Vulvitis: Symptoms and Treatment
- Causes of vulvitis
- Types and forms of vulvitis
- Symptoms of vulvitis
- Diagnosis of vulvitis
- Treatment of vulvitis
- Prevention of vulvitis
Vulvitis is an inflammatory process that affects the vulva (as the medical terminology refers to the external female genital organs). This disease in clinical practice is quite common, and, it affects not only adult women, but also very young girls, as well as elderly patients, and in all cases there is exactly the same symptoms.
With the development of the pathological process, the large and small labia, the clitoris, the eve of the vagina, and the virgin membrane are inflamed (in girls who have not yet had sexual life). Vulvitis is characterized by the appearance of burning and itching in the area of the external genitalia, swelling and hyperemia of the labia, the appearance of profuse discharge and pain, aggravated after urination.
Causes of vulvitis
The most common pathogens of the disease are opportunistic bacteria that, in a healthy body, do not cause any negative symptoms. At the same time, infections that are transmitted through sexual contact and, in rare cases, Mycobacterium tuberculosis, can provoke the development of inflammation.
However, the development of the inflammatory process requires the presence of predisposing factors. These include a decrease in the body's immune defense and damage to the mucous membrane of the external genitalia.
1. Very often, vulvitis develops on the background of coleitis or vaginitis. At the same time, the pathological process can be the result of injuries to the vulva, inadequate intimate hygiene, endocrine disorders, genital and extragenital pathologies. Also, urinary tract infections (UTI), intestinal dysbiosis , frequent acute respiratory infections, tonsillitis, children's infectious diseases, helminthiasis, urinary incontinence, jaundice and various skin pathologies can provoke the development of the disease.
2. In girls, mechanical, thermal and chemical factors, as well as penetration of foreign objects into the vagina, can cause the development of vulvitis. In older women, the disease is often the result of cystitis or diabetes.
3. Itching of the vulva can be triggered by a scabies mite or pubic louse (in this case, severe itching develops in the pubic area, and the vulvitis itself is an allergic reaction to parasite bites).
4. Another of the causes of vulvitis is seborrheic dermatitis of the vulva. This is a rather rare disease of unknown etiology, with the development of which inflammatory foci appear on the skin and mucous membranes, differing in their intensity of staining, covered with very thin, easily removed crusts.
5. Also provoke the development of the disease can purulent hydradenitis. This is a chronic infectious skin lesion, characterized by a long persistent flow. In patients suffering from this pathology, there are unpleasant-smelling discharge, which corrodes the skin and mucous membranes and leads to the formation of painful scars.
6. And finally, the cause of vulvitis may psoriasis (skin pathology of unknown etiology).
Types and forms of vulvitis
In clinical practice, distinguish between primary (isolated) and secondary vulvitis.
1. It should be noted that in adult women, the primary form of the disease is almost not found, because the mucous membrane, due to the prevalence of sour-milk microflora, normal hormonal levels and acidic pH-environment, is more resistant to infection. However, the primary vulvitis is often registered among old women and girls. This condition occurs due to the anatomical and physiological characteristics of the mucous membrane of the vulva and changes that occur due to the low level of female sex hormones. In women of advanced years, in the period of postmenopausal women, atrophy of the mucous membrane of the urogenital organs is observed, the amount of vaginal secretions is significantly reduced, mucous membranes become thinner and dry. As a result, they are easily damaged and become most vulnerable to infection.
In childhood, the skin and mucous membranes of the vulva are thinner, and therefore they are easily injured. The microflora of the vagina of girls, in contrast to the “adult” microflora, is predominantly coccal, pH is alkaline, and local immunity is not fully formed. Also very often, vulvitis in girls can occur due to the presence of pinworms. They cause severe itching, due to scratching the mucous membrane is injured and infection penetrates. Sometimes vaginal discharge occurs in newborn girls. They are triggered by maternal estrogens released by childbirth into the child’s body. Such a state should not be considered pathology, and soon it will pass on its own.
2. Secondary vulvitis is a pathological condition that occurs more frequently. It occurs due to irritation of the external genitalia with infected vaginal and cervical secretions or infected urine (for diseases of the urinary tract).
