Itching in the intimate area in women

If itching in the intimate area in women - the external genital area and the perineal area (perineum) - lasts for more than a few days and gets worse, or if accompanying symptoms such as redness or discharge appear, a doctor should be consulted. Because burning and itching, wherever they appear, are never normal.

Causes of the female intimate itching

In determining the key causes of itching of the above localization, physicians pay attention to the crucial role of the normal vaginal microbiota, which in healthy women of reproductive age is 80-90% composed of a complex of lactobacilli (Lactobacillus spp.).) These commensal bacteria, by secreting lactic acid and hydrogen peroxide, maintain the necessary pH level (from 3.8 to 4.4) and thus prevent the reproduction of opportunistic and pathogenic microorganisms: either those present in the polymicrobial flora of the vagina or sexually transmitted infections.

Lactobacilli deficiency leads to vaginal dysbiosis - vaginal dysbiosis. And violation of the ratio between beneficial bacteria and pathogenic bacteria in favor of the latter can turn out to be even more unpleasant - bacterial vaginosis. [1] When vaginal inflammation, recognized as the most common cause of vulvovaginal problems in gynecology, there are such symptoms as slight or severe itching in the intimate area of women, burning, vaginal discharge.

It is by the nature of the discharge and the result of laboratory tests of their sample that a specific infection is identified: bacterial, fungal or protozoal, including STIs. Thus, if vaginosis is caused by facultative bacteria Gardnerella vaginalis, women have itching and vaginal discharge with an odor that is defined as fishy.

The fungus Candida albicans is part of the normal flora in at least 15% of women and is often asymptomatic. But becoming opportunistic, fungal infection leads to candidal vaginitis or vulvovaginal candidiasis, called thrush. Itching in thrush is accompanied by characteristic discharge (curd-like), swelling of the labia majora and labia minora, vaginal vestibule and perineum, dysuria and discomfort when urinating. [2], [3]

But sexually transmitted Trichomonas vaginalis leads to trichomoniasis, and there is vaginal discharge, severe itching and redness in the intimate area in women - with swelling of the vulva and vagina and desquamation of epithelial cells. [4]

Severe burning, itching and pain in the external genitalia and perineum are felt by women in cases of genital infection caused by herpes simplex virus (HSV type 2). It is in this viral lesion of the skin of the external genitalia that itching and burning is observed in women without vaginal discharge. The first signs of vaginal herpes are manifested by a burning sensation in the genital area, their hyperemia and slight swelling, followed by itching and small bubbling rashes. [5]

When infected with the human papillomavirus (HPV), which is most often activated when the general immune system is weakened, the genitals, the vagina and the cervix are affected by the formation of papillae-like papillomatous growths on the pedicles - itchy genital warts or acute condylomas in women. If the condylomas grow very large, there may be itching and burning in the perineum. [6]

In a third of cases, inflammation of the external female genitalia (vulvitis) may be the result of hypersensitivity or reaction to soaps or parabens in shower gels, synthetic underwear, sanitary products, spermicides, vaginal creams, and condoms.

Skin diseases such as atopic and contact dermatitis, which account for a significant proportion of diagnosed cases of chronic vulvar and vaginal pruritus in women of all ages, may also be responsible. Redness and formation of vesicles, papules or plaques; burning, itching and swelling in the intimate area are the main symptoms of these vulvodermatoses. Chronic course of the disease often leads to lichenization (thickening) of pathologically altered areas of the epidermis. Similar symptoms are observed in chronic simple lichen planus (neurodermatitis).

Itching in the intimate area during postmenopause

In addition to a healthy vaginal microbiota, local protection of intimate places is provided by a sufficient level of estrogens, whose receptors are present on the membranes of keratinocytes. Estrogens have a proliferative effect on the vulvovaginal epithelium, improve blood circulation and moisturization of the skin and connective tissue, i.e. Contribute to maintaining the necessary thickness of the mucous membranes of the female genitalia. [7]

The consequences of the decrease in this hormone after the onset of menopause are manifested by a deterioration in skin hydration, a decrease in collagen in the epidermis and glycosaminoglycans in the mucosal epithelium, and a decrease in fat depots in the external genital area. In addition, in women of this age group, vaginal pH increases and skin cellular immunity is weakened, which increases the risk of dermatologic diseases.

