Pruritus Vulvae

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Description

  • Pruritus vulvae may be a symptom of any of several disorders or can itself be a primary diagnosis.
  • Underlying conditions may cause vulvar pruritus, or it may be a primary diagnosis.
  • It can be acute (<6 weeks) duration or chronic.
  • Pruritus vulvae as a primary diagnosis may also be more appropriately documented as vulvodynia (see “Vulvodynia” topic) or burning vulva syndrome.

Epidemiology

Symptoms may occur at any age during a woman’s lifetime.

  • Young girls most commonly have infectious or hygiene etiology.
  • The primary diagnosis is more common in postmenopausal women.

Incidence

The exact incidence is unknown, although most women complain of vulvar pruritus at some point in their lifetime.

Prevalence

  • Prevalence not known
  • Small US study found 6.6% women aged 20 to 59 experienced persistent genital itching or burning (1).

Etiology and Pathophysiology

  • Etiology of condition can be due to inflammatory, infectious, and neoplastic processes that affect female genitalia. Nonlocal causes include systemic, genetic, psychogenic and neurogenic conditions (2).
  • Age-related hormonal changes result in different risk factors in various age groups (2).
    • Early childhood (age 2 to 7 years) physiologic and skin and vaginal flora changes
    • Prepubertal atopic and irritant dermatitis, dermatoses, and infections
    • Postmenopausal atrophy increases risk of infection, irritation.

Risk Factors

Vary depending on etiology

  • High-risk sexual behavior
  • Immunosuppression
  • Autoimmune disease
  • Medication

General Prevention

  • Hygiene
  • Avoid irritants.
  • Tight-fitting clothing should be avoided.
  • Only cotton underwear should be worn.
  • Management of associated systemic conditions

Commonly Associated Conditions

  • Infectious etiology
    • Vaginal or vulvar candida
    • Gardnerella vaginalis
    • Trichomonas
    • Human papillomavirus
    • Herpes simplex virus
    • Dermatophytosis
    • Parasites: scabies, Pthirus pubis
  • Vulvar vestibulitis
  • Dermatoses
    • Lichen sclerosus (LS)
    • Lichen planus (LP)
    • Lichen simplex chronicus (LSC)
  • Malignant or premalignant conditions
  • Immune mediated
    • Autoimmune progesterone dermatitis: perimenstrual eruptions
    • Irritant or allergic contact dermatitis
    • Atopic dermatitis
    • Psoriasis
  • Fecal or urinary incontinence
  • Neurogenic
    • Small fiber polyneuropathy (SFPN)—amyloidosis, vitamin B12 deficiency, sarcoidosis (3)
  • Extramammary Paget disease
  • Dietary: methylxanthines (e.g., coffee, cola), tomatoes, peanuts

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