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Crown of the vulva
Kraurosis of the vulva is a pathology characterized by pronounced atrophic processes of the skin and mucous membranes of the vagina, which arises from the action of external and internal factors. This problem concerns mainly postmenopausal women, which is associated with the peculiarities of hormonal regulation, but also happens in women of young age. The possibility of an increased risk of oncopathology in women with vulva kraurosis proves the need for early diagnosis and correction of this pathology.
Epidemiology
Epidemiology of kraurosis of the vulva is characterized by a predominant distribution among women in the menopause period, which is associated with etiological and pathogenetic factors. Among young women, this pathology occurs in no more than 5%, and of these women, more than 85% of cases are secondary kraurosis, that is, post-traumatic or postoperative.
Causes of the kraurosis of the vulva
Speaking about the prevalence of this problem in women over 50, the reasons for the development of this pathology can be generalized. But if we are talking about women for 30 years, then there are some peculiarities in the etiology and pathogenesis of the disease.
The exact cause of the development of kraurosis of the vulva can not be established even in women in individual cases, since often these reasons are many.
One of the most common causes of the development of kraurosis is hormonal disorders that affect not only female sex hormones, but also a common hormonal background under the influence of the work of other endocrine glands. The pathogenesis of the development of such a process depends heavily on the regulation of the hormonal balance. In the menopause period, kraurosis develops most frequently, as the level of estrogen that plays an important role in the female body decreases. They provide division and differentiation of body cells, primarily skin and epithelium. This provides the woman with youth and a healthy fresh look. With a lack of estrogen, the division of cells of the skin of the vagina is impaired, which leads to a decrease in their number and normal function. This also disrupts blood circulation in the pelvic region, ischemia of not only internal organs, but also of the skin - this further disrupts the differentiation of the endothelium. Thus, changes are intensified and skin atrophy gradually occurs, the amount of endothelium decreases, which leads to secondary processes in the form of cracks and dysplasia in such cells. Therefore, kraurosis initially only a surface process with skin atrophy, but later there is a violation of the mitotic activity of such cells, and dysplasia develops, which is dangerous in terms of precancerous condition.
But the reason for such changes may be a number of other factors. As for the hormonal background, the immediate cause is also the diseases of other endocrine glands. Such pathologies include insufficiency of the adrenal cortex, which also disrupts the circulation of the vulva, innervation, and cell division due to a lack of catecholamines. Also one of the reasons is hypothyroidism in women. This is a pathology in which the level of thyroid hormones of the thyroid gland decreases, which also regulate the process of tissue regeneration and cell growth. In this case, the lack of such hormones leads to inhibition of active mitosis and there is atrophy with further replacement by connective tissue. Insufficiency of ovarian function can also cause atrophy of the vulvar mucosa.
Such causes can be called endogenous common causes that can be inherent in every woman. But there are some local reasons for the development of vulva vulgaris, which include chronic inflammatory diseases of internal and external genital organs, chronic foci of infection of the ovary or uterus, frequent surgical interventions on the uterus, and burns of mucous chemical etiology. If there are primary foci of infection or viruses in the vagina, this only enhances the effect of the etiological factors, which contribute to the development of dysplastic disorders and atrophy.
Risk factors
Given all the possible causes of kraurosis, it is necessary to identify the main risk factors for this pathology, to limit the group of women who need more careful monitoring. The risk factors for the development of this pathology include:
- women with concomitant hypothyroidism;
- women with obesity - while there is a violation of the regulation of the hormonal background at the level of target cells;
- active hepatitis or cirrhosis of the liver at a young age - this disrupts the exchange of many hormones and their regulation, which occurs mainly in the liver;
- women with frequent vaginitis, colpitis or chronic adnexitis - this is a springboard for the action of other etiological factors;
- women with disorders of the neurovegetative system - this is closely related to the hormonal regulation of the body's functions, as well as to local blood circulation (psychosomatic disorders);
- Women with the pathological course of menopause and its various manifestations.
These risk factors should be taken into account not only for the identification of sick patients, but primarily for the primary prevention of the development of kraurosis of the vulva.
Symptoms of the kraurosis of the vulva
The clinical picture of the disease depends on the stage at which the disease is detected and on which treatment begins. Often the symptoms are not expressed enough that the woman treated this problem with the doctor, but this is only at the initial stages, and in the future the symptoms are more pronounced.
The stages of crourosis of the vulva are consistent and in the absence of treatment the changes become more serious.
