Itching in the intimate area in women

If itching in the intimate area of women - in the vulva and perineal area (in the perineum) - lasts more than a few days and becomes more severe, or accompanying symptoms appear, such as redness or discharge, you should consult a doctor. Because burning and itching, wherever they appear, are never a normal condition.

Causes of the itching in the intimate area in women

Determining the key causes of itching of the indicated localization, physicians pay attention to the decisive 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, releasing lactic acid and hydrogen peroxide, maintain the required 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  infections that are predominantly sexually transmitted .

The lack of lactobacilli leads to vaginal dysbiosis -  vaginal dysbacteriosis . And the violation of the ratio between beneficial bacteria and pathogenic ones in favor of the latter can turn into even more trouble -  bacterial vaginosis . [1] With inflammation of the vagina, recognized as the most common cause of vulvovaginal gynecological problems, symptoms such as slight or severe itching in the intimate area in women, burning,  vaginal discharge appear .

It is by the nature of the discharge and the result of laboratory tests of their sample that a specific infection is revealed: bacterial, fungal or protozoal, including STIs. So, if vaginosis is caused by the facultative bacteria Gardnerella vaginalis, women experience 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 when it becomes opportunistic, the fungal infection leads to candidal vaginitis, or vulvovaginal candidiasis, called thrush. Itching with thrush  is accompanied by characteristic discharge (curdled appearance), swelling of the large and small labia, vaginal vestibule and perineum, dysuria and discomfort during urination. [2], [3]

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

Severe burning, itching and pain in the vulva and perineum are felt by women in cases  of genital infection caused by the herpes simplex virus  (HSV type 2). It is with this viral lesion of the skin of the external genitalia that itching and burning are observed in women without vaginal discharge. The first signs of vaginal herpes appear with 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 immunity is weakened, the formation of papillomatous formations similar to papillae on the leg is observed on the genitals, in the vagina and on the cervix - itchy genital warts or  genital warts in women . If warts grow strongly, then there may be itching and burning in the perineum. [6]

In a third of cases, inflammation of the external female genital organs (vulvitis) may be due to hypersensitivity or reaction to soap or parabens in shower gels, synthetic underwear, hygiene products, spermicides, vaginal creams, condoms.

The causes may also be skin diseases such as atopic and contact dermatitis, which account for a significant proportion of diagnosed cases of chronic itching of the vulva and vagina in women of any age. Redness and formation of vesicles, papules or plaques; burning, itching and swelling in the intimate area are the main symptoms of these vulvodermatoses. The chronic course of the disease often leads to lichenification (thickening) of pathologically altered areas of the epidermis. Similar symptoms are observed in chronic lichen simplex (neurodermatitis).

Itching in the intimate area during the postmenopausal period

In addition to the beneficial vaginal microbiota, local protection of intimate places is provided by a sufficient level of estrogens, the receptors of which are present on the membranes of keratinocytes. Estrogens have a proliferative effect on the vulvovaginal epithelium, improve blood circulation and hydration of the skin and connective tissue, that is, help maintain the required thickness of the mucous membranes of the female genital organs. [7]

The consequences of a decrease in this hormone after the onset of menopause are manifested by a deterioration in skin hydration, a decrease in the content of collagen in the epidermis and glycosaminoglycans in the mucous epithelium, and a decrease in fat depots in the vulva. In addition, in women of this age group, the pH of the vagina increases, and the cellular immunity of the skin weakens, which increases the risk of dermatological diseases.

In addition, all of 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 with menopause [8]

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

Irritation, burning, itching and cracks in the intimate area in women who have passed the menopause may be due to erosive or hypertrophic flat lichen (lichen planus). More information in the article -  Itching, burning of the skin in the intimate area with menopause

Risk factors

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

• insufficient hygiene and hypertrophied sensitivity;
• increased sexual activity and unprotected sex;
• frequent douching;
• long-term use of antibiotics (which can reduce the number of lactobacilli and reduce the protection of the mucous membrane of the vulva and vagina);
• alkaline vaginal pH (due to menstrual flow, semen, or bacterial imbalance);
• the state of immunosuppression, including during pregnancy and after radiation therapy of the pelvic organs;
• a history of diabetes mellitus, thyroid disease, metabolic syndrome, oophorectomy;
• deficiency of iron, zinc, vitamins A or D;
• postmenopausal age.

