.
  • Psycho-social situation
    • Stress
  • Overweight (BMI ≥ 25; obesity).
  • Tight clothing, intimate shaving → microtraumas (minor, subliminal injuries).
  • Intimate hygiene
    • False (wiping after defecation from back to front).
    • Excessive (deodorants, disinfectants, rinses, washes, etc.).
    • Uncleanliness
  • Sexual practices
    • Sexual intercourse (e.g., changing from vaginal to anal or oral coitus).
    • Promiscuity (sexual contact with relatively frequently changing different partners).

Disease-related causes

Blood, blood-forming organs – immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

Skin and subcutaneous (L00-L99).

  • Allergic reactions – due toe.g. medicines, detergents,dyes on printed toilet paper, wet wipes with fragrances and preservatives,insecticides, intimate sprays, clothing, cosmetics, medicines, oils, soaps,conditioners, laundry, detergents, etc.
  • Behçet’s disease (synonym: Adamantiades-Behçet’s disease) – relapsing immunodeficiency disease from the rheumatic form; occurs in the oral cavity and genital region.
  • Dermatitis (inflammatory reaction of the skin).
  • Eczema
  • Epidermal cyst – bulging elastic node filled with horny masses.
  • Hidradenitis (inflammation of apocrine sweat glands).
  • Hyperhidrosis (excessive sweat gland secretion).
  • Idiopathic pruritus vulvae (with unknown cause).
  • Kraurosis vulvae (synonyms: craurosis vulvae, vulvar dystrophy), i.e. degenerative change of the skin, accompanied by atrophy and hyperplasia (“excessive cell formation”). This leads to shrinkage of the vulva with subsequent sclerosis (tissue hardening) of the subcutaneous adipose tissue.
  • Lichen ruber/planus (nodular lichen).
  • Lichen sclerosus – chronic disease of the connective tissue, which is probably one of the autoimmune diseases.
  • Leukoplakia – cornification disorder of the mucous membranes as well as genitals.
  • Psoriasis (psoriasis)
  • Urticaria (hives)

Infectious and parasitic diseases (A00-B99).

  • Chlamydia – most common bacterial agents of urogenital infections (infectious diseases affecting the urinary tract and/or reproductive organs).
  • Gonorrhea (gonorrhea)
  • Genital herpes
  • Herpes zoster
  • Mites
  • Mycoses (fungal diseases) – especially dermatophytoses (Candia albicans)/candidoses; especially common in diabetics as well as after systemic therapy with antibiotics or steroids; appearance: reddish and whitish plaques (areal or plate-like substance proliferation of the skin), erosions (superficial corneal defect affecting the epithelium) or ulcers (ulcers).
  • Molluscum cotagiosum
  • Pemphigus vulgaris
  • Phthiriasis (crabs)
  • Scabies (scabies)
  • Streptococcus group A
  • Syphilis (lues; venereal disease)
  • Trichomonads
  • Varicella (chickenpox)
  • Vulvitis plasmacellularis
  • Warts (condylomata acuminata; synonyms: genital warts, wet warts and genital warts).
  • Worm infestation
    • Nematodes (threadworms)
    • Oxyuras (pinworms, oxyuriasis); mostly diagnosed in children.

Musculoskeletal system and connective tissue (M00-M99).

  • Behçet’s disease (synonym: Adamantiades-Behçet’s disease; Behçet’s disease; Behçet’s aphthae) – multisystem disease of the rheumatic type associated with recurrent, chronic vasculitis (vascular inflammation) of the small and large arteries and mucosal inflammation; The triad (the occurrence of three symptoms) of aphthae (painful, erosive mucosal lesions) in the mouth and aphthous genital ulcers (ulcers in the genital region), as well as uveitis (inflammation of the middle eye skin, which consists of the choroid (choroid), the corpus ciliary (corpus ciliare) and the iris) is stated as typical for the disease; a defect in cellular immunity is suspected

Neoplasms – tumor diseases (C00-D48).

  • Leukemia (blood cancer)
  • Clitoral carcinoma – malignant neoplasm of the clitoris (clitoris).
  • Bowen’s disease – skin disease, which belongs to the precancerous (cancer precursors).
  • Hodgkin’s disease – malignant neoplasia (malignant neoplasm) of the lymphatic system.
  • Vulvar intraepithelial neoplasia (VIN I, II, III) (precursor of vulvar carcinoma).
  • Vulvar carcinoma – vulvar cancer / cancer of the external genital organs of women; median age of onset for vulvar cancer is about 70 years.

Psyche – Nervous System (F00-F99; G00-G99).

  • Depression
  • Partner conflict
  • Psychosomatic disorders – especially in sexual conflicts (sexual disorder).
  • Vulvodynia – insensations and pain of the external primary sex organs that last longer than three months without an identifiable cause; complaints are localized or generalized over the entire perineal area (tissue area between the anus and the external sex organs); possibly also present as a mixed form); prevalence (disease frequency) of essential vulvodynia: 1-3 %.

Symptoms and abnormal clinical and laboratory findings not classified elsewhere (R00-R99).

  • Fecal incontinence – inability to retain bowel movements.
  • Uremia (occurrence of urinary substances in the blood above normal levels).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Chronic kidney disease
  • Urinary incontinence (bladder weakness)

Injuries, poisoning, and other consequences of external causes (S00-T98).

  • Trauma (injury) from foreign bodies, sexual practices, etc.
  • Vulvar hematoma – bruising in the area of the vulva.

Laboratory diagnoses – laboratory parameters that are considered independent risk factors.

  • Iron deficiency

Medication

  • Drug intolerances