The first stage of kraurosis is characterized by initial changes in blood circulation and innervation of the mucosa, which has a transitory character. In this case, the first signs of the disease appear in the form of severe itching and burning in the vagina. As a rule, this is the first and only symptom in the initial stages. Itching can only be in the daytime, it is provoked by physical activity or occurs after after sexual intercourse. Also there is a feeling of dryness of the mucosa, which requires the use of moisturizers. But such symptoms in the beginning of the disease are not permanent, and the woman does not pay much attention to these symptoms.
The second stage develops when there are not only persistent changes in blood circulation, but also when there are initial changes in nerve endings and atrophy of endothelium of a mosaic nature. Then the division of cells is also broken and cracks and erosions appear, which gives already more discomfort and makes you turn for help. In this case, the symptoms of burning, itching of the vagina intensify and worry constantly. Dryness of the vagina is strengthened, which also causes another symptom - dyspareunia. At the same time a woman does not get pleasure from sexual intercourse and the process itself is broken - because of dryness and burning, painful sensations arise. This greatly affects the overall psychological state of women and against the background of concomitant hormonal disorders there is a deficiency in the regulation of nervous activity. This is manifested by increased nervousness, bad mood, sleep disturbance, nervous excitability, hyperestrogenism.
The third stage of kraurosis is final in terms of profound changes not only in the vagina, but also in surrounding tissues. In this case, the disturbance of blood flow is irreversible, atrophy is diffuse and the proliferation of endothelium and other cells is completely impaired. This is accompanied by complete atrophy and sclerosis of the vaginal mucosa, which leads to a significant narrowing of the lumen of the vagina. This has a significant effect on the urethra as well - the urination becomes painful and the burning, discomfort, and itching intensifies. Cracks and erosion of the mucosa may be accompanied by contact bleeding, which is difficult to treat. Pronounced edema of the labia, their hyperemia and signs of inflammation in secondary infections, because there are incoming gates for different pathogens of infection. There are also signs of skin atrophy and its appendages - loss of pubic hair, dry skin, peeling. All this has a significant effect not only on the severity of local symptoms, but also on the general condition of a woman.
Speaking about the symptoms of vulva kraurosis it is necessary to know that even with the initial manifestations of such changes it is necessary to consult a doctor for treatment, since this pathology is dangerous in terms of complications.
Diagnostics of the kraurosis of the vulva
The diagnosis of kraurosis should be carried out in time, before the onset of complications and possible malignancy, and all complex research methods should be conducted. To do this, conduct a physical examination, instrumental and laboratory diagnosis.
Diagnosis begins with a careful collection of anamnesis of life and disease. It is necessary to find out the characteristic of the menstrual cycle, especially if the woman is in the menopause period, then it is necessary to determine how this period proceeds and the connection of complaints with the onset of menopause. As a rule, the symptoms of kraurosis develop gradually, which is necessary to find out from the woman with the details of all the complaints. Next, you need to examine the woman on the chair. A simple vaginal examination of a woman in mirrors is very informative, as many symptoms are visually determined and, according to the severity of their symptoms, one can judge the stage of the disease. On examination, you can see pronounced dryness of the vaginal mucosa, cracks and surface erosion, which can make it difficult to insert a mirror. You can also see flushing of the labia, swelling, whitish shade of the mucosa and areas of atrophy or even sclerosis. For more informative diagnosis, additional research methods are needed. Since kraurosis is a precancerous condition, a biopsy is a mandatory stage of diagnosis. For this purpose, as well as for the purpose of differential diagnosis, conduct instrumental diagnostics using colposcopy. This is a method of research, which consists in using a special device - the colposcope. This allows you to see the mucous membrane of the vagina in an increase of several dozen times. In this case, you can visualize those changes that are not visible during normal inspection. The advantage of this method is also the possibility of a parallel biopsy. It can be performed with special forceps, which are on the end of the colposcope. The mucosal material is sent for histological examination to detect the degree of changes and exclude malignant transformation.
Smears on the bacterial flora and the degree of purity of the vagina are also an obligatory method of investigation, since they exclude bacterial inflammation or a specific infectious process.
Analyzes that necessarily carry out with kraurosis is a study on HPV, which is associated with cervical cancer in women. Therefore, given the precancerous condition, this study allows you to study the risk of malignant transformation and determine the prognosis of pathology. To do this, a blood test is performed using a polymerase chain reaction and determining the antigen of the virus. A positive reaction allows you to more accurately determine the tactics of treatment and use specific methods. If there is a suspicion of vulva vulgaris in a woman of menopausal age, then a hormonal panel with a study of the level of the main hormones is necessarily needed, since in complex treatment there may be a need for substitution therapy.
