genital itching
Introduction
Introduction to genital pruritus Vulvar itching is a self-conscious symptom caused by various vulvar lesions and is common to many skin diseases, not a specific disease. However, it can also occur in patients with completely normal vulva, such as scrapie if there is only itchy skin without obvious primary damage. The term scrapie is limited to the skin with itching and no primary lesions. Chinese medicine calls it "itchy wind", and the disease is generally divided into two categories: limited and systemic. basic knowledge The proportion of illness: 0.025% Susceptible people: women Mode of infection: non-infectious Complications: vestibular gland inflammation vestibular gland cyst vulvar ulcer condyloma acuminata
Cause
Causes of genital pruritus
Special infection (20%):
Vulvovaginal Candida albicans vaginitis and trichomonas vaginitis are the most common causes of genital itching. Haze, hemorrhoids can also cause itching. The pupa caused by tsutsugamushi is usually around the anus and genital itching at night.
Disease factors (12%):
Due to the stimulation of glucosuria to the skin of the vulva, especially with vulvovaginal candidiasis, the genital itching is particularly serious. Many patients are treated first because of genital itching and redness. After further examination, the diagnosis is diagnosed as diabetes. Astragalus, vitamin A, vitamin B deficiency, anemia, leukemia and other chronic diseases, when the genital itching occurs, is often part of the body itching.
Hormone changes during pregnancy (15%):
Intrahepatic cholestasis of pregnancy can also cause generalized skin itching including vulva. Congestion during pregnancy and premenstrual genital vaginal discharge can occasionally cause genital itching and discomfort.
Squamous epithelial cell hyperplasia (15%):
With itching as the main symptom, it may be accompanied by whitening of the vulva skin.
Drug allergy or chemical irritation (10%):
Soap, condom, benzalkonium bromide, etc. may cause contact or allergic dermatitis due to direct irritation or allergies, and genital itching.
Bad health habits (5%):
Do not pay attention to local cleansing of the vulva, sebum, sweat glands, menstrual blood, vaginal secretions, even urine, fecal impregnation, long-term stimulation of the vulva can cause itching, menstrual sanitary napkins, usually wear non-breathable chemical fiber underwear can induce itching due to hot and humid stagnation.
Other skin lesions (3%):
Bruises, common warts, herpes, eczema, tumors, etc. can cause genital itching.
Unexplained genital itching (8%):
In some patients, the genital itching is very serious, and even suicidal thoughts are sprouted, but no obvious systemic or local causes can be found. Some scholars believe that this may be related to mental or psychological factors.
Pathogenesis
Itching is defined as an uncomfortable feeling that can cause a desire to scratch. The itching occurs in the superficial layer of the skin, the mucous membrane, the upper respiratory tract and the binding membrane. The polymorphic c-fiber fiber tip is a pruritic receptor that can be used by many species. a substance called itch-causing stimulus, which produces nerve impulses, which are transmitted to the ipsilateral spinal dorsal root ganglia, where they form synaptic connections with secondary neurons, and then the secondary neurons cross the contralateral spinal thalamus. The bundle reaches the ventral nucleus of the thalamus and then passes through the inner capsule to reach the center of the somatosensory cortex. The cerebellum cortex can integrate and downregulate the itching. Itching can also start in the center. Some central system diseases such as trauma, stroke, Brain abscesses, tumors and multiple sclerosis can induce itching. The occurrence of pruritus is basically caused by the release of chemical mediators such as histamine, kinins and proteases. The role of proteases is particularly important. , blood, bacteria and candida are all present, due to trauma or other reasons can be released in the tissue activation, leading to skin itching, histamine It is the most common pruritic medium causing itching, but not all itching is related to histamine. Many diseases cause itching antihistamines to be ineffective. It can be seen that different diseases cause different itching mechanisms. Recently, many chemical molecules have been found in research. It is closely related to the occurrence of itching.
Prevention
Vulvar pruritus prevention
Pay attention to menstrual hygiene, keep the vulva clean and dry, avoid scratching, do not use hot water to wash, avoid using soap, use potassium permanganate bath when there is infection, but it is forbidden to scrub locally, especially the underwear should be loose and breathable, avoid alcohol And spicy or allergic foods.
Complication
Vulvar pruritus complications Complications vestibular gland inflammation vestibular gland cyst vulvar ulcer condyloma acuminata
Vestibular gland inflammation
The vestibular gland grows in the lower back of the labia majora on both sides, opening in the groove between the vaginal opening, the labia minora and the hymen. Because of the characteristics of the anatomical site, the pathogen is easy to invade and cause inflammation.
2. Vestibular gland cyst
If the opening of the duct is blocked due to hyperemia and secretion of inflammation, the exudate accumulates in the glandular cavity and forms an outward protruding mass, a large vestibular cyst. Absent of bed rest in the vestibular gland inflammation, pay attention to keep the vulva clean.
