Vulval irritation may occur at any age. There is wide range of causes that may rise to this uncomfortable and embarrassing symptom. The most common causes of vulva itchiness are infection. In older women, the most common causes are oestrogen deficiency and vulval dermatoses.
I am sure that some of us have heard about vaginal candidiasis. Candidia infection is the most common cause producing this symptom. Non infectious causes are lichen sclerosus, Paget’s disease and vulval intraepithelial neoplasia (VIN). Paget’s disease of the vulva usually present in elderly. VIN is a precursor of invasive carcinoma so if the person complaint of frequent itchiness it might be wise to do biopsy if any skin lesion present during perenium examination.
On examination, there may be evidence of excoriation and discoloration of the vulva. Thickening or thinning of the vulval skin may be present. In some cases like vaginitis, vaginal discharge may present upon examination.
The definitive management is mainly treating the underlying cause. Symptomatic wise, sedative antihistamine will be prescribed by your physician to reduce the itchiness.
Reference:
1. Gynecology in focus. Janice Rymer and Andrew Fish. Churchill Livingstone.2005.
2. Oxford Handbook of Clinical Medicine. 7th edition. Oxford. 2008.
Vaginal candidiasis is also known as vaginal thrush. Most vaginal candidiasis is caused by Candida albicans. It is yeast like fungus that may present in the vagina without causing any symptoms. Thrush is not necessarily sexually transmitted. It may be transmitted sexually or spread from anus to vulva and vagina. Once established, it can be transmitted sexually even by asymptomatic partner.
Vaginal candidiasis is far most common cause of vaginitis and vaginal discharge. High risk group include people who is immunosuppressant, diabetes mellitus and pregnant ladies. Those who are on antibiotics or oral contraceptive pill may also carry some risk to get vaginal thrush. Some physicians practice to check for glucose level in elderly lady who is present with vaginal candidiasis. The discharge is white, particulate and non offensive. Classically, it is known as white curds. It may cause irritants and itchiness. The vulva and vagina may appear red, edematous, fissured and sore. Her partner might be asymptomatic. It might be covered with whitish discharge. In vagina, it may appear as white discharge adheres to vaginal walls.
Investigations wise, high vaginal swab with gram staining will show yeasts formation. Under microscope, we can see strings of mycelium or oval spores. Sample for culture on Sabouraud’s medium will grow the yeasts. Recurrent history of vaginal discharge warrants an investigation for other types of sexual transmitted disease.
Treatment includes topical antifungal agents, pessaries and cream. Some antifungal agents are clotrimazole, miconazole and nystatin. For example, we can give imidazole pessary (500mg clotrimazole) and cream to be use on vulva and also the partner. In severe or persistent case, oral antifungal agent (e.g.: fluconazole 150mg orally) may be required. Oral antihistamine can be taken to control the symptom of itchiness.
Prevention is always the best choice. If we care about the hygiene, it will reduce the incidence of vaginal candidiasis. Practice safe sex and stick to one partner is always a good idea.
Reference:
1. Gynecology in focus. Janice Rymer and Andrew Fish. Churchill Livingstone.2005.
2. Oxford Handbook of Clinical Medicine. 7th edition. Oxford. 2008.