In addition, all these factors often provoke the development of postmenopausal atrophic vaginitis, the first signs of which are dryness and itching in the intimate area. For details, see the publication - Dryness in the vagina at menopause. [8]

The appearance of fringed papular plaque-like skin rashes (white-yellow or grayish) on the genitals corresponds to the clinical picture of scleroatrophic lichen (lichen sclerosus), a chronic inflammatory dermatosis. [9]

Irritation, burning, itching and cracking of the intimate area in post-menopausal women may be due to erosive or hypertrophic lichen planus (lichen planus). More information in the article - Itching, burning skin in the intimate area at menopause

Risk factors

Risk factors that predispose to the activation of pathogenic bacteria include:

• lack of hygiene and hypertrophic sensitivity;
• increased sexual activity and unprotected sex;
• Frequent sprays;
• prolonged use of antibiotics (which can reduce the number of lactobacilli and reduce the protection of the vulvar and vaginal mucosa);
• Alkaline vaginal pH (due to menstrual discharge, semen, or bacterial imbalance);
• immunosuppression state, including in pregnancy and after radiation therapy of the pelvic organs;
• presence of a history of diabetes mellitus, thyroid disease, metabolic syndrome, ovariectomy;
• deficiency of iron, zinc, vitamins A or D;
• Postmenopausal age.

Pathogenesis

The mechanism regulating microbial colonization of the lower female genital tract has not been fully elucidated. Thus, the disease does not necessarily develop when exogenous bacteria are introduced; on the other hand, inflammation may be initiated by increased replication of endogenous (present in the normal vaginal flora) but pathogenic potential anaerobic microorganisms, particularly Gardnerella vaginalis, Atopobium vaginae, Prevotella spp, Mobiluncus spp., Mycoplasma hominis, Ureaplasma urealyticum, as well as some species of Bacteroides, Porphyromonas, Peptostreptococcus. Apparently, their dominance - against the background of a decrease in the number of beneficial lactobacilli - and leads to the development of vaginosis, accompanied by discharge and itching.

Finding out the pathogenesis of this process, researchers have revealed the ability of G. Vaginalis bacteria to adhere to the cells of the mucous epithelium of the vagina and cover it with a kind of biofilm, which allows microorganisms to accumulate in significant quantities and protects them from immune cells, that is, plays a leading role in the development of inflammation.

Vaginal discharge is the result of increased transudation of epithelial cells and their exfoliation (separation from the common layer). The foul odor of the discharge is due to the fact that pathogenic anaerobic microbes produce a large number of proteolytic carboxylase enzymes that degrade vaginal peptides to form volatile amines - ammonia derivatives.

And the mechanism of itching in all infectious and atrophic vaginosis is due to changes in the state of the mucous membranes, which arise due to the activation of proinflammatory cytokines, polymorphonuclear cells and macrophages, as well as the release of histamine from mast cells. This is the main mediator that affects receptors (H1 and H2) and ensures the conduction of afferent nerve signals.

Epidemiology

And according to the WHO, globally, more than 350 million people are infected with STIs each year (nearly 143 million with trichomonads); more than 500 million with herpes simplex virus (HSV).

According to clinical statistics, at least 290 million women are infected with human papillomavirus (HPV).

Although the prevalence of bacterial vaginosis varies considerably from country to country, it is estimated to range from 4.9% to 36% in Europe and the Americas; in Asian regions, it is approximately 65%. Bacterial vaginosis can occur in any age group, but it is diagnosed much more frequently among women of childbearing age. An average of 7.5 million women in all countries visit gynecologists for vaginal inflammation over the course of a year.

Vulvovaginal symptoms, including dryness, irritation, and itching, are reported in 27% of postmenopausal women (others report at least 80%).

Diagnostics of the female intimate itching

In the case of itching in the area of external genitalia, the diagnosis is carried out by a gynecologist and/or dermatologist, and the main task of the examination is to find out the cause of this symptom.

This requires a complete anamnesis of the patient, a standard gynecologic examination is performed, such tests as:

• general clinical and biochemical blood tests;
• blood test for STDs;
• Analysis of vaginal microflora based on gynecologic cervicovaginal swab samples;
• PCR assay for detection and identification of inflammatory agents.

