Senile vulvar atrophy

　　The causes of vulvar skin atrophy are as follows:

　　1. Primary vulvar atrophy

　　Post-menopausal elderly women have degeneration of ovarian function and a decrease in estrogen levels, and their target organs also atrophy accordingly.

　　2. Vulvar leukoplakia

　　It is also known as chronic vulvar dystrophy. It is divided into hyperplastic type,硬化苔藓type, and mixed type. After a long time of硬化苔藓type changes, inflammatory changes cause the disappearance of elastic tissue in the dermis and fibrosis, leading to the atrophy of the clitoris and the labia minora.

　　3, Lichen planus

　　Caused by chronic stimulation such as leukorrhea and scratching, it often occurs with severe atrophic changes.

　　4. Vulvar leukoplakia

　　It is the proliferative change of vulvar mucosa, with 10% to 20% of cases developing into malignancy. It may be formed due to long-term stimulation from trauma, inflammation, allergy, infection, etc., and can also lead to vulvar atrophy in the end.

　　The main complications of senile vulvar atrophy are related to skin atrophy. Due to excessive vulvar atrophy, the barrier function is reduced, making it easy to trigger bacterial infections. At the same time, there is a significant itching after vulvar atrophy, and patients often have the habit of scratching, making it more likely to develop infections. Severe cases may present with vaginal and urinary tract infections, urinary incontinence, sexual intercourse difficulties, mild fecal incontinence, anal fissures, and other conditions.

　　Senile vulvar atrophy manifests as thinning and drying of the skin, reduced elasticity and relaxation, the appearance of wrinkles, atrophy of sweat glands, reduced sweat, decreased secretion of sebaceous glands, hair loss and thinning; in addition, pigmented spots and hypopigmented spots may appear, capillary dilation, thin scales and ecchymosis, often accompanied by seborrheic keratosis, senile keratosis, senile angiomatosis, purpura, skin tags, senile elastic fiber disease, and other diseases. The specific manifestations are as follows:

　　1. Primary vulvar atrophy

　　At the beginning, the subcutaneous fat of the vulva disappears, the labia majora becomes flat, followed by hair loss, the epidermis becomes withered, the surface becomes smooth, dry and shiny, with a waxy luster, and sometimes red spots appear; the labia minora and clitoris may eventually disappear, and the vulva has an itchy, burning, or pricking sensation. If there is secondary infection, urination may also be painful; the vaginal orifice becomes narrow due to atrophy, making sexual intercourse difficult; the range of atrophy can extend to the perineal body, around the anus, and may cause a decrease in anal sphincter tone, resulting in mild fecal incontinence; due to atrophy, anal fissures may also occur.

　　2, Sclerotic lichenoid type

　　Malnutrition is mainly manifested as itching in the damaged area, the lesion involves the vulvar skin, mucosa, and perianal skin. Among them, the glans clitoris, labia minora, and posterior commissure are the most common sites of damage. The appearance of the skin and mucosa becomes white, thin, dry, and prone to cracking and losing elasticity, the glans clitoris often becomes atrophic, and the labia minora becomes flat. In the late stage, the skin becomes very thin like cigarette paper, the vaginal orifice becomes narrow, making sexual intercourse difficult. Severe cases may resemble the condition after vulvar surgery, that is, 'vulvar dryness'.

　　3, Lichen planus

　　Local severe itching, umbilical-like areas appear in the brown moist area, the surface is rough and moist, and there are scratch marks; pink reticulate spots can be seen on the vestibule and the inner side of the labia minora; in addition to involving the labia majora, labia minora, clitoris, and perineum, it often affects the vaginal mucosa as well; it often occurs with severe atrophic changes, but the vaginal orifice and vagina do not become atrophic and narrow.

　　4, Vulvar leukoplakia

　　Commonly seen in perimenopause, the lesion site is often on the inner side of the labia majora, the labia minora, and the clitoris, and can affect the entire labia majora, perineum, or around the anus. Local itching, dryness, with pricking and burning sensation, small pieces of thickened tissue can be seen on the mucosa, which are white or gray, and sometimes there may be cracks and ulcers.

