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.
This is an embarrassing condition where most of us have difficulty to seek for advice or discuss to other people regarding this matter. Well, it also can be very distressing. Just imagine if you are at work or in a crowd of people, scratching will drop your reputation but ignoring it means disaster. However, do not worry too much; getting some knowledge involving this will help. If nothing else can be done, then, it’s time to seek for medical advice.
What are the possible causes?
It can be either local causes (primary) or general causes (systemic). The majority of causes are probably idiopathic or psychogenic. Most of the time the “itch-scratch” vicious cycle is created and symptoms usually persist even after initial cause has been eradicated.
Local causes:
- Poor hygiene
- Sweating
- Anal fistula
- Hemorrhoids
- Anal neoplasia / cancer
- Warts
- Fungal infections
- Contact dermatitis
- Worms
- Certain antibiotics (possibly via the complication of diarrhea or fungal infection)
- Dermatological diseases include scabies, pediculosis, psoriasis and atopic eczema
General causes:
- Diabetes mellitus
- Obstructive jaundice
- Hodgkin’s disease
Symptoms:
- Whatever the cause is the itchiness usually severe at night. Most probably because we have nothing to do at night so our mind can concentrate more on the symptom.
- Excoriations (scratch mark) of the skin area
- Lichenification (skin thickening)
- Papules or nodules (localized skin thickening)
Investigations:
Most of the time, no investigation is required. However, in certain cases, the doctor will run several investigations.
- Full blood count to look for hemoglobin and white cell count
- Blood sugar level
- Perianal scrapings
- Microscopy for fungal
Treatment:
- If any primary cause is known, it should be treated specifically
- Increase hygiene
- Avoid certain food that might worsen the itchiness, especially if someone is allergic to the food (e.g.: eggs, seafood, etc)
- Wearing loose underclothes
- Cleansing after defecation with simple soap (make sure that you are not allergic to that soap)
- Application of glycerin end witch hazel
- Symptomatic relief like antihistamine (e.g.: chlorpheniramine tablet) to improve the symptom. Sedative antihistamines at night will always be a big help.
- Application of hydrocortisone cream may help
- Zinc oxide can be used for local application to soothe anal irritation
- The scratch part might be painful so analgesic should be considered
Reference:
1. Churchill’s Pocketbook of Surgery. Andrew T. Raftery. 2nd edition. 2001.
2. Oxford handbook of clinical specialties. 5th edition. 2001.
3. Oxford handbook of clinical medicine. 4th edition. 1999.
