Vulvar Itching Research Articles

Health-related quality of life as measured with the Short-Form 36 (SF-36) questionnaire in patients with recurrent vulvovaginal candidiasis.

BackgroundRecurrent vulvovaginal candidiasis (RVVC) has a poor therapeutic outcome and a severe impact on women and their partners, both physically and psychologically. Health-related quality of life (HRQOL) is significantly affected in patients with RVVC; however, little is known about HRQOL in patients with this disease. In this study, we aim to identify the clinical and mycological characteristics of women with RVVC and the effects of RVVC on women’s HRQOL.MethodsWe designed this study as a comparative cross-sectional study. The Short-Form Health Survey (SF-36) was used to measure HRQOL in 102 patients with RVVC and 101 women seeking general health care (controls). RVVC was defined as four or more episodes of proven VVC in the previous 12-month period. VVC was defined as vulvar itching, burning, erythema, vaginal discharge, pseudohyphae or blastoconidia on a wet 10 % potassium hydroxide (KOH)-treated vaginal slide and a positive Candida culture. Group comparisons were conducted with independent samples t test. Correlation analysis was performed on the variables.ResultsThe mean age at first diagnosis of the patients with RVVC was 30.96 years (SD 5.38), and the mean age of the controls was 29.75 years (SD 5.83; p > 0.05). The duration of the patients’ complaints varied from 6 months to 10 years, with a mean duration of 22.28 (±21.75) months. The most common complaints were increased vaginal discharge (102 cases, 100 %), itching (97 cases, 95.1 %), dyspareunia (65 cases, 63.7 %), burning (79 cases, 77.5 %) and erythema (25 cases, 24.5 %). C. albicans was the predominant Candida species (86 strains, 84.3 %) in the patients, followed by C. glabrata (12 strains, 11.8 %). C. parapsilosis (1 strain, 0.9 %), C. tropicalis (1 strain, 0.9 %), C. krusei (1 strain, 0.9 %) and C. lusitaniae (1 strain, 0.9 %). The mean SF-36 dimension scores for physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health were significantly lower in the patients with RVVC than in the controls (85.20, 61.39, 77.79, 54.95, 53.17, 67.89, 52.48 and 59.17 vs. 90.20, 80.87, 87.08, 67.38, 59.69, 79.86, 68.01 and 65.38). The physical composite and mental composite scores of the patients with RVVC were 63.06 and 64.87, respectively, which were lower than those of the controls (75.01 and 74.87; p < 0.05).ConclusionsNearly all of the patients with RVVC had clinical symptoms. In our sample, RVVC was mainly caused by C. albicans. RVVC has negative effects on women’s HRQOL, as indicated by lower physical and mental composite scores among the RVVC group compared with controls.