　　To prevent elderly vulvar atrophy, the elderly should maintain a regular lifestyle, reasonable diet, pleasant mood, moderate exercise, and keep the vulva clean. Once abnormalities are found, seek medical attention as soon as possible, make an early diagnosis, actively treat, follow up well, and prevent the occurrence of malignancy.

　　Elderly vulvar atrophy can be diagnosed based on symptoms and signs, but it depends on biopsy of living tissue, which should be performed at the suspected lesion site, and multiple sampling should be taken to exclude malignancy. In recent years, colposcopy has also been applied to vulvar lesions, which helps to exclude malignancy.
　　1, Laboratory examination:Hormonal level detection, vaginal secretion examination.
　　2, Other auxiliary examinations:Histopathological examination, colposcopy.

　　Recommend 3 dietary recipes suitable for elderly patients with vulvar atrophy.

　　1, Huaiyu Coix Seed Porridge

　　10g of Fructus Corni, 50g of山药 and Coix seed, all three cooked into porridge for consumption. Take for 2 weeks consecutively, it has the effects of tonifying the kidney, strengthening the spleen, and drying dampness, suitable for those with waist pain and dizziness, and loose stools.

　　2, Stir-fried dried seaweed with chive

　　60g of dried seaweed, 120g of chive, and an appropriate amount of yellow wine. Heat the oil in a wok, quickly stir-fry the cleaned dried seaweed, then add 2 bowls of water and bring to a boil. Add the cleaned and chopped chive and yellow wine, and boil until ready to serve. It has the effect of tonifying the kidney and stopping leukorrhea, suitable for patients with leukorrhea with white discharge and soreness in the lower back and knees.

　　3. Lotus and Coix Seed Stewed Clam Meat

　　Lotus seeds (with peel and kernel removed) and coix seed each 60g, clam meat 120g (sliced), all added to a pot, 750ml of water, cooked over low heat for 1 hour, and then it can be eaten. It has the effect of drying dampness and stopping leukorrhea, and is suitable for patients with spleen deficiency and dampness, and vulvar pruritus.

　　Currently, non-surgical treatment is mainly used for senile vulvar atrophy, controlling local itching, and restoring the normal shape of the vulvar skin. Medication can achieve satisfactory results. However, follow-up should still be conducted after treatment to prevent cancer transformation.
　　1. General Treatment:Keep the vulvar skin clean and dry, avoid using soap or other irritant drugs for washing, avoid scratching with hands or instruments, and avoid spicy foods. Clothing should be loose, avoid wearing non-breathable synthetic underwear to prevent dampness and heat accumulation, which may worsen the condition.
　　2. Oral Medication:Supplementing a variety of vitamins, regulating the body's function, and improving local nutrition. For those who are anxious, have obvious itching symptoms, and can not sleep, oral tranquilizers, hypnotics, and desensitizing drugs can be taken.
　　3. Local Medication:Topical application of antipruritic agents, for malnutrition in hard parakeratosis, 10% to 20% cod liver oil ointment or 1% to 2% testosterone propionate ointment can be used, applied 3 to 4 times a day until the skin softens, adhesions are loosened, and itching is relieved. For lichen planus, chronic localized type, 5% to 10% salicylic acid ointment can be applied externally; for thickened skin, 0.1% tretinoin ointment can be used.
　　4. Laser:Carbon dioxide laser or helium-neon laser treatment of hard parakeratosis has good effects in stopping itching, reducing secretions, and reducing skin keratinization, improving blood perfusion, and restoring tissue to normal. The disadvantage is that it is easy to recur.
　　5. Surgical Treatment:If the vulvar atrophy is severe and medication has not been effective, surgical treatment can be considered. Vulvar leukoplakia lesions belong to grade II to III. For safety reasons, surgical treatment can be considered, such as simple vulvectomy, with specimens sent for pathological examination and postoperative follow-up. If there is already malignancy, it should be treated as vulvar cancer.