Depending on the type of pathogen, it is customary to distinguish between bacterial and candidal vulvitis, and depending on the nature of the pathological transformations of the mucous membrane of the external genitalia, vulvitis is divided into atrophic, ulcerative and adhesive.
This disease is caused by yeast-like fungi of the genus Candida. It affects the large and small labia, the clitoris and the eve of the vagina. As a result, severe itching and burning develop, which intensifies before the beginning of the menstrual period and subsides a bit during the postmenstrual period. In patients with candidal vulvitis, the mucous membranes acquire a purple-bluish color, sometimes rashes appear in the vulva in the form of small bubbles (vesicles), and a white curd film forms on the area between the labia minora.
In women suffering from ovarian hypofunction, diabetes and myxedema, the pathological process sometimes extends to the perianal region and to the femoral-inguinal folds.
Bacterial vulvitis is a pathological condition triggered by conditionally pathogenic microflora, or sexually transmitted infections (gonococci, trichomonads, chlamydia). Much less often mycobacterium tuberculosis can provoke the disease.
During pregnancy, bacterial vulvitis, as a rule, develops on the background of reduced immunity, due to the activation of staphylococcal microflora. Due to the significant functional and hormonal changes that occur in the body of the future mother, specific and nonspecific pathogens are much easier to penetrate into the thickness of the mucous membrane of the external genitalia.
This form of pathology is characterized by thinning of the mucous membrane of the vulva, which often occurs in women after menopause. It should be emphasized that without hormone replacement therapy, atrophic vulvitis will steadily progress, and, in the end, will lead to the formation of painful erosions.
Ulcerative vulvitis is a chronic form of the pathological process, which is characterized by the formation on the damaged mucous membrane of the external genitalia of the plaque, in place of which, after removal, the ulcers remain. Most often, this pathology is found in patients of reproductive age.
Note: after healing of ulcers, there is often marked deformity of the external genitalia.
Adhesive vulvitis, or fusion (synechia) of the labia minora - is a disease of unknown etiology that occurs in girls under the age of five. It is characterized by adhesion of the labia, for which, in fact, got its name. At the early stage of the pathological process, an epithelial bridge is formed between the labia minora, which almost completely overlaps the vulva. In some cases, children complain of slow urination, but, at the same time, synechiae are much more often detected quite by chance, with careful examination of the external genital organs. At the same time, the labia minoras are connected along the “edge” to the front edge, where a small hole remains, from which urine leaves.
As a rule, this state does not cause any subjective sensations, and with the onset of puberty, its self-healing occurs. However, with the development of coarse adhesions, in some cases, surgical intervention (dissection of the labia minora) is indicated.
Symptoms of vulvitis
The clinical signs of the disease depend on the nature of its course.
1. Acute vulvitis is a pathological condition characterized by an unbearable burning sensation in the vulvar region, aggravated by urination and walking. Further, the mucous membrane develops edema and hyperemia, accompanied by painful itching and the occurrence of purulent-fibrinous plaque. Often in the inguinal region, lymph nodes increase, pain appears in the lumbosacral region and in the lower abdomen, and body temperature rises. In the case when the infection affects the urethra, there may be such comorbidities as cystitis and urethritis.
In girls suffering from acute vulvitis, sleep is disturbed, and there are pronounced signs of nervous excitability.
It should be emphasized that with the wrong and late treatment, acute vulvitis often turns into a chronic form, characterized by a relapsing course.
2. Chronic vulvitis is a form of the pathological process that proceeds against the background of subsiding itching and pain. At this stage, the inflammatory process moves to the internal genitalia, and, as a result, the patient appears scanty discharge, accompanied by burning and itching. In some parts of the vulva mucosa, painful hyperemic lesions are noted, and sebaceous gland hypertrophy is observed.
Diagnosis of vulvitis
When making a diagnosis, the patient's medical history is taken into account, and the clinical picture and laboratory parameters (microscopic and bacteriological examination of discharge from the genitals) are also taken into account.
Note: during the culture sowing with the release of the pathogen is determined by its sensitivity to antibiotics.
