Vulvitis

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Vulvitis is inflammation of the vulva, the external female mammalian genitalia that include the labia majora, labia minora, clitoris, and introitus (the entrance to the vagina). It may co-occur as vulvovaginitis with vaginitis, inflammation of the vagina, and may have infectious or non-infectious causes. The warm and moist conditions of the vulva make it easily affected. Vulvitis is prone to occur in any female especially those who have certain sensitivities, infections, allergies, or diseases that make them likely to have vulvitis. Postmenopausal women and prepubescent girls are more prone to be affected by it, as compared to women in their menstruation period. [1] It is so because they have low estrogen levels which makes their vulvar tissue thin and dry. Women having diabetes are also prone to be affected by vulvitis due to the high sugar content in their cells, increasing their vulnerability. Vulvitis is not a disease, it is just an inflammation caused by an infection, allergy or injury. Vulvitis may also be symptom of any sexually transmitted infection or a fungal infection.[ medical citation needed ]

Contents

Causes

Vulvitis may be caused by the following reasons:

  1. Allergies or sensitivities towards certain products like - coloured or perfumed toilet papers, vaginal sprays or douches, shampoos and hair conditioners, laundry detergents, creams or medications.
  2. Reactions to - bubble bath or soaps used on genital area, spermicides, sanitary napkins.
  3. Irritations caused by - a yeast infection, chlorinated water in swimming pools or hot tubs, synthetic underwear or nylon pantyhose without a breathable cotton crotch, wearing a wet bathing suit for a long time, bike or horseback riding, douching, poor personal hygiene, incontinence, by urine or stool if it remains in contact with the vulva (as may occur in women who have incontinence or are confined to bed), contact with urine and stool sometimes cause ongoing (chronic) vulvitis.
  4. Infections such as - vaginitis, genital herpes, viral and fungal infection.
  5. Factors such as - Diabetes, scabies or pubic lice, eczema or dermatitis, oral sex. [2]

Symptoms and signs

The symptoms of vulvitis are:[ citation needed ]

  1. Extreme and constant itching
  2. A burning sensation in the vulvar area
  3. Vaginal discharge
  4. Small cracks on the skin of the vulva
  5. Redness and swelling on the vulva and its labia (lips of the vulva)
  6. clear fluid-filled blisters on the vulva
  7. Scaly, thick, whitish patches on the vulva
  8. Bumps or warts
  9. Soreness
  10. Pain with sex
  11. Increased sensitivity when wiping with toilet paper

Symptoms of vulvitis may also be an indication of other diseases or disorders. A doctor should be consulted when one is having any of these symptoms. The symptoms may vary on depending on the cause and the time period it has been infected for.[ medical citation needed ]

Diagnosis

Vulvitis can have many different causes which makes the diagnosis difficult. The diagnosis of vulvitis starts with examining the medical history and pelvic examination of the person affected by it. Other diagnostic tools like pap smears, urine tests, blood tests and tests for sexually transmitted infections are also done. [ medical citation needed ]

In children

Vulvitis can have a variety of etiologies in children and adolescents, including allergic dermatitis, contact dermatitis, lichen sclerosus, and infections with bacteria, fungi, and parasites. Dermatitis in infants is commonly caused by a soiled diaper being left on for an extended period of time. Increasing the frequency of diaper changes and topical application of emollients are sufficient to resolve most cases. Dermatitis of the vulva in older children is usually caused by exposure to an irritant (e.g. scented products that come into contact with the vulva, laundry detergent, soaps, etc.) and is treated with preventing exposure and encouraging sitz baths with baking soda as the vulvar skin heals. Other treatment options for vulvar dermatitis include oral hydroxyzine hydrochloride or topical hydrocortisone. [3]

Lichen sclerosus is another common cause of vulvitis in children, and it often affects an hourglass or figure eight-shaped area of skin around the anus and vulva. Symptoms of a mild case include skin fissures, loss of skin pigment (hypopigmentation), skin atrophy, a parchment-like texture to the skin, dysuria, itching, discomfort, and excoriation. In more severe cases, the vulva may become discolored, developing dark purple bruising (ecchymosis), bleeding, scarring, attenuation of the labia minora, and fissures and bleeding affecting the posterior fourchette. Its cause is unknown, but likely genetic or autoimmune, and it is unconnected to malignancy in children. If the skin changes are not obvious on visual inspection, a biopsy of the skin may be performed to acquire an exact diagnosis. Treatment for vulvar lichen sclerosus may consist of topical hydrocortisone in mild cases, or stronger topical steroids (e.g. clobetasol propionate). Preliminary studies show that 75% of cases do not resolve with puberty. [3]

