Inflammation of the female external genitalia, manifested by itching, burning, copious discharge, swelling and redness of the genitals, pain after urination. The inflammatory process will not go away on its own if its cause is not eliminated. When the first symptoms of vulvitis appear, come to the Alfa Health Center clinic in Moscow. Our gynecologists will diagnose and prescribe adequate therapy.
What are the main signs of vulvitis in women and treatment methods - we will consider in detail in this article.
Etiology of vulvitis
The vulva is a thin and sensitive epithelial lining of the labia majora. Folds of tissue surround the clitoris and extend to the hymen. On the surface of the membrane there is a healthy vaginal microflora, a natural acidic environment is formed, which provides local immunity. Infectious agents, once on the mucous membrane, die under the influence of acids or are inhibited by lactobacilli.
In childhood, the environment of the epithelial membrane is closer to the alkaline spectrum. There are no lactobacilli in girls yet. There is also no hormonal protection against infections, since estrogen production is still at a minimum level. During this period, the genitals are vulnerable to pathogenic microbes. The infection does not encounter natural barriers on its way and actively develops on the mucous membranes, moving further and further.
The risk of inflammation also increases during menopause. The female body produces less estrogen during menopause. The secretion of the internal genital organs decreases, the mucous membranes become dry, and part of the beneficial microflora dies. If an infectious agent enters, acute vulvitis can quickly develop with further transition to a chronic form.
Forms and causes of vulvitis
Inflammation occurs both in adulthood and in girls under 10 years of age against the background of frequent acute respiratory viral infections, reduced immunity, pinworm infection and antibiotic use. At risk are pregnant girls, women with menopausal syndrome, whose mucous membranes become thinner due to decreased estrogen production. Symptoms of vulvitis appear from infection with pathogenic microorganisms (Trichomonas, chlamydia) or from an increase in one’s own opportunistic flora (fungi, herpes viruses, E. coli).
There are vulvitis:
- primary – an independent disease;
- secondary – a consequence of other diseases.
The main causes of primary vulvitis:
- genital injuries;
- intestinal dysbiosis;
- tight, synthetic underwear;
- using sanitary pads without changing for a long time;
- insufficient personal hygiene.
Secondary vulvitis occurs against the background of:
- infections, inflammations of the genitourinary system – colpitis, vaginitis, cervicitis and others;
- changes in the vaginal microflora due to long-term self-medication with antibiotics;
- disruptions in the functioning of the endocrine system (diabetes mellitus, adrenal gland diseases);
- infection with worms and other parasites (symptoms worsen at night when roundworms or pinworms emerge from the anus);
- vitamin deficiency;
- immunodeficiency.
Depending on the main provoking factor, several forms of the disease are distinguished:
- Bacterial vulvitis. The cause of inflammation is opportunistic microorganisms or infections. There is a distinction between nonspecific vulvitis, caused by an imbalance of microflora, and a specific form, which develops when infected with an infection from a sexual partner. Among the most aggressive pathogens are gonococci, chlamydia, trichomonas;
- Allergic vulvitis. Inflammation is caused by contact with an allergen, for example, when particles of washing powder are not completely rinsed out of the laundry, or a gel with fragrances is used for intimate hygiene;
- Candidiasis (fungal) vulvitis. The causative agent of the disease is fungi of the genus Candida. Candidiasis vulvitis more often than others becomes chronic. An exacerbation can be triggered by any factors: from stress to a cold. Candidiasis (fungal vulvitis) is also classified as nonspecific inflammation;
- Atrophic vulvitis. The disease develops during natural changes in the tissues of the internal genital organs during menopause. Atrophic processes can begin after removal of the ovaries.
Vulvitis occurs acutely and chronically. In the acute form, the symptoms of the disease appear suddenly and quickly intensify, increasing over 2-3 days. During this period, it is important to consult a doctor, undergo a diagnosis of vulvitis and receive quality treatment. The risk of relapse will be minimal.
If acute vulvitis is treated incorrectly or if the doctor’s recommendations are not followed, the inflammation will become chronic. Symptoms will subside and reappear, reducing quality of life. Even a young girl can become a regular gynecology patient if she ignores the signs of the disease.
There is also subacute vulvitis - a transitional form of inflammation.