How genital warts are diagnosed, detailed in the material - Papillomavirus infection

Instrumental diagnostics is used: colcoscopy, ultrasound examination of the pelvic organs.

To avoid diagnostic errors, all examination results are compared - laboratory and imaging results, i.e. Differential diagnosis is performed.

Bacterial vaginosis is usually suspected when vaginal pH is elevated (>4.5), but it is also elevated in cases of trichomoniasis, atrophic vaginitis, and desquamatous vaginal inflammation, so conclusions are drawn based on microbiologic and bacterioscopic examination of vaginal discharge.

It is important to consider the possibility of a neuropathic origin of pruritus, which may be from spinal compression, postherpetic neuralgia, or diabetic neuropathy.

Treatment of the female intimate itching

The occurrence of this symptom immediately poses two questions for women: why does TAM itch and burn, and how to relieve itching in the perineum and genital area?

Treatment should be directed at the real cause (which should be identified by a doctor), but in some cases only symptomatic therapy is possible - to reduce and relieve itching.

The basis of traditional (etiologic) treatment of bacterial vaginosis is antibacterial drugs Metronidazole (other trade names - Metrogil, Trichopol, Trihazol, Ginalgin, Flagyl) or Clindamycin (Dalacin, Climycin, Zerkalin). These drugs are available in various forms and can be used both systemically (internally) and externally. Following the instructions of the attending physician, with the help of the prescribed antimicrobial agents carry out treatment of itching and burning in women at home.

Antiprotozoal and antimicrobial drug of nitroimidazole group Metronidazole - suspension and tablets for oral intake; vaginal tablets, gel, cream and suppositories (suppositories) - used daily, twice a day, the course of treatment can last one or two months. As clinical practice shows, treatment with this drug for 4 weeks gives a positive result in 80% of patients, but in an average of 25% of cases in two to three months there is a relapse. And the list of side effects of Metronidazole includes erythema and rashes, itching and local loss of skin sensitivity, muscle and joint pain, urine staining, development of thrush.

Clindamycin can be administered orally (four times a day, 0.15-0.45 g with a minimum duration of 10 days). Vaginal cream with clindamycin - Vagicin (Kindatsin, Clindes) - is used for a maximum of one week (contraindicated in pregnant women). Possible side effects are the development of fungal infection, menstrual irregularities, vaginal pain and burning, urinary problems. Although Clindamycin is more active against Gardnerella vaginalis and Atopobium vaginae compared to Metronidazole, it also affects lactobacilli, which affects the effectiveness of treatment and increases the likelihood of recurrences and superinfection.

Practitioners note the higher effectiveness of the nitrofuran derivative Nifuratel, synonyms - Macmiror, Methylmercadone, Metilmercadon, Thiodinon), acting on Trichomonas vaginalis, Gardnerella vaginalis, Atopobium vaginae, fungal infection, but not affecting lactobacilli.

What suppositories for itching in the intimate zone in women are recommended by doctors, read in the materials:

• Vaginal suppositories for infections
• Vaginitis suppositories
• Mammary suppositories
• Candles for vaginal dryness

Also in gynecology and dermatology, ointments, creams for itching in the perineum, vulva and vagina are widely used.

In severe inflammation of bacterial etiology prescribed ointments containing antibiotic chloramphenicol (Levomekol, Contricomycetin, Iruksol, syntomycin emulsion), ointments with silver sulfadiazine (Sulfargin, Dermazine), etc.

To treat viral vaginosis caused by Herpes simplex virus, there are special ointments, liniments and creams for herpes: Acyclovir (other trade names - Herpevir, Zovirax), Gossypol, Riodoxol, Bonafon, Florenal.

Scleroatrophic and other vulvovaginal lichenes are difficult to treat; unless a bacterial or fungal infection joins, antihistamines are used systemically: Cetirizine (Cetrin, Zyrtec, Allertek), Loratadine (Lorizan, Lomilan, Claritin, Claridol), and topically, moderately to fairly strong topical corticosteroids in the form of itch ointments, as well as steroidal and non-hormonal itch creams. However, topical corticosteroid therapy is carried out in short courses, as these agents can aggravate atrophic processes in the dermis.

