Identification and management of vulval problems of the postmenopausal woman - Tips and tricks.

Vulval irritation and discomfort can be a common presentation to both primary and secondary care. These symptoms can become increasingly prevalent due to physiological changes, which occur to the female genitalia following menopausal transition or due to inflammatory conditions. The correct diagnosis and management can have a huge impact on the patients' quality of life. However, due to the nature of the symptoms, there can be delayed presentation to healthcare professionals. This article gives an overview of the most common benign vulval conditions in the post-menopausal woman, their clinical features and the diagnosis and initial management.

Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach.

BACKGROUND: In Germany, 17-23% of the population suffers from chronic itching of the skin; in 5-10% of cases, the female genitalia are affected, specifically, the vulva. Vulvar pruritus is thus a common symptom that often markedly impairs the affected women's quality of life. METHODS: This review is based on pertinent publications that were retrieved by a selective search in MEDLINE/PubMed for articles on the pathogenesis, diagnosis, and treatment of vul- var pruritus. The search terms were (in German and English) "vulvärer Juckreiz," "pruritus vulvae," and "genital itch," alone and in combination with "Behandlung," "Therapie," or "treat- ment." RESULTS: The most common cause of vulvar pruritus is vulvo- vaginal candidiasis followed by chronic dermatoses, such as lichen sclerosus and vulvar eczema. Especially in refractory cases, an invasive or preinvasive lesion such as squamous epithelial dysplasia (VIN, vulvar intraepithelial neoplasia) should be borne in mind in the differential diagnosis. Rarer causes include infection, atrophy, and vulvodynia. The essen- tial elements of treatment are topical/oral antimycotic drugs and high-potency glucocorticoids, along with consistently ap- plied, basic moisturizing care and the avoidance of potential triggering factors. CONCLUSION: As vulvar pruritus has multiple causes, standard- ization of its diagnostic evaluation and treatment would be l efficacy and to meet the diverse needs of women who suffer from this condition.

Female Genital Itch.

Vulvar pruritus is a common complaint among young girls and women presenting to primary care physicians, gynecologists, and dermatologists. Female genital itch is especially disruptive because of its interference with sexual function and intimacy. Causes of vulvar itch are vast and may be inflammatory, environmental, neoplastic, or infectious, often with several causes coexisting simultaneously. Diagnosis may be difficult because of the unique anatomy and inherent properties of genital and perianal skin. Treatment is aimed at eliminating outside irritants, restoring epidermal barrier function, and suppressing inflammation.

Itch in Special Skin Locations Management.

Itch management can be particularly complicated in some small areas like the scalp or the anogenital region for many reasons: the frequently poor diagnosis of the causes of itch in these areas, the dense innervation of these areas, and the symbolic value of these areas for the human psyche. The diagnosis of itchy scalp is easier than that of anogenital pruritus. Clinical examination and a careful inventory of all diseases of the patient and of the local environment are necessary. Localized treatments are frequently used at both sites, whereas specific pharmaceutical formulations are necessary for the pilose or the mucous environment. Nonetheless, systemic treatments or psychological interventions can be very useful.

Level of use and safety of botanical products for itching vulvar dermatoses. Are patch tests useful?

BACKGROUND: Topical remedies based on botanical ingredients are popular. OBJECTIVES: To assess: (i) the usage of botanical substances in subjects affected with itching and chronic vulvar complaints; (ii) the incidence of side-effects associated with their use and the frequency of contact allergy; (iii) the diagnostic usefulness of patch testing. METHODS: Sixty-six patients were provided with a questionnaire to assess the prevalence and type of topical botanical preparations used and the occurrence of adverse reactions. Patients were patch tested with (i) the Italian baseline series, (ii) a topical medicament series, and (iii) a botanical series. RESULTS: Forty-two patients (63.6%) reported the use of natural topical products on the vulva. Seven (16.7%) noted adverse reactions; 27 showed positive reactions with the baseline series; 14 (21.2%) had at least one relevant reaction, mainly to allergens in topical products and cosmetics; and 2 (3%) showed positive reactions to the botanical series. Of the 7 patients complaining of adverse effects of botanical products, 3 (42.8%) showed relevant sensitization. CONCLUSIONS: The use of natural topical products is widespread among women affected with itching vulvar diseases. Contact dermatitis is a possible adverse effect. Botanical series are of questionable usefulness, owing to the wide variety of botanical ingredients.

History of Abuse in Women With Vulvar Pruritus, Vulvodynia, and Asymptomatic Controls.

