Interstitial cystitis, limited vulvitis, and desquamative vaginitis syndrome

　　What causes interstitial cystitis, limited vulvitis, and desquamative vaginitis syndrome?

　　One, Etiology

　　Interstitial cystitis, limited vulvitis, and desquamative vaginitis syndrome are related to multiple sexual partners, candidal infection, and ureaplasma infection, or are sequelae of infection. The tissues involved in limited vulvitis and interstitial cystitis include the bladder, urethra, and vestibular tissues, all originating from the embryonic genital sinus. This non-infectious inflammatory syndrome may be related to autoimmune causes.

　　Two, Pathogenesis

　　Interstitial cystitis, limited vulvitis, and desquamative vaginitis syndrome patients have thinning of the bladder mucosa, visible ulcers under the microscope, edema, congestion, dilated capillaries, and interstitial hemorrhage around blood vessels, with lymphocytic infiltration, as well as mast cells and eosinophils. Pain is associated with persistent or only during bladder congestion, after bladder emptying, or when the bladder is impacted, such as during sexual intercourse. The course of the disease is long, or the bladder of elderly women may atrophy and become smaller with obvious ulcers.

　　It was previously thought that localized vulvitis was caused by infection of the vestibular glands, but recently it cannot be determined whether the disease is related to the vestibular glands.

　　The vaginal pH value of patients with desquamative vaginitis is often increased to 4.5～5.5. .

　　Patients with interstitial cystitis, localized vulvitis, and desquamative vaginitis syndrome have a thinning bladder mucosa, which can be seen under a microscope as ulcers. There are edema, congestion, dilated capillaries, and interstitial hemorrhage around blood vessels in the subepidermal layer, with lymphocytic infiltration, and also macrophages and eosinophils can be seen. Pain is associated with persistent pain or only during bladder congestion, bladder emptying, or bladder impact, such as during sexual intercourse. The course of the disease is long, or the bladder of elderly women may shrink and become smaller with obvious ulcers.

　　What are the manifestations and how to diagnose interstitial cystitis, localized vulvitis, and desquamative vaginitis syndrome?

　　Patients with interstitial cystitis, localized vulvitis, and desquamative vaginitis syndrome have symptoms such as frequent urination, purulent urine, and bladder pain, nocturia, vulvar itching, vulvar discomfort, sexual difficulty, pain during sexual intercourse, abnormal vaginal discharge, and abnormal genital tract odor. There may be lesions in the vestibule, urethral tenderness, and bladder tenderness.

　　There are small erythematous lesions on the lateral vestibule of the hymen, and other examinations are normal. Pressing these lesions with a cotton swab or examination finger can produce tenderness or discomfort.

　　There is discomfort, burning sensation, or pain in the vulva. Vaginal purulent discharge is present, and the vaginal pH value is 4.5～5.5. Adding 10% potassium hydroxide solution to the secretion does not produce a fishy smell.

　　Most patients are young women, with multiple sexual partners, and women who drink alcohol are more prone to this syndrome. In addition to the above clinical manifestations, the existence of this syndrome should be considered.

　　Under anesthesia, cystoscopy can make a diagnosis of interstitial cystitis. The bladder appearance and capacity are normal at the beginning, but scattered submucosal hemorrhage is often visible after bladder filling, emptying, and refilling. Biopsy can show pathological changes such as edema, congestion, dilated capillaries, and interstitial hemorrhage around blood vessels in the subepidermal layer, and can also be used to exclude some in situ carcinomas and tuberculosis lesions. There are small erythematous lesions on the lateral vestibule of the hymen in the localized vulvitis, and the rest are normal. The vaginal pH value is measured, and adding 10% potassium hydroxide solution to the vaginal secretions does not produce a fishy smell. Microscopic examination of the suspension of secretions does not show cells that can suggest a diagnosis, and the secretions only contain a large number of white blood cells and immature vaginal epithelial cells (similar to basal cells). Cultures for chlamydia trachomatis, gonococcus, and vaginal trichomoniasis are all negative.

　　How to prevent interstitial cystitis, limited vulvitis, and desquamative vaginitis syndrome:

　　How to prevent interstitial cystitis, limited vulvitis, and desquamative vaginitis syndrome:

　　1. Interstitial cystitis often occurs in middle-aged women, and its main characteristic is fibrosis of the bladder wall. It is accompanied by a decrease in bladder capacity, with frequent urination, urgency, and bladder area distension and pain as the main symptoms.