Differential diagnosis
Differential diagnosis of kraurosis of the vulva should be performed at the initial stages of the disease, when the symptoms are not specific. Especially important is differential diagnosis in young women, because they have a rare pathology. Therefore, it is necessary to conduct differential diagnostics with vulvitis, vulvovaginitis, vaginosis, neurodermatitis, and flatworm. With vulvitis vulvovaginitis also there is burning and itching of the vaginal area, there may be dry mucosa, but this is a bacterial inflammation, so the specific symptoms are white, green or yellow discharge. The main diagnostic sign of pathology is the definition of a specific pathogen in a vaginal smear. With kraurosis, the symptoms of dryness, burning, and cracks are not accompanied by any secretions, but on the contrary their number decreases. Also, with primary kraurosis, there are no bacterial pathogens. Flat lichen is a dermatological pathology, which primarily affects the skin of the genital organs, and again the vagina. Therefore, in lichen, there may be redness and atrophy of the skin, but only then mucosal atrophy. In contrast, kraurosis is accompanied by atrophy of the mucosa, and the skin is affected already in the third stage of the disease.
Such a diagnostic program of kraurosis of the vulva is the most complete and necessary for timely diagnosis and treatment.
Treatment of the kraurosis of the vulva
Treatment of kraurosis is not very successful, which depends not only on timely diagnosis, but also on an integrated approach to such treatment. It is very important to apply not only local symptomatic remedies, but also systemic pathogenetic ones. Therefore, first of all, treatment should start with dietary recommendations, because the state of our cells directly depends on the energy material that we give to our body. Therefore, you need to turn off the body of spicy dishes, fried, as well as spicy spices - this will help reduce the severity of subjective symptoms of the disease. It is also necessary to exclude bad habits, because nicotine narrows the blood vessels and further disturbs the trophism of the mucous membranes.
Speaking about drug treatment, it is necessary to allocate systemic and local treatment. Among the systemic means, it is necessary to use complex approaches to treatment using the following medicines:
- Substitution therapy with estrogens, in case kraurosis develops against the background of climacteric changes. In this case, estrogens restore the normal function of endothelial cells and remove common symptoms of the disease.
Ovret is a hormonal remedy whose active ingredient is norestrel from the group of gestagens, which makes it possible to use it at the initial stages of treatment of kraurosis with climacteric changes. The way of using the drug is in tablets at the same time of the day, preferably before meals. Dosage of the drug - one tablet a day for the entire time without interruption. Side effects are possible on the part of the gastrointestinal tract in the form of a stool, nausea, a feeling of bitterness in the mouth. Possible fluid retention and headaches, so the drug is not recommended with concomitant hypertension. It is also possible the appearance of jaundice and uterine bleeding, which requires dose adjustment. Contraindications to taking the drug is the pathology of the blood coagulation system, the pathology of the coronary vessels and veins, diabetes, a history of cerebral hemorrhage or ischemic stroke. Precautions - in the case of antibiotics, the effectiveness of the drug is reduced, so you need to properly dose the drugs and take into account their interaction.
- Antihistamines are used for the purpose of general desensitization, as well as reducing the expression of pruritus and soothing effect. To this end, the drugs of the first or second generation are more recommended.
Diazolinum is an antihistaminic drug that has a pronounced effect on the symptoms of itching and burning when the vagina is atrophic. The drug also has a sedative effect, which improves the general condition of a woman and normalizes sleep. The method of application of the drug - one tablet per night at night. Treatment can be carried out throughout the week, when the symptoms are most pronounced. Side effects are possible in the form of apathy, drowsiness, irritation of the gastric mucosa and epigastric pain. Nausea and pain in the liver are also possible. Precautions - do not apply when driving a car and controlling other means, since the drug may cause a decrease in attention.
- Antidepressants or anxiolytics - they are used for severe symptoms of kraurosis of the vulva, which violates the general condition of a woman and affects the mental sphere. In complex treatment, they are mandatory in the case of severe depression and mood depression, and also to improve sleep if the symptoms of kraurosis are disturbed at night.