OBJECTIVE: Chronic vulvar pruritus and vulvodynia are common vulvar diseases. The aim of this study was to compare gynecologic and sexual and physical abuse histories from patients with these diagnoses and from healthy controls. MATERIALS AND METHODS: Questionnaires were self-completed by patients diagnosed with vulvar itch-scratch (n = 93), patients diagnosed with vulvodynia (n = 232), and patients presenting for annual gynecologic examinations (n = 104) at the University of Michigan Hospitals, Ann Arbor, MI. RESULTS: Patients who came for annual examinations were less likely to report past gynecologic infections (p < .05) and indicated higher interest in and more frequent sexual activity than the other 2 groups (p = .003). Vulvodynia patients had the highest scores on the McGill Pain Questionnaire (p < .001). Subjects with either vulvar disorder were more likely to self-report a history of gynecologic infections than annual examination controls. Rates of sexual (p = .78) and physical abuse (p = .12) were similar for all 3 groups. CONCLUSIONS: Patients with vulvar pruritus and vulvodynia report similar rates of sexual and physical abuse.

Resolution of Chronic Vulvar Pruritus With Replacement of a Neuromodulation Device.

Vulvar pruritus is typically associated with fungal, bacterial, and/or dermatological conditions that routinely resolve with the use of topical medications. Pruritus rarely becomes chronic in nature without a definable pathological diagnosis. However, when this occurs, management is difficult and has limited treatment options. Few cases have reported resolution of vulvar pain or discomfort with sacral neuromodulation implantation. We report a case in which a patient experienced chronic vulvar pruritus that was refractory to medical treatments and did not have a pathological diagnosis. A neurological etiology was suspected, and upon replacement of the patient's sacral neuromodulation device, complete resolution of the vulvar symptoms occurred.

Symptoms in plasma cell vulvitis: first observational cohort study on type, frequency and severity.

BACKGROUND: Studies assessing symptoms of plasma cell vulvitis (PCV) are lacking. OBJECTIVES: To assess the prevalence and severity of PCV-related symptoms and identify possible associations between patient characteristics, clinical features of PCV and treatments administered before a definitive diagnosis. METHODS: Thirty-six patients affected with PCV were included. Data were collected by direct interview and clinical examination. RESULTS: Thirty patients (83.3%) complained of symptoms: burning was the most frequent (80.6%) while dyspareunia was the severest. Of the symptomatic patients, 73.3% experienced severe symptoms. Severity of symptoms was not associated with age at onset and duration of PCV. Almost 70% of the patients had previously undergone treatments. CONCLUSIONS: Symptoms in PCV are frequent and more than often severe. Neither age at onset nor duration of the disease nor the extent of vulvar involvement were associated with symptom severity. Both the delay in diagnosis and the inappropriate previous treatments seem to indicate frequent misdiagnosis.

Multiple localized epidermolytic acanthomas of the vulva associated with vulvar pruritus: a case report.

Epidermolytic acanthoma (EA) is a rare benign acquired tumor that most commonly presents as a solitary lesion on the trunk, extremities, male genitalia, and face with a male predominance. Cases occurring on the female genitalia have rarely been reported. We describe the case of multiple localized EAs occurring on the vulva of a 31-year-old woman presenting with the chief complaint of vulvar pruritus. Although rare to occur in the vulvar area, EAs should be included in the differential diagnosis of multiple vulvar papules.

Vulval pruritus: the experience of gynaecologists revealed by biopsy.

Pruritus of the vulva is a common symptom among patients attending to outpatient clinics. In the present study, we aimed to assess pathologies causing vulval pruritus in the reliability of biopsy in a tertiary referral centre. A total of 137 patients undergoing vulval colposcopy because of vulval pruritus were reviewed from the hospital records retrospectively. The mean age of the patients was 47.61 ± 11.88 years and 36.5% of the patients were postmenopausal. In 101 (73.7%) of the patients, macroscopic lesions were present. In 88 (64.2%) of the patients, tolidine-positive stained areas were determined under colposcopy. In total, 68 (49.6%) of the lesions were plain, whereas 51 (37.2%) of them were depigmented. Lichen simplex chronicus, lichen sclerosis and chronic inflammation were the major pathologies associated with vulval pruritus (25.5%, n = 35; 20.4%, n = 28; 14.6%, n = 20). In conclusion, several pathologies out of vulvovaginal candidiasis may lead to vulval pruritus and clinicians should be aware of the importance of biopsy in determining the underlying pathology.

Risk factors for candida infection of the genital tract in the tropics.

