Vulvar Pruritus—Causes, Diagnosis and Therapeutic Approach

Abstract

I n Germany, 17% to 23% of the population suffer from chronic (≥ 6 weeks) pruritus of the skin (1, 2). In 5% to 10% of cases, the female genitalia-and in particular the vulva-are affected (3-6). Thus, vulvar pruritus is a common symptom which often significantly impairs the patient's quality of life. The underlying pathophysiological mechanisms are not yet fully understood. In the past, itching was generally considered to be a subtype of pain sensations. Today, however, it is assumed that it is an independent sensory quality mediated by free nerve endings of unmyelinated C-fibers. These nerve endings respond to chemical, mechanical and thermal stimulation and are activated by specific mediators, such as kinins, prostaglandins, and neuropeptides (7, 8). In patients experiencing genital itching, the medical history should be taken in a systematic manner (Figure 1), covering the following aspects: • Symptom duration (acute/chronic) • Localization (local/generalized) • Intensity (scale 1-10) • Pre-existing systemic disorders (e.g. autoimmune disease/diabetes mellitus) • Ameliorating/aggravating modulators • Previous treatments.

Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management

“…In a study that surveyed 480 women from the general population in Boston, Massachusetts, 6.6% of women reported experiencing vulvar itch or burning ( 1 ). This is similar to rates of vulvar pruritus reported amongst the general German population, which was noted to range from 5 to 10% ( 2 ). The true prevalence of vulvar pruritus may be difficult to assess as it is likely underreported given the embarrassment many women feel when discussing genital symptoms ( 3 ).…”

“…In adult women, vulvovaginal candidiasis is a frequent cause of vulvar pruritus, with some studies suggesting candidiasis accounts for 35–40% of vulvar itch cases in this age group ( 2 ). Multiple epidemiologic studies have indicated that Candida albicans is responsible for the excess of episodes of vulvovaginal candidiasis, although reports indicate than non- albicans Candida species, notably Candida glabrata , account for 10–20% of episodes in certain regions ( 61 – 63 ).…”

“…Ethnic differences also correlate with microbiome composition, with Blacks and Hispanics demonstrating higher levels of anaerobic bacterial species ( 125 – 127 ). By acidifying the vagina and producing antimicrobial substances, such as lactic acid and hydrogen peroxide, lactobacilli protect against opportunistic infections ( 2 ). Similarly, in keratinized squamous epithelia like that of the labia majora, resident microbiota such as Cutibacterium acnes promotes reduces skin pH via production of short-chain fatty acids ( 128 ).…”

An exploratory, prospective cohort study of non-invasive dynamic quadripolar radiofrequency energy in vulvar lichen management. The new-generation DQRF™ option

“…Chronic (≥6 weeks) skin pruritus troubles about 20% of Europeans; in 5% to 10% of them, the itching involves the vulva and female genitalia [1]. After candidiasis, the most common causes of vulvar pruritus are chronic dermatoses, including vulvar lichen sclerosus (VLS), vulvar lichen planus (VLP), and vulvar eczema [1].…”

Differenzialdiagnose vulvärer Pruritus – nicht immer Pilze …

“…Diese tritt mit einer Prävalenz von bis zu 40 % zwar häufig auf, darüber hinaus gibt es jedoch eine Vielzahl an Erkrankungen, die ebenfalls vulvären Juckreiz verursachen können. Aufgrund der multifaktoriellen Genese ist ein interdisziplinärer Therapieansatz besonders wichtig [1].…”