　　2. Vulvitis has two types of infections: specific and non-specific. Specific infections are mainly caused by fungi and trichomonas infections; non-specific infections include staphylococcus, Escherichia coli, and streptococcus infections, etc. Non-specific infections are more common. In addition, it can also be secondary to other local or systemic diseases, such as cervicitis, vaginitis, cervical cancer, etc. Due to the stimulation of increased secretion, or excessive and prolonged stimulation by menstrual blood or lochia, inflammation of varying degrees can be induced. Other factors such as the soaking of menstrual napkins, fecal stimulation from patients with urinary fistula or fecal fistula, and the stimulating effect of glucose in diabetic patients can also lead to vulvitis.

　　Urinalysis and bacterial culture, vaginal secretion smear examination, vaginal pH test. Vaginal epithelial cell pathological examination, immunological detection of mycoplasma infection. Measure the vaginal pH value, add 10% potassium hydroxide solution to the vaginal secretion without a fishy smell, and microscopic examination of the secretion suspension does not show cells that can suggest a diagnosis, while the secretion only contains a large number of white blood cells and immature vaginal epithelial cells (similar to basal cells). Cultures for chlamydia trachomatis, gonococcus, and vaginal trichomonas are all negative.

　　Therapeutic diet for cystitis:

　　1. Corn porridge, ingredients: corn bran or flour, 50 grams, a little salt. Preparation and usage: Boil corn bran with an appropriate amount of water to make porridge, then add a little salt and it is ready. It is suitable for consumption on an empty stomach.

　　2. Barley porridge, ingredients: 50 grams of barley, appropriate amount of brown sugar. Preparation and use: Grind the barley into powder, boil it into porridge with water, then mix with the appropriate amount of brown sugar and stir well before eating.

　　3. Bamboo leaf porridge, ingredients: fresh bamboo leaves 30-45 grams, gypsum 15-30 grams, glutinous rice 50-100 grams, a little sugar. Preparation and use: Boil bamboo leaves and gypsum in water, take the juice and cook with glutinous rice and a little sugar, first boil with high heat, then simmer with low heat to make a thin porridge.

　　4. Diet should be light, avoid eating meat, shrimp, crab, eel, salted fish, black fish, and other promoting foods.

　　5. Eat more lean meat, chicken, eggs, quail eggs, crucian carp, turtle, whitefish, cabbage, asparagus, celery, spinach, cucumber, winter melon, mushrooms, tofu, kelp, seaweed, and fruits, etc.

　　6. Dietary taboos for interstitial cystitis, limited vulvitis, and desquamative vaginitis syndrome

　　7. Avoid hot and warming tonics. Because this disease is caused by damp-heat evil, it should be forbidden to use drugs with warming and Yang-invigorating effects during the illness, such as red ginseng, aconite, ginger, evodia, clove, asarum, ginger, deer antler, epimedium, bull penis, Cistanche, etc.

　　8. Avoid eating spicy food such as chili, Sichuan pepper, scallion, garlic, white wine, and other刺激性 drinks.

　　9. Avoid eating longan, jujube, glue, royal jelly, and other hot, clotting, and hormone-containing foods.

　　10. Avoid spicy and刺激性 food, any fruit can be eaten.

　　1. Interstitial cystitis has no safe, convenient, and effective treatment methods. Currently, under anesthesia, dilation and injection of dimethyl sulfoxide (DMSO) can be used, which are two commonly used methods. Limited vulvitis can be treated with topical application of lidocaine and lubricants to reduce contact pain and sexual pain for patients. For severe and refractory cases, surgical removal of the hymen and nearby vestibular mucosa can be performed. The histopathological examination of the resected tissue does not show any characteristic phenomena of inflammation.

　　1. Vaginitis with desquamation can be treated with metronidazole (Grodin) to convert vaginal discharge to normal. For those with Candida albicans, treatments such as miconazole, clotrimazole, nystatin, clotrimazole (Ketodin) can be used. Local application of hydrocortisone cream is also effective for the treatment of desquamative vaginitis.