Vulvar itching syndrome

　　The causes of vulvar itching are mainly divided into two categories: local causes and systemic causes. Most local causes are due to personal hygiene and external skin damage, while systemic causes are caused by diseases such as diabetes, jaundice, anemia, leukemia, and other diseases. In addition, there are special infections, such as candidal vaginitis and trichomonal vaginitis, which are the most common causes of vulvar itching. Lice and scabies can also cause itching, and pinworm disease can cause itching around the anus and vulva of young girls, which usually occurs only at night.

　　1. Local causes

　　(1) Chronic vulvar malnutrition It is mainly characterized by severe itching, accompanied by whitening of the vulvar skin.

　　(2) Allergic reactions to drugs or chemical irritation Soaps, condoms, new and clean, mercuric red, and other substances can cause contact dermatitis due to direct irritation or allergy, resulting in itching symptoms.

　　(3) Poor hygiene habits Not paying attention to the local cleanliness of the vulva, sebum, sweat, menstrual blood, vaginal secretions, and even urine and feces can cause long-term irritation of the vulva and lead to itching: using rubber or plastic menstrual belts during menstruation and wearing non-breathable chemical fiber underwear can all lead to itching due to dampness and heat accumulation.

　　(4) Other skin lesions, abrasions, common warts, herpes, eczema, and tumors can all cause pruritus vulvae.

　　Second, systemic causes

　　(1) Diabetes: Due to the stimulation of diabetes on the vulvar skin, especially when accompanied by candidal vulvitis, vulvar itching is particularly severe. Many patients first seek medical attention due to vulvar itching and redness, and then diagnosed as diabetes after further examination.

　　(2) Jaundice, vitamin A, B deficiency, anemia, leukemia, and other chronic diseases may cause vulvar itching, which is often part of systemic itching.

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

　　(4) Unexplained vulvar itching: Some patients have severe vulvar itching but cannot find any obvious systemic or local cause. Currently, some people believe that it may be related to psychological or psychological factors.

　　Vulvar itching not only affects daily life and work, but some can also lead to marital discord. Prolonged itching can lead to the occurrence of multiple diseases at the same time. It is a common and cannot be ignored symptom in women. When women have diabetes, due to the stimulation of uric acid on the vulvar skin, it is easy to develop vulvar and vaginal candidiasis, causing vulvar itching. When jaundice occurs due to liver and gallbladder diseases or other diseases, due to increased bilirubin in the blood, the skin is stimulated by bile salts, vulvar itching may also occur. In addition, some women may develop vulvar itching due to psychological factors when they are stressed. After women have vulvar itching, they should pay attention to keeping the vulvar skin clean and dry, wear loose and breathable underwear, avoid using soap water or irritant detergents to wash, try to control scratching to relieve itching, and avoid spicy and allergic foods.

　　The following diseases may also be accompanied by vulvar itching

　　7. Fungal vaginitis: Vulvar and vaginal itching, vulvar erythema, accompanied by curd-like white discharge, with an odor, and can cause vulvar dermatitis and eczema changes after scratching.

　　6. Trichomoniasis vaginitis: Vulvar and vaginal itching, with frothy white discharge, often accompanied by a peculiar smell, and similar dermatitis and eczema changes on the vulva after scratching. Vaginal secretion smears can differentiate it from the above diseases. Do not clean blindly on your own.

　　5. Local skin uncleanliness: Some women use toilet paper improperly, causing the vulvar skin to be soaked in menstrual blood, vaginal secretions, even urine, feces, and sweat, leading to chronic inflammation of the local skin and resulting in vulvar itching.

　　4. Drug allergy: Allergic women with a tendency to allergic reactions may develop 'fixed drug eruptions' caused by sulfonamides or other drugs, which often occur at the junction of the vulvar mucosa. In addition to local itching, they may also develop erosion and exudation. Allergic reactions and contact dermatitis may also cause vulvar itching when using drugs for vaginal irrigation or insertion.