Pathogenesis

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

Elucidating the pathogenesis of this process, the researchers 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, it plays a leading role in the development of inflammation.

Vaginal discharge is the result of increased extravasation of epithelial cells and their exfoliation (separation from the common layer). The unpleasant smell of secretions is explained by the fact that pathogenic anaerobic microbes produce a large amount of proteolytic carboxylase enzymes that decompose vaginal peptides with the formation of volatile amines - ammonia derivatives.

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

Epidemiology

And according to the WHO, worldwide every year more than 350 million people become infected with STIs (almost 143 million with Trichomonas); over 500 million people - the herpes simplex virus (HSV).

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

Although the prevalence of bacterial vaginosis varies considerably from country to country, in Europe and Bad America it is estimated to range from 4.9% to 36%; in Asian regions - approximately 65%. Bacterial vaginosis can occur in any age group, but it is much more common among women of childbearing age. For inflammation of the vagina, an average of 7.5 million women in all countries visit gynecologists during the year.

Vulvovaginal symptoms, including dryness, irritation and itching, occur in 27% of postmenopausal women (according to other sources, at least 80%).

Diagnostics of the itching in the intimate area in women

With itching in the vulva, the diagnosis is carried out by a gynecologist and / or a dermatologist, and the main task of the examination is to find out the cause of this symptom.

This requires a complete history of the patient, a standard gynecological examination is performed, and tests such as:

• general clinical and biochemical blood test;
• blood test for STIs;
• analysis of the microflora from the vagina  based on samples of gynecological cervico-vaginal smears;
• PCR analysis for detection and identification of pathogens of inflammation.

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

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

To eliminate diagnostic errors, all examination results are compared - laboratory and obtained by imaging, that is, differential diagnosis is carried out.

Bacterial vaginosis is usually suspected in elevated vaginal pH (>4.5), but it is also elevated in cases of trichomoniasis, atrophic vaginitis, and vaginal desquamation, so conclusions are drawn from  microbiological and bacterioscopic examination of vaginal discharge .

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

Treatment of the itching in the intimate area in women

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

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

The basis of the traditional (etiological) treatment of bacterial vaginosis is the antibacterial drugs Metronidazole (other trade names are Metrogil, Trichopol, Trihazol, Ginalgin, Flagyl) or Clindamycin (Dalacin, Klimitsin, Zerkalin). These drugs are available in various forms and can be used both systemically (inside) and externally. Fulfilling the prescriptions of the attending physician, with the help of prescribed antimicrobial agents, itching and burning in women are treated at home.

Antiprotozoal and antimicrobial drug of the nitroimidazole group Metronidazole - suspension and tablets for oral administration; vaginal tablets, gel, cream and suppositories (candles) - used daily, twice a day, the course of treatment can last one to two months. As clinical practice shows, treatment with this drug for 4 weeks gives a positive result in 80% of patients, but on average, in 25% of cases, a relapse is observed after two to three months. 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 for 0.15-0.45 g with a minimum duration of admission - 10 days). Vaginal cream with clindamycin - Vagitsin (Kindacin, Clindes) - is used for a maximum of a week (pregnant women are contraindicated). Possible side effects are manifested by the development of a fungal infection, menstrual irregularities, vaginal pain and burning, problems with urination. Although, compared with Metronidazole, Clindamycin is more active against Gardnerella vaginalis and Atopobium vaginae, it also affects lactobacilli, which affects the effectiveness of treatment and increases the likelihood of relapses and the development of superinfection.

Practitioners note a higher efficiency 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 candles for itching in the intimate area in women are recommended by doctors, read in the materials:

• Vaginal suppositories for infections
• Suppositories for vaginitis
• Suppositories from thrush
• Suppositories for vaginal dryness

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

With severe inflammation of bacterial etiology, ointments containing the antibiotic chloramphenicol (Levomekol, Contricomycetin, Iruxol, synthomycin emulsion), ointments with silver sulfadiazine (Sulfargin, Dermazin), etc. Are prescribed.

For the treatment of viral vagininosis caused by Herpes simplex virus, special ointments, liniments and  creams for herpes are intended : Acyclovir (other trade names - Gerpevir, Zovirax), Gossypol, Riodoxol, Bonafon, Florenal.