Unmet needs in VVA

Vulvo-vaginal atrophy, also called atrophic vaginitis, is a chronic, progressive condition that results from the decrease in oestrogen levels in the vagina that commonly occurs after the menopause. Symptoms include vaginal dryness, dyspareunia, vulval and vaginal irritation and itching, soreness, vaginal discharge, post-coital bleeding, etc. [ [1] MacBride M.B. Rhodes D.J. Shuster L.T. Vulvovaginal atrophy. Mayo Clin Proc. 2010; 85: 87-94 Abstract Full Text Full Text PDF PubMed Scopus (334) Google Scholar ]. It is estimated that between 69% [ [2] Gass M.L.S. Cochrane B.B. Larson J.C. et al. Patterns and predictors of sexual activity among women in the Hormone Therapy trials of the Women's Health Initiative. Menopause. 2011; 18: 1160-1171 Crossref PubMed Scopus (67) Google Scholar ] and 98% [ [3] Freedman M.A. Vaginal pH, estrogen and genital atrophy. Menopause Manage. 2009; 17: 9-13 Google Scholar ] of postmenopausal women have signs of vaginal atrophy, with worsening features with increasing age after the menopause. In cross sectional surveys, around 50% of postmenopausal women complain of symptoms of vaginal discomfort attributable to VVA [ [4] Nappi R.E. Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric. 2014; 17: 3-9 Crossref PubMed Scopus (170) Google Scholar ]. VVA has a significant impact on the personal and sexual lives of women and their partners. Vaginal discomfort had a negative impact on many aspects of women's self-esteem and emotional well-being [ [5] Nappi R.E. Mattsson L.Å. Lachowsky M. Maamari R. Giraldi A. The CLOSER survey: impact of postmenopausal vaginal discomfort on relationships between women and their partners in Northern and Southern Europe. Maturitas. 2013; 75: 373-379 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar ]. 75% of postmenopausal women surveyed admitted it had a negative impact on quality of life [ [6] Nappi R.E. Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012; 15: 36-44 Crossref PubMed Scopus (254) Google Scholar ] and relationships with more than 70% of men noting that their partner avoided sexual intimacy because of vaginal discomfort. Despite the impact on quality of life and relationships, the fact that 62% of women complain of moderate or severe symptoms and 55% had the symptoms for 3 or more years, vulvar and vaginal atrophy remain an underreported, underdiagnosed and therefore also an undertreated condition [ [7] Parish S.J. Nappi R.E. Krychman M.L. et al. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Womens Health. 2013; 5: 437-447 Crossref PubMed Scopus (141) Google Scholar ] for a number of different reasons.

Dehydroepiandrosterone intra vaginal administration for the management of postmenopausal vulvovaginal atrophy

The effects of intravaginal administration of dehydroepiandrosterone (DHEA) for the management of symptomatic vulvovaginal atrophy are reviewed.A literature search related to vulvovaginal atrophy, vaginal atrophy, atrophic vaginitis, estrogen, dehydroepiandrosterone, vulvar itching, burning, dryness, dyspareunia, and libido was performed. Relevant articles addressing the incidence, management, and outcome of DHEA therapy were identified and used for this Expert Opinion.DHEA compared to a placebo is an effective treatment improving symptoms of vaginal atrophy: dyspareunia, burning, itching, and dryness. Objective parameters of vaginal atrophy, specifically pH, vaginal maturation index (VMI), and investigator-evaluated changes in the vagina: moisture, epithelia integrity and color were improved compared to baseline and placebo. There were significant improvements in libido and dyspareunia with the intravaginal use of DHEA that contribute to improved quality of life for postmenopausal women.Dehydroepiandrosterone administered intravaginally on a daily basis is an effective treatment for symptoms, and signs of vulvovaginal atrophy along with libido in postmenopausal women.This article is part of a Special Issue entitled ‘Essential role of DHEA’.

Benign vulvar tumors

In the last few decades, gynecological visits for vulvar conditions have increased, often for symptoms of vulvar itching and burning. Although benign vulvar tumors are an uncommon condition of the lower genital tract, it is important to consider these tumors in the differential diagnosis of vulvar complaints. To date, there is no accepted classification for benign tumors. However, these tumors can be differentiated by clinical criteria, such as benign cystic and solid tumors. Common benign tumors of the vulva include the Bartholin gland cyst or abscess, epidermoid inclusion cysts, and angiomas. Many benign vulvar tumors are asymptomatic and are found only on self-examination. Depending on the type of lesion, most do not require excisional treatment. It is important for the gynecologist to differentiate between benign and malignant lesions as malignant tumors require proper treatment.

Botryomycosis of the Vulva

Vulvar ulcers may be caused by various etiologies including infection, trauma, dermatosis, and cancer. We report a case of a vulvar ulcer caused by botryomycosis. An 85-year-old woman presented with vulvar itching, pain, bleeding, and ulcerations suspicious for cancer. Biopsies of the ulcers returned without dysplasia or malignancy. She was referred to the tertiary care vulvar vaginal disease clinic. Dermatopathologic reevaluation of pathologic slides diagnosed lichen sclerosus and botryomycosis. The patient was treated with ciprofloxacin for 7 weeks with complete resolution of vulvar ulcerations. Botryomycosis should be included in the differential diagnosis of infectious etiology of vulvar ulcers.