　　Vulvar itching is commonly located around the clitoris and labia minora. It can also affect the labia majora, perineum, and even perianal skin areas. Chronic scratching may lead to scratch marks, blood crusts, or secondary folliculitis. It often occurs in a sporadic manner, can also be persistent, generally worsens at night, and itching of the vulva without a cause usually only occurs in women of childbearing age or post-menopausal women. It often affects the entire vulva, but it may also be limited to a specific area or one side of the vulva. However, the local skin and mucosa appear normal, or there may only be scratch marks due to excessive scratching.

　　Vulvovaginal candidiasis, trichomoniasis vaginitis - vulvar itching and increased leukorrhea are the main symptoms.

　　Vulvar squamous epithelial hyperplasia is mainly manifested by severe vulvar itching, accompanied by vulvar skin hypopigmentation. Pruritus caused by pinworms is more severe at night. Diabetic patients with urinary sugar can stimulate the vulvar skin, especially when complicated with vulvovaginal candidiasis, vulvar itching can be especially inflammatory, even difficult to bear, but the local skin and mucosa appear normal, or only with scratches and blood scabs due to excessive scratching.

　　Jaundice, vitamin A and B deficiency, anemia, leukemia, and other chronic diseases such as anemia may appear as part of generalized itching when patients with vulvar itching. Cholestasis in pregnancy can also cause generalized skin itching, including vulvar itching.

　　The prevention of vulvar itching is a long process, and only long-term persistence can be effective. The following is the prevention and treatment of vulvar itching in terms of clothing, food, residence, and transportation:

　　Clothing:Underwear and panties should be kept clean, and underwear should be soft and loose, preferably made of cotton fabric, and it should be avoided to wear synthetic clothing next to the skin.

　　Food:Pay attention to adjusting the gastrointestinal function, and it is best to eat light, vitamin-rich fresh vegetables and soy products; avoid刺激性 food such as cigarettes, alcohol, chili, strong tea, and coffee; and keep the bowels regular.

　　Residence:Adjust the indoor temperature to 16℃～20℃ and the relative humidity to 30％～40％. When the relative humidity is below 20%, the indoor air is too dry, and dust and other allergens are easy to fly. Therefore, water should be sprinkled on the ground, and humidifiers can be used if possible.

　　Action:People with sensitive skin should not only reduce their activities appropriately, but also pay attention not to bathe too frequently or with water that is too hot, otherwise the sebum on the skin surface will be washed off, making the skin drier and more prone to itching. After bathing, you can apply some 30% to 50% glycerin to the body surface. In addition, don't scratch the itching randomly, as this may cause hyperplasia of the epidermal cells, making them rough and thick, resulting in more itching when scratching, forming a vicious cycle.

　　In addition, it is also necessary to arrange the diet reasonably, such as eating some seaweed, pork liver, milk with eggs every day, which can effectively prevent vulvar itching.

　　After the consultation, you need to go to the examination bed behind the partition, take off your clothes for a gynecological examination. If you feel the need to urinate at this time, don't be embarrassed, as a full bladder can directly affect the examination. Lie on the examination bed and spread your legs apart. If you are nervous, in addition to deep breathing and self-adjustment, the doctor will help you distract your attention. The speculum is usually disposable or sealed after disinfection. The doctor will warm it in hot water, then apply Vaseline, and then insert the closed duckbill into the vagina, making the examination more bearable. When the duckbill opens, the vaginal walls that are usually close together are stretched apart, allowing the doctor to clearly see the vagina and cervix.

　　1. Vulvar examination

　　Objective of examination: Check whether the skin of the vulva is smooth, the color is normal, whether there are ulcers, dermatitis, exophytic growths, and hypopigmentation phenomena. Normal vulva: pubic hair is downward, triangularly distributed, the labia majora is pigmented, the labia minora is slightly red, and the length of the clitoris

　　2. Vaginal examination

　　Objective of examination: Check whether the vaginal mucosal surface is smooth, the texture is normal, whether there are bleeding points, and whether the nature and smell of vaginal secretions are normal. Normal vagina: the vaginal mucosal color is pale pink, with folds, without ulcers, exophytic growths, cysts, congenital malformations, secretions are egg white-like or white paste-like, without foul smell, less in amount, but increased during ovulation and pregnancy. If the vaginal discharge needs to be examined, the doctor will take a sample at this time.

