Vulvitis: Symptoms and Treatment
- Causes of vulvitis
- Types and forms of vulvitis
- Symptoms of vulvitis
- Diagnosis of vulvitis
- Treatment of vulvitis
- Prevention of vulvitis
Vulvit is an inflammatory process affecting the vulva (as in medical terminology, external female genital organs are called). This disease in clinical practice occurs quite often, moreover, it affects not only adult women, but also very young girls, as well as elderly patients, and in all cases there is absolutely the same symptomatology.
With the development of the pathological process, large and small labia, the clitoris, the vestibule of the vagina, and the hymen (in girls who have not yet had a sexual life) become inflamed. Vulvitis is characterized by the appearance of burning and itching in the region of the external genitalia, edema and hyperemia of the labia, the appearance of abundant discharge and pain intensifying after urination.
Causes of vulvitis
The most common pathogens are conditionally pathogenic bacteria, which in a healthy body do not cause any negative symptoms. At the same time, infections that are transmitted during sexual intercourse 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 reducing the immune defense of the body and damage to the mucous membrane of the external genitalia.
1. Very often vulvitis develops on the background of colpitis or vaginitis. However, the pathological process can be a consequence of trauma to the vulva, unsatisfactory intimate hygiene, endocrine disorders, genital and extragenital pathologies. Also, urinary tract infections (UTIs), intestinal dysbiosis , frequent acute respiratory infections, tonsillitis, childhood infectious diseases, helminthiases, urinary incontinence, hepatitis with jaundice and various skin pathologies can also trigger 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 advanced women, the disease is often a consequence of cystitis or diabetes.
3. Itching of the vulva can be triggered by an itch mite or pubic lice (with the disease developing a strong itch in the pubic area, and directly vulvitis is an allergic reaction to the bites of parasites).
4. Another of the causes of vulvitis is seborrheic dermatitis of the external genitalia. This is a fairly rare disease of unclear etiology, with the development of which on the skin and mucous coverlets there are inflammatory foci, different in intensity of staining, covered with the finest, easily removable crusts.
5. Purulent hydradenitis can also provoke the development of the disease. This is a chronic infectious skin lesion, which is characterized by a long persistent current. In patients suffering from this pathology, there are unpleasant smelling secretions, which corrode skin and mucous membranes and lead to the formation of painful scars.
6. And, finally, the cause of vulvitis can be psoriasis (skin pathology of unclear etiology).
Types and forms of vulvitis
In clinical practice, primary (isolated) and secondary vulvitis are distinguished.
1. It should be noted that in adult women the primary form of the disease is practically not found, since the mucosa, due to the predominance of acid-milk microflora, normal hormonal background and acidic pH-environment, is more resistant to infection. At the same time, primary vulvitis is often registered among old women and girls. This state occurs due to the anatomical and physiological features of the vulvar mucosa and the changes that occur due to the low level of female sex hormones. In advanced women, during the postmenopausal period, atrophy of the mucous membrane of the urogenital organs is observed, the amount of vaginal discharge is significantly reduced, the mucous membranes become thinner and dry out. As a consequence, they are easily damaged and become the most vulnerable to infection.
In childhood, the skin and mucous membranes of the vulva are thinner, and therefore they are easily traumatized. The microflora of the vagina of girls, unlike the "adult" microflora, mostly coccal, pH - alkaline, and local immunity is not fully formed. Also very often vulvitis in girls can arise due to the presence of pinworms. They cause severe itching, because of scratching the mucous membrane is injured and the infection gets through. Sometimes vaginal discharge occurs in newborn girls. They are provoked by mother's estrogen, which fell before the birth. Such a condition should not be considered a pathology, and it soon passes on its own.
2. Secondary vulvitis is a pathological condition that occurs much more often. It occurs due to irritation of the external genitalia by infected secretions from the vagina and the cervical canal or infected urine (with 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 pathological transformations of the mucous membrane of the vulva, vulvitis is divided into atrophic, ulcerative and adhesive.
This disease is caused by yeast-like fungi from the genus Candida. It affects the large and small labia, the clitoris and the vestibule of the vagina. As a result, a strong itching and burning sensation develops, which intensifies before the onset of menstruation and slightly subside in the postmenstrual period. In patients with candidal vulvitis, the mucous membranes acquire a purplish-cyanotic color, sometimes rashes appear in the vulva in the form of small vesicles (vesicles), and white curdled film forms on the site located between the labia minora.
In women with ovarian hypofunction, diabetes mellitus and myxedema, the pathological process sometimes spreads to the perianal region and to the femoral-inguinal folds.
Bacterial vulvitis is a pathological condition provoked by a conditionally pathogenic microflora, or sexually transmitted infections (gonococci, trichomonas, chlamydia). Mikobakterii tuberculosis can be much less likely to provoke the disease.
In pregnancy, bacterial vulvitis, as a rule, develops against a background of reduced immunity, due to the activation of staphylococcal microflora. Because of 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.
For this form of pathology is characterized by thinning of the vulvar mucosa, which very often occurs in women after the onset of menopause. It should be emphasized that without hormone replacement therapy, atrophic vulvitis will progress steadily, and, in the end, lead to the formation of painful erosions.
Ulcerative vulvitis is a chronic form of the pathological process, which is characterized by the formation of the external genitalia of the plaque on the damaged mucosa, on site of which ulcers remain after removal. Most often this pathology is found in patients of reproductive age.
Note: after healing of ulcers, there is often a marked deformation of the external genitalia.
