Pruritus vulva Causes, signs and symptoms, diagnosis and treatment 2023 | by Dr.lalit b.

              PRURITUS VULVAE

Definition:

 Pruritus means sense of itching. 

When it is confined to the vulva, it is called pruritus 

vulvae. It should not be confused with pain.

                   Itching of vaginal 

Mechanisms of Itching: 

The possible 

mechanisms of the repetitive ‘itch-scratch’ cycle are 

mediated through the following:

™ Special sensory innervation of the area.

™ Underlying vascular instability (greatly influenced 

by emotion) results in production of histamine-like 

substance → induction of itching.

™ Aggravation at night because of:

− Absence of distraction of mind.

− Tired central nervous system.

− Local warmth and lack of aeration.

Etiology:

 Vaginal discharge—The most common 

cause of pruritus vulvae is vaginal discharges either 

due to Trichomonas vaginalis or Candida albicans or 

both.

Local skin lesions—The lesions may be either 

localized in the vulva or part of generalized lesions. 

Such lesions include — psoriasis, seborrheic derma-

titis, intertrigo, etc.

Infections of the vulva

Fungal—Candida.

Viral—Herpes genitalis, genital warts.

Parasitic—Threadworm may migrate to the area 

(especially in children), scabies, pediculosis.

STD—Gonorrhea, Trichomoniasis.

Allergy or contact dermatitis—Use of nylon 

undergarments or washing those with certain soaps 

or detergents, idiosyncrasy to chemical contrace-

ptives or condom is often related.

Non-neoplastic epithelial disorders of the vulva 

 Squamous hyperplasia 

 Lichen sclerosus 

Neoplastic epithelial disorders

 vin.

 Paget’s disease

 Invasive carcinoma of the vulva 

Pruritus vulvae due to some systemic diseases

A. Medical disorders: Glycosuria (diabetes

mellitus) causes local changes in the skin (raw

beef color) and pruritus. It favors the growth of

Candida. Others:Thyroid disorders, Chronic liver

disease.

B. Dermatological causes:Contact dermatitis, drug

allergy.

C. Deficiency state:Deficiencies of iron, folic acid,

vitamin B12 and vitamin A are all implicated.

D. Psychosomatic causes: When no cause is de-

tected, psychic factor is to be excluded. Mental

anxiety or sexual frustration may be responsible

for scratching.

Investigations :

• Microscopic examination of the vaginal discharge

or vulval scraping to detect Candida or Tricho-

monas vaginalis.

• Urine for sugar, protein and pus cells.

• Blood—Complete blood count, postprandial

glucose. Detailed hematological workup (polycy-

themia, leucemia), thyroid profile, liver function

and renal function tests are carried out.

• Stool—Ova, parasites and cysts are to be looked

for.

• In long-standing cases (more than one year)

especially with vulval epithelial disorders, biopsy

either random or colposcopic directed, is to

be taken to note the type of skin changes and

exclude malignancy.

Examination 

General examination—Thorough systemic exami-

nation is needed. Examination for diabetes mellitus,

liver and thyroid disorders, hematological diseases

are to be made.

Local examination—The extent of the lesion is to

be noted.

Treatment: 

General principles

™ Appropriate local hygiene is to be taken care of.

™ To use loose fitting undergarments preferably

made of cotton to keep the area aerated.

™ To prevent the vicious cycle of ‘itch-scratch’.

Local application of antibiotics or clobetasol

propionate 0.05 percent ointment may be

helpful. If the skin is atrophic, estrogen or testosterone

cream may be helpful.

™ To treat the specific etiological factor causing

pruritus by appropriate therapy—local or systemic.

Surgery:

 Surgery may be needed when biopsy

confirms features of neoplasia (VIN or invasion).

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