Cipralex is an antidepressant, which is often used in the treatment of climacteric changes in the mental sphere. Such therapy is explained by the fact that often for the removal of anxiety and a sense of fear it is necessary to take these drugs in combination with hormonal drugs. With vulva vulva, the drug removes the increased excitability of the nervous system caused by the symptoms of the disease. This drug increases the number of molecules that are responsible for the transmission of the nerve signal, and the number of excitatory mediators that relieve the state of depression and fear increases. The drug is available in the form of tablets and as an initial dose is recommended taking one tablet during meals. Dosage - 10 milligrams per day. Side effects of the drug can be expressed in the form of changes from the nervous system - dizziness, drowsiness, increased excitability, as well as lack of appetite, nausea, vomiting, diarrhea, excessive sweating or dry mouth, palpitation and tremor of the extremities. Contraindicated taking the drug in the pathology of the liver and kidneys, increased sensitivity to the components of the drug, while treating monoamine oxidase inhibitors.
- Vitamin preparations should be used to improve trophism, improve the condition of the vascular wall, normalize the nerve conduction, which contributes to the restoration of normal proliferative activity of cells with kraurosis. Recommended multivitamins with ascorbic acid, which affects the vascular wall.
Supradin is a complex vitamin preparation that is recommended for pregnant women as a preventive and curative vitamin remedy. Given the rich composition, the drug replenishes stocks of not only vitamins, but also microelements, which allows using it as a vitamin preparation for the complex treatment of various pathologies. Due to the complex action of vitamin C and magnesium, the action on the vascular wall and nerve endings is simultaneously revealed with the restoration of the normal level of electrolytes in the tissues. The drug is available in pharmacological form of dragees and effervescent tablets. It is taken in a dose of one tablet once a day, dissolving in a small amount of water. Side effects with respect to the dose are not detected, there may be changes in the color of urine due to the composition of the drug. Contraindications to taking the drug - this is an increased level of any hormones, serious violations of kidney and liver. Precautions - do not combine with other vitamins.
- Local remedies to restore microflora and improve the function of local immunity are also used to reduce the severity of symptoms. This is achieved due to the moisturizing effect and due to the normalization of endothelial cell function.
Gynoflora is a drug from the group of combined probiotics and hormones, the main active ingredient of which is lactobacilli and estriol. Due to this composition, the bilateral effect of the drug is manifested - normalization of the vaginal microflora and increased proliferation of epithelial cells due to the local effect of estrogens. The drug is available in the form of vaginal tablets and dosage - one tablet per day. The way of application - vaginally it is necessary to introduce a candle not too deeply into the vagina after all hygienic measures and outside the reception of other local remedies. Side effects are rare, allergic reactions to the components of the drug are possible. Precautions - tablets should be used for the entire course and everything, long-term storage and incomplete course reduces the effectiveness of the drug.
You can also use other local remedies based on antiseptic ointments with vitamins, oils, antihistamine components. A good effect have sea buckthorn candles, ointments with a testosterone base, as well as ointments with vitamins A, C, E.
Operative treatment of kraurosis of the vulva can be used with ineffectiveness of conservative therapy or as a combination therapy. Use minimally invasive interventions only if there are results of histological examination and there are no atypical cells. Then the methods of laser coagulation, cryodestruction or moxibustion of the affected mucous areas, which can be seen with the naked eye or with the help of a colposcope, are used. This breaks the upper layer of atrophic cells, which improves the circulation of the deep layers and their innervation, and thus increases the proliferative activity of other cells. In the case of the presence of atypical cells in histology, conservative therapy is not used, but immediately a vulvectomy is performed.
Physiotherapeutic treatment of kraurosis of the vulva can also be used as a topical therapy, which is highly effective in combination with other methods. They use laser therapy, iontophoresis and electrophoresis with glucocorticoids, as well as therapeutic mud. These methods can be used outside the period of exacerbation.
Alternative treatment of kraurosis of the vulva
Alternative therapies are aimed at reducing the severity of symptoms and have high efficacy along with medication. Use local lotions and baths that help moisturize dry skin and have an antibacterial and protective effect. The main recipes of alternative medicine are as follows:
- It is necessary to make a sedentary bath from the leaves of calendula and string. To do this, brew in a liter of water two packets of herb grass and several stems with leaves or flowers of calendula, insist until the solution becomes warm. Then you need to add a few drops of olive oil and take such a bath, after sitting in it for at least ten minutes. After the procedure, you need to smear the vagina with olive oil a few drops. Repeat the procedure for ten days.
- To remove an itch and burning sensation the washing out for the night by a solution from an egg and a camomile will help. To do this, you must first take the leaves of chamomile, pour them with boiled hot water and insist before the solution becomes a little warm. After that, you need to add a protein of two eggs and spend the evening hygienic procedures with this solution. The course of treatment is not less than five days.
- As an antibacterial and regenerating agent, the use of sea-buckthorn is recommended. To do this, take the sea buckthorn oil, which can be purchased at the pharmacy in a jar, then make a gauze swab, apply oil on a tampon and insert into the vagina for twenty minutes. Such a product has excellent moisturizing properties that will relieve irritation and symptomatology will decrease.