Verrucous Carcinoma of Vulva: An Unusual Case Report

Introduction: Verrucous carcinoma of the vulva is a variant of squamous cell carcinoma and is a rare type of vulvar cancer, consisting 1-2 % of vulvar cancer overall .It is locally invasive and rarely metastasize. The aetiology is not known. Case report: A 60 year old postmenopausal, multipara Indian woman presented in July 2012 with anexophytic irregular growth that was locally destructive associated with vulvar itching, pain and change in skin colour in the OPD of Obstetrics and Gynaecology department of NIMS Medical College, Jaipur (Rajasthan), India. She was a chronic smoker. Local examination shows 5-6 cm raised verrucous growth on the lower part of right labia majora with 1 cm ulcer at tip. Complete evaluation revealed verrucous carcinoma of vulva FIGO stage IB with no lymph node involvement. The patient was treated with an extensive excision of the damage and radiotherapy was advised.

Psoriasis Superimposed on Vitiligo

This study aimed to describe 2 cases of vulvar psoriasis and vitiligo resulting in a striking clinical appearance. Case 1 was of a 41-year-old woman concerned about a dark pigmentation around the introitus. Case 2 was of an 80-year-old woman with vulvar itch and red, white, and brown areas. The vulva in each case showed a tricolored appearance of well-demarcated red, white, and brown colors. Biopsies showed psoriasis superimposed on vitiligo in the red, vitiligo in the white, and normal skin in the brown areas. When psoriasis and vitiligo are colocalized, the redness of the psoriasis may mask the vitiligo resulting in a striking red, white, and brown tricolored appearance.

Factors Associated with Symptomatic Vulvovaginal Candidiasis: A Study among Women Attending a Primary Healthcare Clinic in Kwazulu-Natal, South Africa.

Background:Symptomatic vulvovaginal candidiasis (VVC) is one of the most common problems leading women to seek advice in primary healthcare facilities.Aim:The aim of this study is to describe the associations between some hypothesized factors and the presence of symptomatic VVC.Subjects and Methods:An analytical cross-sectional study was conducted. A total of 90 women diagnosed with symptomatic VVC and 108 women without symptomatic VVC were recruited when attending Umlazi D clinic, a primary health clinic in KwaZulu-Natal, South Africa between June 2011 and December 2011. Confirmed symptomatic VVC was determined by Gram stain and microbiological culture of vaginal swabs. For human immunodeficiency virus (HIV)-infected women, HIV ribonucleic acid load in plasma and genital fluid was determined by real-time-polymerase chain reaction (BioMerieux, Lyon, France). CD4 counts were obtained from patients’ medical records. Data were analyzed using the statistical package for the social sciences (SPSS) version 21.0 (SPSS Inc.; Chicago, IL, USA). Multiple logistic regression models were used to exclude univariate confounders. All tests were two-sided and a P < 0.05 was considered to be significant.Results:A total of 90% (81/90) of patients with symptomatic VVC complained of vulval itching, soreness and vaginal discharge when compared to 75.9% (82/108) of patients without symptomatic VVC (P < 0.01). Whilst pregnancy was independently associated with symptomatic VVC (P < 0.01), the latter was inversely related to Nugent's scores (P < 0.01). When compared with HIV negative women, the odds for symptomatic VVC increased among women with HIV-associated immunocompromise (CD4 counts < 200 cells/mm3, P < 0.001), significantly shedding HIV in their genital tracts (P = 0.04), with plasma HIV load > 1000 copies/mL (P < 0.001). There was a significant negative association between the use of highly active anti-retroviral therapy and the presence of symptomatic VVC in HIV-infected women (P < 0.01).Conclusion:Although symptomatic VVC is not classified as acquired immunodeficiency syndrome-related condition, HIV-related immune compromised women and particularly those who are anti-retroviral therapy-naïve are likely to develop symptomatic VVC.

