Vulvitis: Causes

Pathogenesis (development of disease)

According to the very different causes of vulvitis, there is no single pathophysiology. However, even for the most common causes, infections, it can be very different or it is very often unclear when, under which conditions, a pathogen leads to disease or symptoms or not. The same is true for many other causes e.g. allergies, dermatoses (skin diseases), dysplasias (precancerous lesions), skin damage, etc. Overall, the pathogenesis of many diseases of the vulva remains unclear.

Etiology (causes)

Biographic causes

• Genetic predisposition may be the cause of atrophic changes in the vulva (kraurosis vulvae)
• Age – While childhood are largely free of diseases of the vulva (oxyuras / pinworms, vulvitis caused by group A streptococci) occur during sexual maturity most infections, skin diseases and preneoplasia (tumor precursors), climacteric and senile (“old age”) it is preferentially atrophic and carcinoma diseases.
• Hormonal factors – mycoses (fungal infections) occur preferentially in periods of estrogen influence (pregnancy, sexual maturity).

Behavioral causes

• Nutrition
  • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
• Consumption of stimulants
  • Tobacco (smoking) may increase the incidence (frequency of new cases) of HPV infection
• Physical activity
  • Mechanical stress e.. E.g. by cycling, horseback riding, etc.
• Psycho-social situation
  • Stress
• Overweight (BMI ≥ 25; obesity) (sweating).
• Intimate hygiene
  • False (wiping after defecation from back to front).
  • Excessive use/measures (deodorants, disinfectants, rinses, washes, etc.).
  • Violation of the vulva due to an exaggerated cleanliness (excessive washing).
  • Uncleanliness
• Sexual practices
  • Sexual intercourse (e.g., changing from vaginal to anal or oral coitus).
  • Promiscuity (sexual contact with relatively frequently changing different partners).
• Varia: self-exploration urge in the little girl; too tight clothes.

Disease-related causes

Endocrine, nutritional and metabolic diseases.

• Obesity
• Diabetes mellitus
• Estrogen deficiency (especially in children, postmenopausal, lactation).
• Thyroid disease (hyper-, hypothyroidism / hyperthyroidism or hypothyroidism).

Skin and subcutaneous

• Abscess
• Acne conglobata, inversa
• Allergies
• Dermatitis (inflammatory reaction of the skin)
• Eczema
• Lichen ruber planus (nodular lichen)
• Lichen sclerosus – chronic disease of the connective tissue, which is probably one of the autoimmune diseases.
• Pemphigus vulgaris (blistering skin disease).
• Pemphigoid (blistering skin disease).
• Psoriasis (psoriasis)
• Toxic reaction
• Injury

Infectious and parasitic diseases

• Bacteria
  • Bartholinitis (esp. coliform bacteria, Neisseria gonorrhoeae, Staphylococcus aureus, anaerobes): Abscess, or pseudoabscess of the Bartholinian gland due to obstruction of the excretory ducts.
  • Lymphogranuloma venereum (inguinal) (Chlamydia trachomatis).
  • Gonorrhea (Neisseria gonorrhoeae)
  • Hidradenitis (Pyodermia fistulans) (bes. Staphylococcus epidermidis, streptococci.
  • Pyoderma (purulent inflammation of the skin):
    • Abscess (bes. Staphylococcus aureus).
    • Erysipelas (bes. A streptococci).
    • Erythrasma (Corynebacterium minutissimum).
    • Folliculitis (Staphylococcus aureus)
    • Boils and carbuncles (Staphylococcus aureus).
    • Impetigo contagiosa (bork lichen; pus lichen) – by streptococci of serogroup A (GAS, group A streptococci) triggered highly infectious, not bound to the skin appendages (hair follicles, sweat glands), purulent infection of the skin (pyoderma).
    • Vulvitis caused by A-streptococci (esp. in children).
    • Vulvitis pustulosa (Staphylococcus aureus).
  • Syphilis (Treponema pallidum)
  • Ulcus molle (Haemophilus ducreyi)
  • Vulvitis plasmacellularis (unknown bacterium).

• Mycoses/fungi (esp. Candida).
• Parasites:
  • Endoparasites:
    • Oxyurans (pinworms).
    • Trichomonads
  • Ectoparasites:
    • Crabs (Pediculi pubis).
    • Scabies (scabies)
  • Viruses
    • AIDS viruses
    • HPV (human papillomaviruses)
      • Condyloma
      • Neoplasia/preneoplasia
    • Herpes viruses
      • Genital herpes
      • Herpes zoster
    • Smallpox virus (Molluscum contagiosum)
    • Varicella zoster virus (chickenpox)

Liver

• Liver diseases

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

• Clitoral carcinoma – malignant neoplasm of the clitoris.
• Bowen’s disease – skin disease that belongs to precancerous lesions (precancerous lesions).
• Hodgkin’s disease – malignant neoplasia (malignant neoplasm) of the lymphatic system.
• Vulvar intraepithelial neoplasia (VIN I, II, III) (precursor of vulvar carcinoma).
• Vulvar carcinoma – malignant neoplasm in the area of the vulva.

Psyche – nervous system

• Depression
• Partner conflict
• Psychosomatic disorders – especially in sexual conflicts (sexual disorder).
• Vulvar Vestibulitis Syndrome (VVS) (Synonyms: Burning Vulva, Painful Vulva, Vestibulodynia, Vestibulitis, Vulvodynia, Vestibulitis Syndrome, Vestibulitis Vulvae Syndrome) – Abnormal sensations and pain of the external primary sex organs lasting 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 genital organs); possibly also present as a mixed form; prevalence (disease frequency) of essential vulvodynia: 1-3 %.

Pregnancy, childbirth and puerperium

• Infections of the genital tract during pregnancy.
• Infections of the genital tract in the puerperium
• Infections after surgical obstetric procedures (e.g. episiotomy (perineal incision), perineal tear).

Symptoms and abnormal clinical findings not classified elsewhere

• Hyperhidrosis
• Fecal incontinence

Genitourinary system (kidneys, urinary tract – sex organs).

• Bladder-vaginal fistula
• Urinary incontinence
• Kidney disease
• Rectal-vaginal fistula
• Cystitis

Injuries, poisoning and other consequences of external causes.

• Foreign bodies in the vulva (eg, piercing) and vagina.
• Sexual abuse
• Special sexual practices
• Trauma/injury to genital area (e.g., defloration, cohabitation, masturbation, pruritus sequelae (scratching, rubbing, chafing), injuries (fall, impact, instruments, etc.).

Medication

• Allergic or intolerance reactions to medications (local and/or systemic).

Environmental pollution – intoxications (poisonings).

• Epithelial damage caused by:
  • Chemical effects e.g. deodorants, disinfectant solutions, intimate spray vaginal rinses, ablutions.
  • Maceration (softening of the tissue) of the skin e.g. fluorine (discharge), fistulas, menstrual blood, sweat, secretion (urinary, fecal incontinence (inability to hold urine or stool), carcinoma secretion).
  • Mechanical irritation: e.g. tight pants, sanitary napkins, underwear.

Other causes

• Sedentary cycling (indirect – chronic).
• Vulvovaginal reflux in the little girl