Vulvar Pruritus

　　Overview of Causes

　　Vulvar itching is not a disease that exists independently; it is often a symptom of many diseases, but sometimes it may be difficult to find a cause, and it may simply be itching. However, it can occur at any time and place, causing restlessness and sleeplessness, bringing women great distress. Washing the vulva with a feminine hygiene product every day can maintain the natural self-cleaning function of the vulva and solve the problem of vulvar itching of unknown cause. Traditional Chinese medicine believes that wind evil, dampness evil, heat evil, blood deficiency, and worm infestation are the main causes of the disease. The treatment principle is to dispel wind and dampness, clear heat and detoxify, nourish blood and moisten dryness, and activate blood circulation to remove blood stasis, in order to achieve the effect of expelling evil, reinforcing the body, and stopping itching.

　　Local causes

　　1. The most common local cause is an increase in leukorrhea, especially vaginitis caused by trichomoniasis or candidiasis, and non-specific vaginitis, which can cause a large amount of abnormal leukorrhea to stimulate the vulvar skin, causing vulvar itching.

　　2. If vulva, vagina, or vagina is irrigated with disinfectant solution or certain irritant drugs are placed in the vagina, it can cause drug allergy, chemical irritation, causing allergic skin of the vulvar skin or dermatitis, causing vulvar itching. It is better to use a vulvar care liquid with Ph4 weak acid formula to maintain the self-cleaning function of the vulva.

　　3. During the menstrual period, if not paying attention to personal hygiene, using unclean or irritating sanitary napkins, or wearing synthetic underwear and pants with poor ventilation, the vulva is often in a wet and hot environment, which can cause vulvar itching.

　　4. Some people often use soaps with strong alkalinity or potassium permanganate solution to clean the vulva, causing the vulvar skin to become dry and lack of oil, resulting in itching.

　　5. People with pinworm disease may experience itching due to the pinworms often crawling out of the anus and stimulating the perianal and vulvar areas, especially at night, which may even affect sleep.

　　6. Vulvar eczema, neurodermatitis, atrophic sclerotic lichen, vulvar dermatitis, etc., not only cause varying degrees of itching, but the skin of the vulva may also change to varying degrees of whitening, atrophy, or thickening.

　　7. The early symptoms of vulvar cancer also include vulvar itching, and some people develop vulvar cancer after years of itching.

　　Systemic causes

　　1. Diabetes, due to the irritation of diabetes to the vulvar skin, especially when accompanied by candidal vulvitis, vulvar itching is particularly severe. Many patients seek medical attention first due to vulvar itching and redness, and are diagnosed with diabetes after further examination.

　　2. Jaundice, vitamin A, B deficiency, anemia, leukemia, and other chronic diseases often cause vulvar itching as part of systemic itching.

　　3. Vulvar congestion during pregnancy and premenstrual period may occasionally cause vulvar itching and discomfort.

　　4. Vulvar itching of unknown cause Some patients with severe vulvar itching cannot find obvious systemic or local causes. Currently, some people believe it may be related to mental or psychological factors.

　　Many women suffer from the困扰 of vulvar itching. In order to help everyone correctly understand this disease, let's analyze the complications of vulvar itching:

　　1. Vestibular gland inflammation

　　The vestibular gland is located below the posterior part of the labia majora on both sides, opening into the groove between the vaginal orifice, labia minora, and hymen. Due to the characteristics of the anatomical location, pathogens are easy to invade and cause inflammation.

　　2. Vestibular gland cyst

　　If the opening of the gland duct is blocked due to inflammation, congestion, and increased secretion, the accumulated exudate in the gland cavity will form a bulge pointing outward, which is the vestibular gland cyst. When suffering from vestibular gland inflammation, one should absolutely rest in bed, and pay attention to keeping the vulva clean.

　　3. Vulvar ulcers

　　Vulvar ulcers often occur on the inner side of the labia majora and minora, and are more common in middle-aged and young adults. The main manifestation is superficial and deep skin damage in the vulva, which often recurs and is difficult to cure. Vulvar ulcers that occur simultaneously with ocular inflammation and oral ulcers are called ocular, oral, and genital syndrome, which may be accompanied by high fever, local severe pain, and poor prognosis due to repeated attacks. It is also known as Behcet's disease in clinical practice.