Extramammary Paget's Disease of the Vulva: A Case Report and Review of the Literature

Abstract Background: Extramammary Paget's disease (EMPD) of the vulva is a rare clinical entity that often affects Caucasian postmenopausal women. The disease presents with vulval itching and soreness. Wide local excision, topical application of chemotherapeutic agents, and radiotherapy have been used to treat this rare condition. Case: A 65-year-old, para 3, postmenopausal woman presented with vulval itching and burning, which topical dermatologic creams failed to resolve. Local and pelvic examinations did not show any abnormality but a biopsy showed that she had Paget cells along the basal part of the squamous epithelium of the skin. The affected area was excised and the removed specimen was examined histologically, showing Pagetoid changes. This patient was treated with imiquimod cream for 6 months. Results: At a 6-month follow-up, this patient was symptom-free and had no clinical evidence of a recurrence. Conclusions: EMPD has a propensity for recurrence and, rarely, may signal an underlying adenocarc...

Clinical analysis for 18 cases of vulvar Bowen's disease

To analyse the clinical and pathological characteristics, diagnosis, treatment and prognosis of vulvar Bowen's disease. Clinical data including pathological characteristics, diagnosis, treatment methods and follow-up of 18 cases with vulvar Bowen's disease admitted to Cancer Hospital, Chinese Academy of Medical Sciences during January 1991 to June 2011 were retrospectively analyzed. The median age of the 18 patients was 37 years (range:23 to 64 years) . Sixteen patients had symptoms of vulvar itching and two patients had no symptom. Five cases were single neoplasm focus and the other 13 cases were multiple focuses. The diagnosis of vulvar Bowen's disease was according to the pathological diagnosis. Its diagnostic characteristic was giant round or ovoid cells with mono nucleolus in the whole layer of epidermis. All the patients received operation, eleven with simple vulvectomy and other seven cases with lumpectomy. The median follow-up time was 123 months (range: 5 to 197 months). Relapse was found in two cases. One patient relapsed five months postoperation and received vulvectomy. Another patient relapsed fifteen moths post-operation and received lumpectomy again. And they were follow-up for 192 months and 55 months respectively after second operation without relapse. The diagnostic characteristic of vulvar Bowen's disease is giant round or ovoid cell with mono nucleolus in the whole layer of epidermis, itsdiagnosis is according to the pathological diagnosis. Operation could get very good curative effect for patients with primary vulvar Bowen's disease and even for the recurrent patients. The prognosis of vulvar Bowen's disease is good.

Lichen sclerosus in children and adolescents

This review of lichen sclerosus in children and adolescents will discuss the disease and highlight the most recent literature. Lichen sclerosus continues to be poorly recognized and misdiagnosed by clinicians. There is growing support for an autoimmune component in the cause of this disease. Recent studies confirm that lichen sclerosus does not resolve after puberty but usually improves. In small case series, topical calcineurin inhibitors are effective as second-line therapy. Lichen sclerosus is an uncommon, poorly recognized disease in girls and adolescents and is likely to have a chronic course requiring long-term follow-up and treatment. There needs to be increased awareness among providers of this disease as a cause of vulvar itching. Because of the lack of knowledge of the natural course and treatment outcomes, prospective, multicenter studies are needed.

P3.078 Prevalence of STI/STDs Among Women of Reproductive Age Group in Tribal District of North India

Research questionWhat is the prevalence of RTIs/STDs among women of reproductive age group in a district of Kinnaur Himachal Pradesh Objectives(1) To estimate the prevalence of RTI/STI among women of...

Post-steroid management of chronic vulvar itching with a topical formula containing natural anti-itching and anti-inflammatory actives