　　1, Kelp and mung bean porridge

　　Ingredients: Kelp 30 grams, mung beans 30 grams, sugar in appropriate amount, glutinous rice 100 grams.

　　Preparation: First, wash the kelp and cut it into pieces, soak the mung beans for half a day, wash the glutinous rice clean, and cook it into porridge. Add sugar for seasoning when it is almost cooked.

　　Usage: Take twice a day in the morning and evening, and it is recommended to continue eating for 7 to 10 days.

　　Effect: Clear heat and detoxify, promote diuresis and reduce heat. It is suitable for vulvar itching.

　　2, Millet and red bean porridge: millet 30g, red dates 10 pieces, rice 50g.

　　Wash and cook as porridge for consumption. It has the effects of clearing heat, invigorating the spleen, and relieving itching.

　　The worst foods for vulvar itching syndrome

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

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

　　3. Avoid eating fried and greasy foods. For example: fried dough sticks, butter, butter, chocolate, etc., these foods have the effect of promoting dampness and increasing 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 very irritating and can exacerbate inflammation.

　　Vulvar itching is one of the common and frequent female diseases. When treating the disease, the doctor will give the corresponding treatment plan according to the patient's condition. The general treatment methods are as follows:

　　1. Oral medication therapy

　　(1) Antihistamines: Traditional antihistamines such as chlorpheniramine (Pulmin), diphenhydramine, hydroxyzine (An泰乐), cimetidine, and others have the effects of calming and relieving itching and can be used for the treatment of this disease. Non-sedative antihistamines such as astemizole (Hismin), loratadine, cetirizine, terfenadine, and azatadine (nitradine) also have certain efficacy for generalized 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 H2-receptor antagonists such as cimetidine (cimetidine) and ranitidine, which can sometimes improve efficacy.

　　(2) Vitamins B1, C, sodium thiosulfate, gamma-oryzanol, bromine, calcium, and sedative-hypnotics, etc., can be used according to the condition or combined with antihistamines.

　　2. Local Therapy

　　Local therapy is generally combined with systemic therapy and can also be used alone. The principle is to calm and relieve itching, and moisturize the skin. Menthol, camphor, diclofenac, benzocaine, thymol, lubricants, anesthetics (lidocaine, benzocaine, procaine), antihistamines, or tricyclic antidepressants (doxepin cream), capsaicin cream, and various corticosteroid hormones, as well as calamine lotion containing antipruritics, and ointments containing antipruritics can be used for treatment. Local cold compress can also be used. They all have a certain effect on relieving itching. Local pruritus can also be treated with triamcinolone acetonide (Triamcinolone), prednisolone (Prednisolone), dexamethasone, and other drugs for local closure. Vitamin B12, diphenhydramine, promethazine (Phenergan), anisodamine (654-2), and other drugs can be injected into acupoints. For pruritus of the perineum, acupoint closure therapy can be used, such as promethazine (Phenergan) and vitamin B12, for Changqiang acupoint closure, twice or three times a week, most effective. For external preparations for the vulva, drugs with low irritation and cleanliness should be selected, and tinctures should not be used.

　　3. Physical and Radiation Therapy

　　For systemic pruritus, mineral bath, bran bath, starch bath, or the combined use of ultraviolet radiation and medicated bath, as well as subcutaneous oxygenation can be used. When local pruritus is ineffective after treatment by various methods, high-frequency electrotherapy or local liquid nitrogen freezing spray, transcutaneous electrical nerve stimulation (TENS), but it is not suitable to use radionuclide 32P, 90Sr, mirror boundary, or superficial X-ray irradiation for pruritus of the vulva.