OBJECTIVE: To investigate the risk factors associated with candida infection of the genital tract in the tropics. METHODS: We performed questionnaire survey and experiments at the Hainan branch of General Hospital of People's Liberation Army, Hainan General Hospital and Sanya Maternity and Child Health Care Hospital in 2013. Controls were without Candida infection of genital tract, and cases had from Candida infection. RESULTS: We recruited 689 cases and 652 controls. The average age of cases with Candida infection of the genital tract was higher than that of controls. In the multivariate modeling, marriage (adjusted odds ratio: 2.49, 95% confidential interval: 1.09-5.67) and vaginal lavage (adjusted odds ratio: 4.41, 95% confidential interval: 1.13-5.14) were significantly associated with Candida infection of genital tract in tropics. CONCLUSION: Candida infection was related with age. Marriage and Vaginal lavage were significant risk factors. Attention should be paid to health education for the prevention of these infections.

Vulvar puritus for one year.

A 60-year-old menopausal female presented with vulvar itching for one year. She had noticed a whitish lesion on the vulva that slowly increased in size over the year. She had been unsuccessfully treated with oral fluconazole and topical clotrimazole-mometasone combinations and the plaque had gradually spread to involve the clitoris and peri-urethral area. She was neither diabetic nor hypertensive and had no other systemic complaints. Examination revealed a well-defined non-tender whitish plaque situated on her left labia minora and clitoris (Figure 1). A swab from the plaque did not grow any organism. Routine blood chemistry including a VDRL and HIV ELIZA were within normal limits. A punch biopsy from the lesion was taken and histopathology findings were as seen in (Figures 2 and 3).

Conduta na dor e prurido vulvar / Pain and pruritus vulvae management

Prurido e dor são as principais manifestações clínicas das doenças vulvares. Estes sintomas podem estar associados a processos inflamatórios, imunológicos, distúrbios metabólicos e neoplasias. Na dúvida, é sempre recomendável o estudo histopatológico. Quando não há definição etiológica, várias opções terapêuticas estão disponíveis: cremes tópicos, fármacos sistêmicos, operações de dessensibilização nervosa da vulva. A conduta terapêutica deve ser individualizada quando não há etiologia definida. São escassos os trabalhos científicos, com metodologia adequada, que abordam o tema. Portanto, anamnese e exame físico cuidadosos irão definir a melhor abordagem terapêutica

Pruritus and pain are common manifestations of vulvae diseases. The symptoms can be associated with inflammatory, immunologic, metabolic or neoplastic diseases. Undoubtedly, the histopathological exam is always recommended. When there is no etiologic definition, many therapeutic options are available: creams, systemic drugs, and surgical neural desensitization of the vulvae. When there is no precise etiology, therapeutical approach must be individualized. Scientific studies, with good methodology, are rare. Therefore, careful anamnesis and physical exam will point to the best therapeutical approach

Estudio de patología vulvar en pacientes menopáusicas / Study of vulvar pathology in menopausal women

Objetivo: Estudiar la patología vulvar de las pacientes en edad menopáusica remitidas a una unidad del tracto genital inferior (UCTI). Material y métodos: Estudio observacional y descriptivo de las pacientes menopáusicas con patología vulvar remitidas a la UTGI del Hospital General Universitario de Alicante entre enero de 2000 y diciembre de 2007. Se evaluaron las patologías más frecuentes, el tipo de lesión, la localización, el diagnóstico y el tratamiento. Resultados: Se estudió a 189 pacientes mayores de 55 años; 68 (36%) presentaban patología vulvar. El liquen escleroso fue la más frecuente (46%), con prurito como síntoma principal (64%) y localizado principalmente en los labios mayores. El tratamiento instaurado con más frecuencia fueron los corticoides de alta potencia (64%).Conclusiones: La patología vulvar más frecuente en las pacientes menopáusicas de nuestra UTGI es el liquen escleroso, que se presenta habitualmente como prurito. Los corticoides de alta potencia fueron el tratamiento más efectivo (AU)

Objective: Study the pathology of the vulva found in menopausal patients referred to a lower genital tract unit (LGTU).Materials and methods: An observational and descriptive study of menopausal patients with vulvar pathology from the LGTU of Hospital General Universitario de Alicante (Spain), between January 2000 and December 2007. We assessed the more common diseases, lesion type, location, diagnosis and treatment. Results: We evaluated 189 patients (that were older than 55 years). Of these, 68 had vulvar pathology (36%), and lichen sclerosus (46%) the most frequent disease. The treatment most often established was with high-powered steroids (64%),which was also the most effective. Conclusions: The most common vulvar pathology in postmenopausal patients of our LGTU is the lichen sclerosus. Pruritus was the main symptom. High-powered steroids were the most effective treatment (AU)

Prurito vulvar de larga duración / Long-standing Vulvar Pruritus

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