AimTo determine whether use of a topical, nonsteroidal, anti-inflammatory, and anti-itching formula was able to preserve the absence of symptoms, mainly itching and burning, induced by an earlier and relatively short treatment with topical steroids in women diagnosed with vulvar dermatitis or lichen simplex.MethodsNinety-six subjects (36 with contact dermatitis, 29 with allergic dermatitis, 31 with lichen simplex) were enrolled in the study. All participants were first treated with topical mometasone furoate (MF) 0.1%. When the symptoms disappeared, they were treated either with Zantogin®, a multicomponent topical formula containing anti-inflammatory and anti-itching natural actives, or a control cream for 60 days.ResultsThe study demonstrated that, in about 85% of the participants treated with Zantogin®, symptoms disappeared completely, and only 15% had to resort to MF as needed, with an average use of about three applications per subject (in total). In the placebo group, approximately 90% of participants had to resort to MF as needed, with an average use per person of more than 16 applications in 60 days.ConclusionOur study demonstrates that, following use of a topical steroid, symptoms such as burning and itching can be validly controlled with subsequent and longer therapy with a herbal topical formula, Zantogin®, which is able to properly counteract itching and inflammation, prevent symptom relapse, and avoid the typical side effects associated with prolonged use of topical steroids.

AKT answer relating to vulval itching and dyspareunia

AKT answer relating to vulval itching and dyspareunia

AKT question relating to vulval itching and dyspareunia

AKT question relating to vulval itching and dyspareunia

Persistent aching and itching of the clitoris

We encountered a case of persistent clitoral aching and itching, a condition that to the best of our knowledge has not been reported before in the medical literature. Briefly, a 32-year-old woman, G2P2, presenting with persistent, discomforting vulvar itch and irritation extending from the clitoris over the right labium minus, was referred to us. The patient reported a history of recurrent vulvovaginal candidiasis, while having an otherwise uneventful medical history and in particular no history of dermatological disease, allergy or atopy. Careful history taking revealed no intimate hygiene practices that could have led to contact dermatitis. In the absence of any visible signs of mucocutaneous disease a biopsy of the right labium minus was taken and sent to the dermatopathology laboratory. The biopsy showed epithelial hyperplasia and a modest lymphohistiocytic infiltrate of the underlying stroma. There was no evidence of any histologically classifiable disorder, and therefore the biopsy was considered to be consistent with discrete, non-specific chronic dermatitis. Repeated fungal cultures did not reveal the presence of Candida. The patient was prescribed an empirical treatment course with betamethasone dipropionate 0.064 % ointment once daily for 14 days. Upon re-assessment, the patient reported that she had not experienced any improvement of her complaints under this regimen. Careful re-assessment revealed that she continued to suffer from discomforting itching and aching in the clitoral area. She described the pain as stinging and tingling. A cotton-tip test of vestibular area was negative for provoked pain. We therefore concluded that patient might suffer from clitorodynia, a less common presentation of localized unprovoked vulvodynia [1], and prescribed the tricyclic antidepressant nortriptyline at increasing doses until a daily dose of 75 mg was reached after 2 weeks. The patient returned after 3 weeks and reported significant improvement of her complaints, but also disturbing side effects including dry mouth, tremor, impaired concentration and extreme dizziness. We recommended the patient to discontinue nortriptyline and to initiate duloxetine. The patient returned 1 month later and reported she had continued the nortriptyline treatment for 7 weeks now. She no longer experienced side effects except for a dry mouth, while having almost complete resolution of the disabling clitoral aching and itching. She was particularly relieved. The patient was recommended to continue the treatment for another 3 months and she remained symptom-free. Clitorodynia has previously been associated with a variety of causes including female genital mutilation, posttraumatic neuroma, neuropathic pain following hysterectomy, pudendal nerve entrapment, epidermoid cyst of the clitoris, preclitoral abscess, vulvar cancer, priapism of the clitoris, pubic hair tourniquet, lichen sclerosus, urethral sphincter dyssenergia, multiple sclerosis, Guillain–Barre syndrome, and indeed also with vaginismus and vulvodynia [2]. It may be acknowledged that itch as a presenting symptom of vulvodynia may be misleading as it primarily reminds of candidiasis or common vulvar cutaneous conditions like lichen Simplex chronicus and lichen sclerosus. In summary, vulvodynia, most commonly known for H. Verstraelen (&) K. Roelens M. Temmerman Department of Obstetrics and Gynaecology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium e-mail: hans.verstraelen@ugent.be

Sexual stimulants and their effects on women of reproductive age group in Kano, northern Nigeria