Treatment of scleroatrophic and other vulvovaginal lichens is difficult; if a bacterial or fungal infection does not join,  antihistamines are used systemically : Cetirizine (Cetrin, Zyrtec, Allertec), Loratadine (Lorizan, Lomilan, Claritin, Claridol), and locally - moderately or fairly strong topical corticosteroids in the form of an  ointment from itching , as well as steroid and non-hormonal creams for itching. However, local corticosteroid therapy is carried out in short courses, since these agents can aggravate atrophic processes in the dermis.

Additional information in the article -  Treatment of postmenopausal atrophic vaginitis: suppositories, alternative means

Ointments Kondilin or Kondyloks (with podophyllotoxin), Imiquimod cream (Aldara) are prescribed for genital warts and papillomatosis. See also:  ointment for genital warts

With candidiasis, Mikoseptin or Zincundan ointments (with undecylenic acid), Nystatin, Amicazole, Clotrimazole, Octicil, Esulan are used. Detailed information about the treatment of candidal vaginitis -  Effective treatment of thrush with creams, gels and suppositories

Practicing cervico-vaginal lavage or  douching with thrush , for which they use saline, an aqueous solution of furacilin (0.02%), antiseptic solutions Miramistin or Chlorhexidine.

Homeopathy

Homeopathic remedies can also be used:

• to moisturize dry flaky rashes that cause itching, relieve erythema - Graphites;
• for inflammation with rash and itching - Arsenicum iodatum, Thuja (oil), Hydrastis;
• in the pustular nature of the eruption and itching in the folds of the skin, Sulphur;
• if prurite of allergic origin - Mezereum.

With dryness, cracks, peeling and itching of the skin of any localization, homeopaths - after examination - prescribe Petroleum, Lycopodium and Sepia (in an individually selected dosage).

Treatment of itching in the perineum in women with alternative means

In most cases, the use of alternative means involves herbal treatment, although modern medicine is difficult to imagine without herbal medicine.

With itching in the intimate area, sitz baths or douching with decoctions of chamomile, calendula, and tansy flowers are recommended; herbs of peppermint, thyme (thyme), horsetail, common centaury, purple lamb, field cornflower; calamus roots, elecampane; bark of barberry and oak.

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

Surgery

Itching may not be an indication for surgery, but surgical treatment may be required in cases of serious complications. For example, when the fallopian tubes become inflamed and pus accumulates around them. Or narrowing of the urethra in patients with lichen sclerosus

They also resort to the removal of genital warts that have grown on the genitals and in the perineum.

Complications and consequences

Recently, in gynecology, the consequences and complications of bacterial vaginosis, which is considered a predisposing factor for infection with herpevirus, HIV, Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae infections, have been especially carefully considered.

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

Bacterial vaginosis can be of particular danger during pregnancy: it greatly increases the risk of its spontaneous interruption in the later stages, premature birth, rupture of the membranes and the development of inflammation of its membranes (chorioamnionitis), as well as inflammation of the uterine mucosa (endometritis) after childbirth.

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

Prevention

The general recommendations are understandable regarding the expediency of visiting a gynecologist from time to time, the need to observe absolute hygiene and the rejection of everything that harms the body as a whole. Of course, lifestyle choices and overall health are major factors that help prevent many problems. But there are only specific  STD/HIV prevention methods.

Prevention of vaginal dysbiosis, and, consequently, bacterial and fungal vaginosis, is to maintain normal vaginal microflora, and for this purpose, vaginal pro and prebiotic agents with lactobacilli are now resorting to.

It is also necessary to monitor the level of glucose in the blood, and in the diet try to do without foods containing sugar. The intestines should work normally, since problems with its microflora affect almost all organs, including the genitals. Live bacterial culture yoghurts, sauerkraut (and all other lacto-fermented vegetables) and also foods with dietary fiber (i.e., plant-based foods) are a good help in maintaining the balance of the intestinal microbiota.

Forecast

For any symptoms, the prognosis correlates with the cause of its occurrence. Therefore, the most disappointing prospects for atrophic vaginitis, which develops during the postmenopausal period, as well as for lichen sclerosus in women of age who experience itching in the intimate area.