Organisms responsible for vulvitis in children include pinworms ( Enterobius vermicularis ), Candida yeast, and group A hemolytic Streptococcus. Though pinworms mainly affect the perianal area, they can cause itching and irritation to the vulva as well. Pinworms are treated with albendazole. Vulvar Candida infections are uncommon in children, and generally occur in infants after antibiotic therapy, and in children with diabetes or immunodeficiency. Candida infections cause a red raised vulvar rash with satellite lesions and clear borders, and are diagnosed by microscopically examining a sample treated with potassium hydroxide for hyphae. They are treated with topical butoconazole, clotrimazole, or miconazole. Streptococcus infections are characterized by a dark red discoloration of the vulva and introitus, and cause pain, itching, bleeding, and dysuria. They are treated with antibiotics. [3]

Zoon vulvitis (Plasma cell vulvitis)

This is an uncommon, benign condition which was originally described in the glans penis of older men but has a counterpart in women under a variety of terms (Zoon vulvitis, vulvitis circumscripta plasmacellularis, plasmacytosis mucosae). [4]

Most patients are adult, in reproductive age or postmenopausal (age range 26–70 years). Lesions on the vulva are usually asymptomatic, composed of solitary or multiple, sharply defined, red-brown, shiny patches which frequently exhibit a speckled and hemorrhagic surface. Ulceration commonly supervenes. Treatment includes topical steroids for symptomatic relief. Rarely excision for refractory lesions. [4]

Microscopic Findings:

  1. Dense plasma cell-rich band-like infiltrate in papillary and upper reticular dermis
  2. Spongiotic epidermis with absent stratum granulosum and stratum corneum
  3. “Lozenge”-shaped configuration of superficial keratinocytes
  4. Vascular proliferation in superficial submucosa with red cell extravasation and/or hemosiderin [5]

Related Research Articles

<span class="mw-page-title-main">Candidiasis</span> Fungal infection due to any type of Candida

Candidiasis is a fungal infection due to any species of the genus Candida. When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth and throat. Other symptoms may include soreness and problems swallowing. When it affects the vagina, it may be referred to as a yeast infection or thrush. Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina. Yeast infections of the penis are less common and typically present with an itchy rash. Very rarely, yeast infections may become invasive, spreading to other parts of the body. This may result in fevers, among other symptoms.

Vulvodynia is a chronic pain condition that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. It has been established by the ISSVD that for the diagnosis to be made symptoms must last at least three months.

<span class="mw-page-title-main">Dermatitis</span> Inflammatory disease of the skin

Dermatitis is a term used for different types of skin inflammation, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is also called eczema but the same term is often used for the most common type of skin inflammation, atopic dermatitis.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Irritation</span> State of inflammation

Irritation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant. Irritants are typically thought of as chemical agents but mechanical, thermal (heat), and radiative stimuli can also be irritants. Irritation also has non-clinical usages referring to bothersome physical or psychological pain or discomfort.

<span class="mw-page-title-main">Tinea cruris</span> Fungal infection

Tinea cruris (TC), also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates.

<span class="mw-page-title-main">Lichen sclerosus</span> Itchy skin rash usually affecting the genitals

Lichen sclerosus (LS) is a chronic, inflammatory skin disease, of unknown cause, which can affect any body part of any person, but has a strong preference for the genitals, and is also known as balanitis xerotica obliterans (BXO) when it affects the penis. Lichen sclerosus is not contagious. There is a well-documented increase of skin cancer risk in LS, potentially improvable with treatment. LS in adult age women is normally incurable, although treatment can lessen its effects, and it often gets progressively worse if not treated properly. Most males with mild or intermediate disease, restricted to foreskin or glans, can be cured by either medical or surgical treatment.

<span class="mw-page-title-main">Triamcinolone</span> Steroid medication

Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others. It is also used to prevent worsening of asthma and COPD. It can be taken in various ways including by mouth, injection into a muscle, and inhalation.