　　Vulvar itching usually occurs in the clitoris, labia minora, and can also spread to the labia majora, perineum, and even the perianal skin damage area. It is often episodic, but can also be persistent, generally worsening at night. Uncaused vulvar itching generally only occurs in women of childbearing age or postmenopausal women, and often affects the entire vulva, but may also be limited to a certain area or unilateral vulva. Although the itching is very severe and even unbearable, the local skin and mucosa appear normal, or only have scratches due to excessive scratching.

　　Top ten precautions for vulvar itching

　　1. Pay attention to menstrual hygiene and wash frequently.

　　2. Private parts also need daily care, and the vulva should be washed with a pH4 weak acid formula feminine hygiene fluid every day.

　　3. Avoid滥用 and overuse of drugs, and avoid scratching and local friction.

　　4. Avoid alcohol and spicy foods, and do not eat seafood and other allergenic drugs that may cause allergies.

　　5. Do not wear tight shorts, and the underwear should be loose and breathable, preferably made of cotton.

　　6. Check for candidiasis or trichomoniasis when seeking medical attention. If present, treatment should be prompt, and self-treatment with 'itch relief water' should be avoided.

　　7. People with long-term unhealed symptoms should have blood sugar tests.

　　8. Keep the vulva clean and dry, especially during menstruation, pregnancy, and postpartum period. Wash the vulva with a feminine hygiene fluid and change underwear every day.

　　9. Do not wear synthetic underwear or tight pants, and wear cotton underwear and pants. Pay attention to the concentration, temperature, and time of the solution, as well as precautions when taking a local bath.

　　10. People with vulvar itching should often trim their nails, wash their hands frequently, and do not scratch the skin to prevent ulceration and infection, which may lead to secondary bacterial infection.

　　Vulvar itching examination is also very necessary for women. Generally, when performing vulvar itching examination, the doctor will analyze and judge the problems that may appear on the patient's body based on the patient's medical history and clinical reaction.
　　The diagnosis of vulvar itching is based on the analysis of medical history. At the initial stage of the disease, the patient may only have itching without skin rash, and the diagnosis can be confirmed. Generally, the diagnosis is not difficult when there is no secondary skin rash. Once secondary skin rash appears, it is necessary to prove, based on the medical history, that the initial disease was only itching without skin rash, in order to diagnose it as itching disease. When diagnosing itching disease, it is relatively important to find the cause, and one should inquire about the medical history in detail, perform a comprehensive physical examination, and conduct necessary laboratory tests to find the primary disease focus.
　　The following is an introduction to the inspection items for vulvar itching:
　　1. Physical examination: Understand whether the patient has jaundice, anemia. And check if the patient's vulva has eczema, dermatitis, whether there are scratch marks, redness, swelling, infection, and lichenification hardening.
　　2. Check for trichomoniasis and fungi in leukorrhea, check for urine sugar, blood sugar, blood routine, drug sensitivity test, etc.
　　3. If necessary, perform a local tissue biopsy.

　　Suitable foods for vulvar itching:

　　1. Eat more foods rich in protein and sugars. For example: milk, soy milk, eggs, meats, etc.

　　2. Drink more water and eat more fresh fruits and vegetables. For example: apples, pears, bananas, strawberries, kiwis, cabbage, green vegetables, rapeseed, mushrooms, laver, kelp, etc.

　　3. Eat cool blood and detoxifying foods. For example: mung beans, glutinous rice, cucumbers, bitter melon, purslane, green tea, etc.

　　Taboo foods for vulvar itching:

　　1. Avoid eating irritants. For example: fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, chicken feet, etc., which can exacerbate the itching and inflammation of the vulva after eating.

　　2. Eat less spicy and stimulating foods. For example: onions, black pepper, chili, Sichuan pepper, mustard, fennel.

　　3. Avoid eating fried and greasy foods. For example, fried dough sticks, butter, butter, chocolate, etc., which have the effect of increasing dampness and heat, which can increase the secretion of leukorrhea and is not conducive to the treatment of the disease.