Treatment
Conservative therapy
The list of general recommendations for most pathologies accompanied by pain in the labia area involves changing hygiene habits, sexual rest, adjusting the diet and nature of the diet, and refusing to use synthetic underwear, highly allergenic or irritating hygiene products. Therapeutic measures for inflammatory and infectious processes include:
- Antibacterial agents.
For bacterial infections, antibiotics are prescribed for systemic and local (creams, suppositories, vaginal tablets) use, selected taking into account antibiotic sensitivity. - Other etiotropic medications.
For polymicrobial vulvitis and vulvovaginitis, combined drugs with antibacterial, antiprotozoal and antimycotic effects are used. Antifungals are effective for candidiasis, and antiviral drugs are effective for HPV and papillomatosis. - Local events.
For vulvitis, vaginal suppositories, douching with antiseptic solutions and herbal decoctions, and sitz baths are recommended. For acute bartholinitis, SMT, UHF and UV irradiation are effective; for chronic bartholinitis, ozokerite, paraffin, infrared laser, and mud applications are effective. - Treatment of background pathologies.
According to indications, insulin therapy or the dose of hypoglycemic agents for diabetes are adjusted, antiallergic drugs are prescribed, deworming is carried out, and infectious foci are sanitized.
Patients with vulvodynia are advised to avoid eating foods high in calcium oxalate (celery, strawberries, chocolate) to reduce the amount of this compound in the urine. For mild pain, exercises to strengthen the pelvic floor muscles are useful. Balneotherapy and physiotherapy are effective. If there are signs of atrophy, suppositories and creams are used to stimulate regeneration. For ovarian hypofunction, hormonal therapy is prescribed.
Antihistamines and sedatives are recommended for patients with vulvar kraurosis. For persistent itching, a pudendal nerve block is performed. Hormonal ointments with estrogens, androgens, corticosteroids and progesterone are used locally. The type of medication is selected taking into account age and endocrine status. Balneotherapy, reflexology, laser therapy, photodynamic therapy, and x-ray therapy are effective. It is necessary to take biostimulants, immunocorrectors and vitamin preparations.
Surgery
In most cases, pain in the labia area is eliminated using conservative methods. Surgeries may be required if the following pathologies are present:
- Bartholinitis:
marsupialization, removal of the cyst, removal of the Bartholin gland, opening of the abscess. - Kraurosis of the vulva:
cryodestruction, laser ablation or denervation of the vulva, if malignant tissue degeneration is suspected - vulvectomy. - Condylomatosis:
radiofrequency ablation, laser vaporization, cryodestruction, electrocoagulation, vulvar resection, vulvectomy.
Symptoms of vulvitis in women
During the acute phase of inflammation the following are observed:
- swelling and redness of the external genitalia;
- itching, burning;
- painful sensations when urinating, walking, sexual intercourse;
- mucous plaque mixed with pus;
- enlarged inguinal lymph nodes;
- temperature increase;
- general weakness, fatigue.
Signs of vulvitis in chronic form are the same symptoms, but in a less pronounced form. As the pathology develops, ulcers of the mucous membrane and scars appear that deform the surface.
Burning of the labia with athlete's foot inguinal
The disease is characterized by a fungal infection of the epidermis that occurs in the groin area.
Athlete's foot occurs much less frequently in women, but nevertheless remains a common skin pathology.
The disease is manifested by the development of spots of a bright, pink hue, with a flaky surface, localized in the groin area and vulva.
The first clinical sign of athlete's foot is the appearance of a pink, itchy spot, usually no more than 1 cm in diameter.
Such spots tend to grow rapidly and can reach 8-10 cm, while being clearly limited.
Burning and itching of the outer labia is a typical symptom for this pathology, which can intensify when walking.
The diagnosis is made by a dermatologist or mycologist.
To confirm the disease, the epidermis is examined with a Wood's lamp and a scraping is diagnosed for the presence of fungal microorganisms.
The duration of the therapeutic effect is about four weeks.
For local treatment, a solution of Resorcinol or silver nitrate is prescribed as a lotion.
The use of antifungal medications may also be recommended.
Clotrimazole ointment has worked well for burning of the labia majora and groin.