Introduction: Sexual stimulants are preparations used for increasing pleasure during sexual intercourse. The study sought to determine the use and effect of such preparations on women of reproductive age group in Kano, northern Nigeria. Materials and Methods: A self administered questionnaire was used to obtain information from 500 women to determine if they use sexual stimulants and the effects of the drugs on them (if any). Results: There were 423 women that responded. Majority 228 (53.9%) of them use sexual stimulants. Most (47.4%) of them were between the ages of 21 and 30 years, married (85.5%), multiparous (46.9%), and attained tertiary education (58.3%). About 39.9% of the respondents benefited from increased sexual pleasure and satisfaction, 20.2% obtained extra favors from their husbands while 29.9% did not benefit anything from the preparations. About 37.3% developed complications, which included coital laceration (5.9%), copious vaginal discharge (16.5%), vulval itching and rashes (17.5%), lower abdominal pains (14.1%), painful intercourse (16.5%), vaginal dryness (13.0%), and irregular menses (5.9%). Conclusion: A large number of women use sexual stimulants mainly sold by traditional healers. There is need for setting up more orthodox care for sexual dysfunction. There is need for more community health education on female sexual dysfunction.

Clinical and microbiological features of vulvovaginitis in Mexican girls

Study Objective: To determine the prevalence of vulvovaginitis, predisposing factors, microbial etiology and therapy in patients treated at the Hospital del Nino DIF, Pachuca, Hidalgo, Mexico. Design. This was an observational and descriptive study from 2006 to 2009. Setting: Hospital del Nino DIF, Pachuca, Hidalgo, Mexico. Participants. Patients from 0 to 16 years, with vulvovaginitis and/or vaginal discharge were included. Interventions: None. Main Outcome Measures: Demographic data, etiology, clinical features, risk factors and therapy were analyzed. Results: Four hundred twenty seven patients with diagnosis of vulvovaginitis were included. The average prevalence to 4 years in the study period was 0.19%. The age group most affected was schoolchildren (225 cases: 52.69%). The main signs and symptoms presented were leucorrhea (99.3%), vaginal hyperemia (32.6%), vulvar itching (32.1%) and erythema (28.8%). Identified risk factors were poor hygiene (15.7%), urinary tract infection (14.7%), intestinal parasites (5.6%) and obesity or overweight (3.3%). The main microorganisms found in vaginal cultures were enterobacteriaceae (Escherichia coli, Klebsiella and Enterococcus faecalis), Staphylococcus spp, and Gardnerella vaginalis. Several inconsistent were found in the drug prescription of the patients. Conclusion: Vulvovaginitis prevalence in Mexican girls is low and this was caused mainly by opportunist microorganisms. The initial treatment of vulvovaginitis must include hygienic measure and an antimicrobial according to the clinical features and microorganism found.

Lichen sclerosus of the vulva

Lichen sclerosus is a non-neoplastic chronic inflammatory dermatosis that can affect any cutaneous body surface, showing particular predilection for the anogenital area in females. It is clinically characterized by progressive and worsening degeneration of the dermal/epidermal layers, which determines hyperkeratinization, and a thick scar-like appearance of the external genitalia. Very often, atrophic changes of the genital structures – labia majora and minora, clitoris and vulvar vestibule – are evident with architectural alterations of the genitalia that cause significant sexual discomfort. Chronic and severe vulvar itching, especially at night, is the predominant symptom reported by almost all patients. Diagnosis is often delayed by long-term self-administered topical preparations, or by the clinician’s unawareness of the disease. Indeed, the condition is often misdiagnosed as an aspecific vulvitis. Postmenopausal women are more frequently affected, but young girls and even children may also suffer fro...

Verrucous Carcinoma of the Vulva: A Case Report

Verrucous carcinoma of the female genital tract is a rare lesion, primarily affecting postmenopausal women. We present a 78-year-old patient with verrucous carcinoma of the vulva, who was admitted to the “Aretaieion” Athens University Hospital. She had complained of vulvar itching during the last two years without visiting a specialist doctor.