　　4. Quit smoking and drinking. Smoking and alcohol are highly irritating and can exacerbate inflammation.

　　Vulvar itching includes vulvar or vaginal itching, which can affect life and work severely when severe, and is a symptom caused by multiple reasons. It is related to vulvar malnutrition, vaginitis, vulvar parasitic infections, not using vulva hygiene solutions for cleaning, or having unclean sexual intercourse, local eczema, dermatitis, drug allergy, and diseases such as diabetes, vitamin A, and B deficiency. First, find out the cause of vulvar itching, and then treat according to different etiologies.

　　(One) General treatment

　　Pay attention to menstrual hygiene, keep the vulva clean and dry, and use a vulva hygiene solution with a pH of 4, a weak acid formula, for local vulva cleaning. Abstain from scratching. Do not use hot water to wash or soak, and avoid using soap. Clothing, especially underwear, should be comfortable and breathable. Avoid alcohol and spicy or allergic foods.

　　(Two) Treatment of the cause of the disease

　　Eliminate local or systemic factors that cause itching. For example, bacterial vaginosis can be treated with gel disinfectants.

　　(Three) Medication for internal use

　　⑴ Antihistamines: Traditional antihistamines such as chlorphenamine (Pyrilamine), diphenhydramine, hydroxyzine (Antanal), cimetidine, etc., all have the effect of sedation and antipruritic, which can be used for the treatment of this disease. Non-sedative antihistamines such as astemizole (Hismanal), loratadine, cetirizine, desloratadine, and azatadine (nitazidine) also have certain efficacy for systemic itching. For patients with long course of disease, severe symptoms, and poor efficacy, combined medication can be used to improve the effect. H1-receptor antagonists can be used in combination with cimetidine (cimetidine), ranitidine, and other H2-receptor antagonists, which can sometimes improve efficacy.

　　⑵ Vitamin B1, Vitamin C, sodium thiosulfate, oryzanol, bromine, calcium, and sedative-hypnotic drugs, etc., can be selected for application according to the condition or used in combination with antihistamine drugs.

　　⑶ Hormonal Therapy: Female senile pruritus patients can take diethylstilbestrol 0.5mg, twice a day, or use progesterone 10mg, intramuscular injection, once a day. For itching symptoms exacerbated during the menstrual period, 10mg of progesterone can be injected intramuscularly 10 days before the menstrual period. 5mg can be injected intramuscularly 5 days before the menstrual period. If the menstrual period is irregular, 10mg can be injected intramuscularly on the 20th day after the menstrual period, and 5mg can be injected again on the 25th day.

　　⑷ Point Injection Therapy: 10-30ml of 0.25% procaine health search, or calculate according to 4-6mg per kilogram of body weight per day and add to 500ml of normal saline or 5% glucose saline. Venous block, once a day, 10 times as a course. A skin allergy test should be done before use, and the process should be closely observed. Some patients may experience allergic shock and other adverse reactions.

　　(IV) Local Therapy

　　Local therapy is generally combined with systemic therapy, with the principle of sedation and antipruritic, and moisturizing the skin.

　　Keep the vulva clean and dry. Use a pH4 weak acid formula feminine hygiene fluid, or apply local cold compress. All have a certain antipruritic effect. Localized pruritus can also be treated with triamcinolone acetonide (Triamcinolone), prednisolone (Prednisolone), dexamethasone, and other drugs for local injection. Try to avoid long-term or short-term high-dose topical corticosteroid drugs as much as possible. Currently, traditional Chinese medicine Weifu cream overcomes this drawback and treats safely and thoroughly.

　　Vitamin B12, diphenhydramine, promethazine (Antihistamine), atropine (654-2), and other drugs for point injection.

　　For pruritus of the perineum, point injection therapy can be used, such as 12.5mg of promethazine (Antihistamine) and 250g of vitamin B12 for the Changqiang point, 2-3 times a week, most effective.

　　(V) Physical and Radiation Therapy

　　For systemic pruritus, mineral bath, bran bath, starch bath, or the combination of ultraviolet radiation with medicated bath, and subcutaneous oxygenation can be used. For localized pruritus, high-frequency therapy or local liquid nitrogen freezing spray, transcutaneous electrical nerve stimulation (TENS), but it is not suitable to use radionuclide 32P90Sr, mirror boundary, or superficial X-ray radiation for pruritus of the vulva.