Itching in the external genitalia

ITCH IN EXTERNAL GENITAL ORGANS

Vulvar itching is a complaint that bothers women very much. Hair removal in the vulva, epilation, washing with different scented soaps, using synthetic material pads, wearing synthetic underwear can also be counted among the causes of itching. Especially if there are white spots on the vulvar skin, which is itchy, you should definitely go to the doctor.

Among the diseases that cause the most itching in the vulva, there are various causes such as dermatitis, infections, allergies, some systemic diseases, estrogen deficiency before puberty or after menopause. In particular, the disease called lichen sclerosis is an itchy, chronic disease affecting the vulva and perineum, it can be seen at any age. In this disease, discoloration of the vulva, submucosal hemorrhage, disappearance of the mucocutaneous border, atrophy of the labia minora, and shrinkage of the vulvar skin are observed.

CAUSES OF ITCHING IN THE VULVA:

Dermatitis: Seborrheic dermatitis, psoriasis, lichen simplex chronicus, lichen planus, lichen sclerosis,

Infections: Gardnerella vaginalis vaginitis, fungal infections, trichomonas, pinworms, lice, scabies, infection called condiloma acuminata caused by HPV

Squamous cell hyperplasia: Thickening of the stratified squamous epithelium covering the vulva,

HPV effect: Vulvar intraepithelial neoplasia

Cancer of the vulva: Cancer that develops from the skin of the vulva, which is the external genitalia

Paget’s disease: It is more common in advanced ages, it is observed as itchy plaques with clear white borders on the vulva skin. In 10-15% of these patients, cancer is detected in the sweat glands under the lesion.

Fox-Fordyce disease: It is a rare disease caused by the obstruction of apocrine sweat gland ducts in the vulva. It causes severe itching in the vulva.

Diagnosis:

Laboratory examination of vaginal discharge samples, fasting blood glucose, kidney and liver function tests and complete blood count should be performed. Especially in girls, pinworm scanning should be done with the scotch tape test.

Vulva biopsy should be taken in cases of itching whose cause cannot be determined definitively despite all investigations. The importance of vulvar biopsy in the detection of vulvar cancer and precancerous lesions of the vulva, which causes severe itching in the vulva, is indisputable. This procedure can be done painlessly with the help of a scalpel and scissors or with a Punch biopsy instrument after numbing with local anesthesia.

After 5-6 minutes after the application of 3-5% acetic acid to the vulva, the thickened areas (hyperplasia-hyperkeratosis) in the vulva become more prominent, and Punch biopsy is taken from these areas under colposcopic observation, if necessary, and sent for pathological examination. The colposcopy instrument helps to examine the vulva surface in more detail by enlarging it.

Treatment:

To prevent itching in the vulva:

-Cotton underwear should be worn,

-Corsets and tights should not be worn,

– The vulva should not be washed too often,

-The vulva should be dried after a bath or toilet,

– Daily synthetic weight pads should not be used,

-Vulva spray, perfumed materials should not be used

Do not use hair removal creams often.

– Itching from pinworms (oxyuriasis) and pubic lice (pediculosis) is treated with anthelmintic drugs, gamma benzene hexachloride and shampoos as well as appropriate care.

– Creams containing cortisone or pimecrolimus are used in the treatment of lichen sclerosis. If it does not go away and there is scarring in the vulva and stenosis in the vagina, surgical treatment is performed.

-When vulvar cancer precursor lesions (VIN1, VIN2, VIN3) or vulvar cancer are diagnosed, the treatment is surgery.

– Treatment of severe vulvar itching in Fox-Fordyce disease is retinoic acid and birth control drugs, which usually disappear after menopause.

Kiss. Dr. Kutlugul Yuksel

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