If there is a suspicion that the cause of the occurrence of vulvitis is the presence of parasites, the efforts of a specialist should be directed at identifying the pathogens themselves, or at finding nits and eggs, which, as a rule, are attached to pubic hair.
It is mandatory in the diagnosis of vulvitis should be the diagnosis of associated pathologies that reduce the immune status of the body or are a direct source of infection.
When the symptoms of the disease are detected in the girl, it must be shown to the pediatric gynecologist. If necessary (if there are foreign bodies in the vagina), vaginoscopy is performed for the child, after which the foreign body is removed with a finger or forceps (sometimes this procedure requires anesthesia).
During the diagnostic examination, vaginal smears are taken from the girl for bacterioscopic and bacteriological examinations, as well as to determine the susceptibility of the pathogen to antibiotics.
Treatment of vulvitis
Today, in clinical practice, the treatment of this disease is performed in a complex that includes general and local therapy. It should be noted that during treatment not only the inflammatory process is eliminated, but also the factors that provoked its occurrence are eliminated.
Girls who are diagnosed with vulvitis are given bed rest, and women of reproductive age are advised not to have sex during treatment.
When prescribing antibiotic therapy, the sensitivity of the identified pathogen to antibiotics is taken into account. In the case when a woman is diagnosed with gonorrheal, chlamydia, trichomonas or tuberculous vulvitis, treatment provides for the complete destruction of the infectious agent. With the development of candidal vulvitis, patients are prescribed antimycotic drugs.
It is mandatory for the acute form of the disease, as well as for exacerbation of the chronic pathological process, local treatment is recommended. For this, special ointments are prescribed, and the external genitalia are treated. As a rule, in the treatment of vulvitis cold compresses and lotions are used with the use of eucalyptus infusion, furatsilina solution or lead water. Sessile baths with infusions of medicinal herbs or potassium permanganate solution, douching with antiseptic solutions, toilet of the external genitalia with chamomile infusion, solution of potassium permanganate or boric acid, as well as vaginal anti-inflammatory candles have performed well.
In the case when the patient is diagnosed with an allergic vulvitis, she is prescribed a diet that includes the elimination of sweet, spicy and salty foods, as well as being treated with antihistamine drugs.
In the diagnosis of seborrheic dermatitis, which caused the development of vulvitis, the woman is prescribed local treatment with hydrocortisone ointment, and, if necessary, systemic hormonal anti-inflammatory therapy.
Purulent hydradenitis also requires topical treatment. To do this, use steroid homones and antibiotics.
Note: for a long course of the disease without positive dynamics, surgical excision of the affected skin in the vulvar area is indicated.
With the atrophic nature of vulvitis, general or local estrogen replacement therapy is recommended.
Parasitic infections should be treated not only the patient, but also all persons who are in close contact with her. Only after complete elimination of the parasites, can the inflammatory process be relieved.
It is imperative to treat the pathology associated with vulvitis, as well as to take drugs that strengthen the immune system (vitamins and immunostimulants).
Treatment of vulvitis in girls
Experts advise 2-3 times a day to wash the external genitalia with broths of medicinal herbs (chamomile or train), as well as a solution of baking soda or furatsilina. Girls after such procedures, genitals should be wetted with a clean gauze cloth, and then smeared with sterile vegetable oil or baby cream. Also, special powders have performed well. With strong scratching and crusting, ultraviolet irradiation and washing of the vulva with anesthetic solutions, as well as furacilin or rivanol, is recommended. When detecting synechia special ointments are used, which include estrogens.
Prevention of vulvitis
In order to prevent the development of the pathological process, it is necessary to begin the timely treatment of existing pathologies, as well as the rehabilitation of chronic foci of infection. At the first signs of acute vulvitis, you should seek help from a specialist who will prescribe the necessary diagnostic examination and recommend effective treatment.
The main measures of general prevention of the disease include careful observance of the rules of intimate hygiene, refusal from wearing close (in particular, synthetic) clothes, maintaining a healthy lifestyle, rational nutrition, the use of personal protective equipment for casual sexual contacts, regular exercise and strengthening general immunity.