How to treat vulvitis in women
The gynecologist will answer this question after making a diagnosis. The pathology is detected during a gynecological examination, the cause is determined after additional examinations.
Treatment for vulvitis includes:
- Intravaginal irrigations and baths to alleviate the patient’s condition;
- Drug therapy - antibacterial, hormonal, homeopathic, immunostimulating, antifungal, anthelmintic drugs, depending on the causes of the disease. Medicines are prescribed in the form of tablets, ointments, suppositories;
- A diet excluding sweet, salty, spicy and alcohol.
Vulvitis during menopause requires careful selection of hormonal medications. It is necessary to compensate for the deficiency of estrogen in the body with pills in order to relieve a woman of vaginal dryness and other unpleasant symptoms.
In some cases, gynecologists decide how to treat vulvitis, together with an infectious disease specialist, nephrologist, urologist and other doctors of related specialties.
Burning of the labia with lichen sclerosus
Lichen sclerosus is a chronic inflammatory dermatosis of unknown etiology, which most often affects the skin epidermis of the genitals (vulva and penis).
Ringworm can affect patients of any age, but is most often diagnosed in postmenopausal women over 50 years of age.
The exact cause of lichen sclerosus has not been established.
However, there is some evidence to suggest the possibility of an autoimmune and genetic factor.
One of the German clinics conducted a study involving 350 women diagnosed with Lichen sclerosus.
The results showed the following: 21.5% of patients had one or more autoimmune diseases; 21% of women had close relatives with autoimmune pathology.
Autoimmune antibodies were detected in 42% of women.
Common autoimmune diseases associated with lichen sclerosus are autoimmune thyroiditis, alopecia, vitiligo and pernicious anemia.
In addition to the autoimmune factor, genetics also has a pathogenetic role.
It was found that every 8 patients have a positive family history of the disease (at least one relative has this diagnosis).
Less commonly, the cause of the pathology was chronic irritation of the genital area or injury to this area.
The clinical picture can vary from mild to severe skin lesions, which may include hypopigmentation, atrophy, erythema, and fissures.
Women may also complain of burning of the labia, itching and soreness in the clitoral area.
Treatment of the disease is aimed at:
- relief of symptoms of itching and discomfort;
- elimination of dryness and burning of the labia;
- healing of lesions (returning the skin to its normal color and texture);
- preventing the development of scar tissue;
- treating any scar tissue that has developed.
The main treatment is the use of a strong corticosteroid ointment/cream.
Early diagnosis and treatment play a significant role in the patient’s prognosis and lead to a reduction in the risk of developing malignant neoplasms and scarring.
Expert opinion
Often women hesitate to visit a doctor and try to cope with vulvitis on their own. They find folk remedies on the Internet or learn from friends, buy and take medications on their own. You can suppress the symptoms, but you cannot completely cure the inflammation. An integrated approach is needed.
Moreover, taking pills for vulvitis without a doctor’s prescription can complicate the course of the disease. Pathogenic microflora becomes resistant to drugs. It is extremely difficult to treat such patients in the future. If to this is added a burn to the mucous membrane, an allergy, or other “surprises” from folk remedies, then a whole consultation has to be involved in drawing up a treatment regimen.
There is no need to be embarrassed by the symptoms and waste time. The doctor will help you get rid of the disease in just a few days if you start treatment at an early stage.
Complications of vulvitis
Treatment of vulvitis in girls and women must be supervised by an experienced doctor. There is a mistaken ease in relation to the disease, which will go into the chronic stage after 7-10 days. Chronic vulvitis is characterized by disturbing symptoms and constant relapses of exacerbations. Inflammation is also dangerous for girls. It is fraught with deformation of the external genital organs, anorgasmia, infertility and miscarriages if the process spreads to the vagina, uterus, and ovaries.
As inflammation develops, purulent processes occur. The woman cannot have a full sex life, experiences pain, and has a high fever. Ulcers appear on the mucous membranes. Purulent vulvitis threatens sepsis. This is a serious complication with a high risk of death.
Vulvitis during pregnancy is no less dangerous. Ascending inflammation spreads to internal organs: uterus, ovaries. There is a risk of intrauterine infection of the fetus, spontaneous abortion, perinatal or neonatal death.
If you go to the clinic in a timely manner, vulvitis responds well to treatment.