More information in the article - Treatment of postmenopausal atrophic vaginitis: suppositories, folk remedies

Ointments Condylin or Condylox (with podophyllotoxin), Imiquimod cream (Aldara) are prescribed for acute condylomas and papillomatosis. Read also: Ointment for condylomas

In candidiasis, ointments Mycoseptin or Cincundan (with undecylenic acid), Nystatin, Amicazole, Clotrimazole, Octicil, Esulan are used. More information on the treatment of candidal vaginitis - Effective treatment of thrush with creams, gels and suppositories

Practiced cervicovaginal lavage, or sprays for thrush, for which use physiological solution, aqueous solution of furacilin (0.02%), antiseptic solutions Miramistin or Chlorhexidine.

Homeopathy

Homeopathic remedies may also be used:

• for moisturizing dry flaky rashes that cause itching, relieving erythema - Graphites;
• for inflammation with rash and itching - Arsenicum iodatum, Thuja (oil), Hydrastis;
• in pustular rashes and itching in skin folds - Sulphur;
• if the pruritis is allergic-- Mezereum.

In case of dry, cracked, flaky and itchy skin of any localization homeopaths - after examination - prescribe Petroleum, Lycopodium and Sepia (in individually selected dosage).

Treatment of itching in the perineum in women with folk remedies

In most cases, the use of folk remedies involves treatment with herbs, although it is difficult to imagine modern medicine without phytotherapy.

With itching in the intimate area recommended sitting baths or syringing decoctions of chamomile flowers, calendula, pyzhma, peppermint herb, thyme (thyme), horsetail, common goldenseal, purple clary grass, cornflower, roots of marsh aira, elecampane, barberry bark and oak.

Also effective is the use of essential oils: tea tree (Melaleuca alternifolia), palmarosa (Cymbopogon martinii), lavender, thyme, oregano, sage, citronella (lemongrass).

Surgical treatment

Pruritus may not be an indication for surgical intervention, but surgical treatment may be necessary in cases of serious complications. For example, when the fallopian tubes become inflamed and pus accumulates near them. Or narrowing of the urethra in patients with scleroatrophic lichen planus

Also resort to the removal of acute condylomas overgrown on the genitals and perineum.

Complications and consequences

Recently, the effects and complications of bacterial vaginosis, which is considered a predisposing factor for infection with herpesvirus, HIV, Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae infections, have been particularly scrutinized in gynecology.

In cases of STIs, the consequences can be expressed in the development of acute inflammation in the fallopian tubes (salpingitis) with the formation of pus in their lumen, which is diagnosed as pyosalpinx.

Bacterial vaginosis can be particularly dangerous in pregnancy: it repeatedly increases the risk of spontaneous abortion in late pregnancy, premature labor, rupture of the fetal bladder and the development of inflammation of its membranes (chorioamnionitis), as well as inflammation of the uterine mucosa (endometritis) after childbirth.

The chronic nature of vulvodermatosis in postmenopause reduces the quality of life. Atrophy of cutaneous and partially subcutaneous tissues in the genital area can make sexual intercourse, urination and defecation painful. In addition, complications of scleroatrophic and chronic lichen simplex include urethral narrowing, secondary infection, and localized skin atrophy (due to long-term steroid use). There is also a risk of precancerous changes (neoplasia) of the cervical epithelium and vulvar carcinoma.

Prevention

The general recommendations regarding the advisability of visiting a gynecologist from time to time, the need for absolute hygiene and avoiding anything that harms the body as a whole are clear. Certainly, lifestyle choices and overall health are major factors in helping to prevent many problems. But there are only specific methods of preventing STDs/HIV

Prevention of vaginal dysbiosis, and therefore bacterial and fungal vaginosis, is to keep the vaginal microflora normal, and for this purpose now resort to the use of vaginal pro and prebiotic products with lactobacilli.

It is also necessary to monitor blood glucose levels, and try to avoid sugar-containing foods in the diet. The intestines should work properly, because problems with its microflora affect almost all organs, including sexual organs. Yogurt with live bacterial culture, sauerkraut (and all other lacto-fermented vegetables) and also foods with dietary fiber (i.e. Food of plant origin) are a good help in maintaining the balance of the intestinal microbiota.

Forecast

For any symptom, the prognosis is correlated with the cause of the symptom. Therefore, atrophic vaginitis that develops during postmenopause and scleroatrophic lichen planus in older women who experience itching in the intimate area have the most disappointing outlook.