- A good remedy for the treatment of kraurosis is the use as a means to wash away a solution of soap and kefir. To do this, make a soapy solution from the laundry soap and add there three teaspoons kefir. Use should be in the evening before going to bed for a week.
Medicinal herbs are also widely used in the treatment of this pathology, which has a positive both local and systemic effects.
- The red brush is a plant that promotes the stimulation of the function of endothelial cells of the vagina and their proliferation, has an anti-inflammatory effect and prevents the development of secondary bacterial infections against the background of cracks in the mucosa. For medical infusion it is necessary to take three tablespoons of herbs, pour boiling water and boil over low heat for another five minutes, this infusion should be covered and insisted for three hours. Take in warm form five times a day for two tablespoons. The course of treatment is one month.
- Parsley has a tropism to the vaginal tissue and helps to reduce the expression of itching and dryness by improving blood circulation. Also, the infusion of parsley has a calming effect. To prepare the medicine you need to take the leaves of parsley, pour them with alcohol and insist for at least three days. Take this solution should be a teaspoon in the morning and in the evening two weeks.
- Very good means of local treatment is clean. Five tablespoons of herb celandine pour a liter of hot boiled water, and then insist for ten minutes. Warm solution should be washed twice a day. It is better for each time to prepare a fresh solution, since when stored in a refrigerator, the celandine loses its healing properties.
Homeopathic remedies have a good effect in the case of pronounced kraurosis against the background of menopause, which is accompanied by an effect on the nervous system. To do this, use specific tools that are selected individually. The main groups of drugs that can be used in this case are the following:
- Carbo vegetalis is a homeopathic remedy that has a composition of organic substances and helps normalize the hormonal background in menopause due to acoustic and magnetic resonance with the organs and systems of the body. The drug also reduces proliferative processes at the cell level and improves the processes of cellular differentiation in kraurosis. The drug is used in the pharmacological form of homeopathic drops and dosed three drops three times a day for half an hour before meals or an hour after. The course of treatment with the drug is long - about two months. There were no side effects. Contraindications to the admission Carbo vegetabilis - is hypersensitivity to the components of the drug and reception for men.
- Sepia is a homeopathic remedy of inorganic origin. The drug has a regenerating effect, which has a good effect on the recovery of atrophic cells during kraurosis and age-related changes. Also, the drug improves local blood circulation and lymph flow, which increases the effectiveness of the drug with concomitant pelvic pain. The drug is released in the pharmacological form of homeopathic granules and drops are dosed three granules three times a day for half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not washed down with water. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions. Precautions - it is impossible to use the drug for women asthenic physique and depressed mood.
- Strontiana - a plant that improves trophism of tissues, reduces the severity of burning and dryness of the vagina due to its softening properties. The drug is released in granules and its dosage is eight granules once a day. Side effects are rare, a skin rash is possible on the hands. Precautions - it is impossible to use the drug for acute inflammatory processes in the small pelvis.
These are the main non-medicament drugs that can be used in the treatment of kraurosis not only as a local remedy, but also as systemic drugs.
Prevention
What is dangerous krauroz vulva? This question should be asked before any complications arise and at the stage of diagnostic measures, when adequate treatment can improve the prognosis. First of all, kraurosis is dangerous for the development of endometrial cancer or cervical cancer. This is the most terrible complication, which should be feared, as kraurosis can be considered a subradical process. Other complications that may occur in this pathology are secondary, and are caused by atrophy of the mucous membrane, which entails cracks, erosion and deeper lesions with the addition of a secondary bacterial infection. The consequence of improper treatment of kraurosis or the absence of any measures to treat this pathology may be the progression of changes with the development of sclerosis and narrowing of the vagina, secondary changes in the urethra. Therefore, it is very important not only to turn to the doctor in time, but also the correct complex treatment.
Forecast
The prognosis of the croury of the vulva for recovery is relatively positive, and the prognosis for further progression is favorable in case of adequate treatment measures. With this pathology, a secondary place in the prevention of malignancy of this process belongs to secondary prevention, which provides for timely treatment not only medicamental, but also operative in the presence of indications.
Kraurosis of the vulva is a pathology that is more common in women in the menopause when changes occur at the level of the vaginal cells with their atrophy and further sclerosis. This process has been developing for some time, so it is important at the first stage to seek help from a doctor. The risk of malignization of kraurosis is very high, and timely treatment can prevent the development of complications.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"