<span class="mw-page-title-main">Angular cheilitis</span> Cheilitis characterized by inflammation of one or both of the corners of the mouth

Angular cheilitis (AC) is inflammation of one or both corners of the mouth. Often the corners are red with skin breakdown and crusting. It can also be itchy or painful. The condition can last for days to years. Angular cheilitis is a type of cheilitis.

<span class="mw-page-title-main">Allergic contact dermatitis</span> Inflammation of the skin due to contact with an allergen

Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).

<span class="mw-page-title-main">Vulvar cancer</span> Cancer involving the vulva

Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or Bartholin's glands are affected. Symptoms include a lump, itchiness, changes in the skin, or bleeding from the vulva.

<span class="mw-page-title-main">Vulvar intraepithelial neoplasia</span> Medical condition

Vulvar intraepithelial neoplasia (VIN) refers to particular changes that can occur in the skin that covers the vulva. VIN is an intraepithelial neoplasia, and can disappear without treatment. VINs are benign but if the changes become more severe, there is a chance of cancer developing after many years, and so it is referred to as a precancerous condition.

<span class="mw-page-title-main">Vaginal yeast infection</span> Medical condition

Vaginal yeast infection, also known as candidal vulvovaginitis and vaginal thrush, is excessive growth of yeast in the vagina that results in irritation. The most common symptom is vaginal itching, which may be severe. Other symptoms include burning with urination, a thick, white vaginal discharge that typically does not smell bad, pain during sex, and redness around the vagina. Symptoms often worsen just before a woman's period.

<span class="mw-page-title-main">Perineoplasty</span> Plastic surgery procedure

Perineoplasty denotes the plastic surgery procedures used to correct clinical conditions of the vagina and the anus. Among the vagino-anal conditions resolved by perineoplasty are vaginal looseness, vaginal itching, damaged perineum, fecal incontinence, genital warts, dyspareunia, vaginal stenosis, vaginismus, vulvar vestibulitis, and decreased sexual sensation. Depending upon the vagino-anal condition to be treated, there are two variants of the perineoplasty procedure: the first, to tighten the perineal muscles and the vagina; the second, to loosen the perineal muscles.

<span class="mw-page-title-main">Vulva</span> External genitalia of the female mammal

In mammals, the vulva comprises mostly external, visible structures of the female genitalia leading away from the interior parts of the female reproductive tract, starting at the vaginal opening. For humans, it includes the mons pubis, labia majora, labia minora, clitoris, vestibule, urinary meatus, vaginal introitus, hymen, and openings of the vestibular glands. The folds of the outer and inner labia provide a double layer of protection for the vagina. Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.

Labial fusion is a medical condition of the vulva where the labia minora become fused together. It is generally a pediatric condition.

A vulvar disease is a particular abnormal, pathological condition that affects part or all of the vulva. Several pathologies are defined. Some can be prevented by vulvovaginal health maintenance.

Pediatric gynaecology or pediatric gynecology is the medical practice dealing with the health of the vagina, vulva, uterus, and ovaries of infants, children, and adolescents. Its counterpart is pediatric andrology, which deals with medical issues specific to the penis and testes.

Crohn's disease (CD) of the vulva is a rare extra intestinal condition, with granulomatous cutaneous lesions affecting the female genitalia. Lesions connected to the affected gut via a healthy tissue are referred to as metastatic lesions.

References

  1. ↑ "Online Dermatology - Vulvitis". First Derm. 2016-01-02. Retrieved 2018-10-27.
  2. ↑ "Vulvitis - Our Bodies Ourselves". Our Bodies Ourselves. Retrieved 2018-10-27.
  3. 1 2 3 Hoffman, Barbara; Schorge, John; Bradshaw, Karen; Halvorson, Lisa; Schaffer, Joseph; Corton, Marlene M. (2016-04-22). Williams Gynecology, Third Edition. McGraw Hill Professional. ISBN   9780071849098.
  4. 1 2 Nucci, Marisa R. (3 February 2020). Gynecologic pathology : a volume in the series Foundations in diagnostic pathology (Second ed.). p. 35. ISBN   978-0-323-35909-2.
  5. ↑ Nucci, Marisa R. (3 February 2020). Gynecologic pathology : a volume in the series Foundations in diagnostic pathology (Second ed.). p. 36. ISBN   978-0-323-35909-2.
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