Adhesive vulvitis, or fusion (synechia) of the labia minora is a disease of unknown etiology that occurs in girls before the age of five. It is characterized by clumping of the labia, for which, in fact, got its name. At an early stage of the pathological process between the labia minora an epithelial bridge is formed, which almost completely covers the vulva. In some cases, children complain of slow urination, but at the same time, much more often the synechia is detected quite accidentally, with a thorough examination of the external genitalia. In this case, the labia minora are joined along the "edge" to the anterior margin, where there remains a small hole from which the urine leaves.
As a rule, such a state does not cause any subjective sensations, and with the onset of puberty, its self-healing occurs. However, with the development of coarse adhesive process in some cases, surgical intervention (dissection of the labia minora) is indicated.
Symptoms of vulvitis
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 vulva, which is aggravated by urination and walking. Further on the mucosa develops edema and hyperemia, accompanied by painful itching and the onset of purulent-fibrinous plaque. Often in the groin area, lymph nodes increase, there is pain in the lumbosacral and in the lower abdomen, the body temperature rises. In the event that the infection affects the urethra, such accompanying pathologies as cystitis and urethritis may occur.
In girls with acute vulvitis, sleep is disturbed, and pronounced signs of nervous excitability are observed.
It should be emphasized that with incorrect and untimely treatment acute vulvitis often turns into a chronic form, which is characterized by a recurrent course.
2. Chronic vulvitis is a form of pathological process that takes place against the back of itching and pain. At this stage, the inflammatory process passes to the internal genitalia, and as a consequence, the patient develops scant excreta, accompanied by burning and itching. In some areas of the vulvar mucosa, painful hyperemic lesions are noted, and hypertrophy of the sebaceous glands is observed.
Diagnosis of vulvitis
When the diagnosis is made, the patient's history is taken into account, and the clinical picture and laboratory indicators (microscopic and bacteriological examination of the genital separator) are taken into account.
Note: when carrying out culture culture, along with the isolation of the pathogen, its sensitivity to antibiotics is determined.
If there is a suspicion that the cause of vulvitis is the presence of parasites, the specialist's efforts should be aimed at identifying the pathogens themselves, or on the detection of nits and eggs, which, as a rule, are attached to the pubic hair.
Mandatory diagnosis of vulvitis should be carried out to diagnose concomitant pathologies that reduce the immune status of the organism or are the direct source of infection.
When signs of the disease are found in the girl, it must be shown to the children's gynecologist. If necessary (if there are foreign bodies in the vagina), the baby is subjected to a vaginoscopy, then, with the help of a finger or tweezers, the foreign body is removed (sometimes this procedure requires anesthesia).
During the diagnostic examination, the girl is taken vaginal smears to perform a bacterioscopic and bacteriological study, as well as to determine the sensitivity of the causative agent to antibiotics.
Treatment of vulvitis
To date, 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 the treatment not only the inflammatory process is eliminated, but also the factors that triggered its onset are eliminated.
Girls who are diagnosed with vulvitis are given bed rest, and women of reproductive age are advised to refrain from sexual intercourse during treatment.
When prescribing antibacterial therapy, sensitivity of the detected pathogenic microorganism to antibiotics is taken into account. In the case when a woman is diagnosed with gonorrhea, chlamydia, trichomoniasis or tuberculosis vulvitis, the treatment provides for the complete destruction of the causative agent of the infection. With the development of candidal vulvitis, patients are prescribed antimycotic drugs.
Mandatory treatment for acute disease, as well as exacerbation of chronic pathological process, recommended local treatment. To do this, special ointments are prescribed, and external genitalia are treated. As a rule, cold compresses and lotions with the use of eucalyptus, a solution of furacilin or lead water are used in the treatment of vulvitis. Well established sessile baths with infusions of medicinal herbs or a solution of potassium permanganate, douching with solutions of antiseptics, toilet of external genital organs with chamomile infusion, solution of potassium permanganate or boric acid, and also vaginal anti-inflammatory suppositories.
In the case when the patient is diagnosed with allergic vulvitis, she is prescribed a diet that provides for the exclusion of sweet, spicy and salty foods, as well as treatment with antihistamines.
When diagnosing seborrheic dermatitis, which provoked the development of vulvitis, a woman is prescribed local treatment with hydrocortisone ointment, and, if necessary, systemic hormonal anti-inflammatory therapy.
Purulent hydradenitis also requires local treatment. For this, steroid homonas and antibiotics are used.
Note: in the long course of the disease without positive dynamics, surgical excision of the affected skin in the vulva is indicated.
At the atrophic nature of vulvitis, general or local estrogen replacement therapy is recommended.
Parasitic infections should be treated not only by the patient, but also by all persons who are in close contact with her. Only after complete elimination of the parasites can the relief of the inflammatory process be achieved.
It is mandatory to treat vulvitis-related pathologies, as well as 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 sexual organs with decoctions of medicinal herbs (chamomile or turns), as well as a solution of baking soda or furatsilina. Girls after this type of procedure, the genitals should get soaked with a clean gauze napkin, and then lubricate with sterile vegetable oil or baby cream. Also, special powders proved to be a good idea. With strong combs and the formation of crusts, ultraviolet irradiation and the erosion of the vulva with solutions of anesthetics, as well as furacilin or rivanol are recommended. When a synechia is found, 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 timely treatment of existing pathologies, and also to sanitize chronic foci of infection. At the first signs of acute vulvitis, you need to 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 compliance with the rules of intimate hygiene, the refusal to wear close (in particular, synthetic) underwear, maintaining a healthy lifestyle, rational nutrition, the use of personal protective equipment in case of accidental sexual contact, regular exercise and strengthening of general immunity.