3. Vulvar ulcer
Vulvar ulcers occur in the inner side of the labia majora and labia minora, and are more common in young and middle-aged people. Mainly manifested as damage to the epidermis of the vulva, often repeated attacks, not easy to cure. If the vulvar ulcer occurs simultaneously with ophthalmia and oral ulcers, it is called eye, mouth, genital syndrome, may be accompanied by high fever, local severe pain, and repeated prognosis. Clinically known as Behcet's disease.
4. Vulvar condyloma acuminata
It is a small mites caused by viral infections, which occur at the junction of the skin and mucous membranes, and sometimes can be fused into cauliflower. Contagious through contact and repeated attacks.
Symptom
Symptoms of genital pruritus Common symptoms leucorrhea anal fissure anal itching eczema papules dizziness appetite bloodless insomnia melancholy
Systemic scrapie is more common in adults, often starting from a certain part, and then gradually expanding to most parts of the body or the whole body. When itching occurs in a certain part of the body, it is called localized scrapie, and there are several cases at the same time. Anus, scrotum, female yin and other parts are most common, in addition to the head, calf, palmar and external auditory canal, this section mainly introduces the female genital and surrounding scrapie.
1. Female pruritus
Most female pruritus is a woman before and after menopause, which may be related to endocrine disorders, low levels of sex hormones and autonomic dysfunction of menopause. Patients are often accompanied by symptoms such as excessive sweating, emotional instability and insomnia. The itching area is mainly in the labia majora. And labia minora, but the haze, clitoris and vaginal mucosa also often have itching sensation. In severe cases, it can affect the perianal and perineal areas, drinking, emotional changes, high temperature of the bedding, scratching, and even some hints may cause itching. Or aggravation, the degree of itch can vary from person to person, the duration is also different, the itching is paroxysmal, the night is heavy, the itching is severe and unbearable, making the patient restless.
Because itching severely affects sleep, symptoms such as dizziness, mental depression and loss of appetite can occur, due to constant scratching, strip scratches, blood stasis, papules, eczema-like changes, mossy changes and pigmentation. Hair damage, labial skin often infiltrating and hypertrophy, clitoris and vaginal mucosa may appear redness and erosion, local infection due to sputum crushing can be secondary infection, scrapie caused by different causes may have different clinical manifestations, Candida female Female genital itching caused by vaginal vaginitis can be seen in white bean curd slag leucorrhea, secretion microscopic examination or culture of Candida growth, vaginal itching caused by trichomonas vaginitis, more leucorrhea, foamy, can find vaginal hair drops Insects, pruritus caused by pruritus generally have more purulent leucorrhea, atrophy of the vulva skin of elderly women can also cause female pruritus, due to contact with contraceptives, rubber menstrual belt, diabetes and other female genital itching is not uncommon, but There are also some intractable female genital itching (including unmarried young women), the current inspection methods can not find the reason.
2. Anal scrapie
Generally, middle-aged men are more common, but women can also develop the disease. Children with tsutsugamushi can also suffer from it. Itching is usually limited to the skin around the anus and its skin. It can also spread to the perineum, the skin of the female or scrotum. Anal itching caused by insect infection is more common in children, often aggravated at night, can find aphids or eggs (high night positive rate), adult anal itching is often caused by hemorrhoids, anal fissure, etc., many patients can not find the reason The symptoms of anal itching are very serious, because of frequent scratching, anal folds may appear hypertrophy, radial splitting, infiltration, mossy changes or eczema-like secondary damage.
In general, if the location of itching is not related to malignant tumors, it is worth noting that female pruritus may be associated with cervical cancer; perianal itching is associated with colorectal cancer.
Examine
Examination of genital pruritus
General examination: vaginal secretion examination, hormone level detection, blood routine, blood biochemical examination.
Other auxiliary examinations: histopathological examination.
Clinical manifestations: Systemic scrapie is more common in adults starting from a certain part, and then gradually expanding to most or all parts of the body. When itching occurs in a certain part of the body, it is called localized scrapie and there are several cases at the same time. It is most common in the anus, scrotum, and female genitals. In addition, it can also be found in the calf and the external auditory canal.
Diagnosis
Diagnosis and diagnosis of genital pruritus
According to the medical history, only itching at the beginning of the disease, and no rash, can be diagnosed. In the absence of secondary rash, the general diagnosis is not difficult. Once a secondary rash occurs, it is necessary to prove the initial onset according to the medical history. Only itching, and no rash, can be diagnosed as scrapie. When diagnosing scrapie, it is more important to find the cause. The medical history should be consulted for comprehensive physical examination and necessary laboratory tests to find the primary lesion.
Secondary skin lesions can be confused with eczema, neurodermatitis, and femoral hernia, and the disease needs to be differentiated from urticaria, eczema, drug eruption, insect bite dermatitis, rickets, hemorrhoids, etc., but detailed medical history is not difficult to identify. .
