Senile vulvar atrophy
Introduction
Introduction to senile vulvar atrophy Senile vulvar atrophy is atrophic change caused by skin dystrophy caused by skin tissue loss and dysfunction in all or part of vulvar skin mucosa. Aged vulvar atrophy due to aging, endocrine disorders, malnutrition, chronic infection, Poisoning, congenital anomalies or neurotrophic dysfunction, etc., can also be caused by mechanical long-term compression, traction or physical factors such as radioactive damage or chemical stimulation. basic knowledge The proportion of sickness: 0.01% Susceptible people: the elderly Mode of infection: non-infectious Complications: urinary tract infection, urinary incontinence, anal fissure
Cause
Causes of senile vulvar atrophy
Primary vulvar atrophy (30%):
In postmenopausal elderly women, ovarian function declines, estrogen levels decrease, and their target organs shrink. The primary vulvar atrophy is thinner, the stratum corneum is thinner, the dermis has a glassy change, and the subcutaneous elastic fibers are reduced.
Vulvar white lesions (20%):
Also known as chronic vulvar dystrophy, it is divided into proliferative type, sclerotic moss type and mixed type. In the case of hardened mossy type lesions, the inflammatory lesions make the dermal elastic tissue disappear and fibrosis, and the clitoris and labia minora atrophy. The pathological features are excessive keratinization of the epidermis layer and even horn plugs, atrophy of the epidermis with basal cell liquefaction, reduction of melanocytes, edema of the dermis, loss of collagen fiber structure and homogenization, and lymphocytic infiltration of the middle layer of the dermis.
Lichen planus (15%):
Caused by leucorrhea, scratching and other chronic stimuli, often accompanied by severe atrophic changes. The lichen planus granule layer hyperplasia, hyperkeratosis and acanthosis hypertrophy, the dermal layer has banded inflammatory infiltration, and invades the epidermis, the basement membrane often has liquefaction and degeneration, and the epithelial cells degenerate to form a gelatinous body.
Vulvar leukoplakia (10%):
It is a proliferative change of the vulvar mucosa. It has a malignant transformation of 10% to 20%. It may be formed by long-term stimulation such as trauma, inflammation, allergies, infection, etc., and finally it may cause atrophy of the vulva. During the hypertrophy period, the epithelial layer is thickened, keratinized, and the nipple is hypertrophied and often falls into the connective tissue. During the atrophic period, the chronic inflammation changes significantly, the degree of edema is different, the elastic fibers under the epithelial layer almost completely disappear, and the hypertrophy period and thetrophic period There is no clear boundary between them, the epithelial layer may be significantly thicker at one place and thinner at the other.
It has been suggested that vulvar leukoplakia can be divided into three levels according to the degree of epithelial cell hyperplasia:
Grade I: Epithelial spine cells thickened, the nipples were trapped in connective tissue, but the cells showed no atypical changes.
Grade II: Atypical cells appear, with scattered nuclear division and epithelial bead formation.
Grade III: Cells have variability, inconsistent size, and mitotic division, with similar changes to carcinoma in situ.
Prevention
Senile vulvar atrophy prevention
Regularity of life, reasonable diet, comfortable mood, moderate exercise, keeping the vulva clean, early diagnosis, active treatment, good follow-up, prevention of cancer.
Complication
Senile vulvar atrophy complications Complications urinary tract infection urinary incontinence anal fissure
Severe cases may occur vaginal and urinary tract infections, urinary incontinence, difficulty in sexual intercourse, mild incontinence of the stool, anal fissure, etc.
Symptom
Symptoms of senile vulvar atrophy Common symptoms Vulvar atrophy Skin dry hair Loss anal fissure muscle tension Reduce subcutaneous fat disappears Vulva leukoplakia pruritus Itching scales
It is characterized by thinning and dry skin, reduced elasticity and relaxation, wrinkles on the surface, atrophy of sweat glands, decreased sweat, decreased secretion of sebaceous glands, thinning of hair, and pigmentation and hypopigmentation, telangiectasia, thin scales and Freckle, often accompanied by seborrheic keratosis, senile keratosis, senile hemangioma, purpura, skin sputum, senile fibrosis and other diseases, the specific performance is as follows:
1. When the primary vulvar atrophy starts, the subcutaneous fat disappears, the labia majora is flat, and then the pubic hair falls off, the epidermis is withered, the surface is smooth, dry and shiny, waxy luster, sometimes red spots, labia minora and clitoris eventually May disappear, genital itching, burning or tingling, if there is secondary infection, urinary pain, vaginal opening due to atrophy and narrow, so that sexual intercourse is difficult, the extent of atrophy can be extended to the perineal body, around the anus, and anal sphincter Reduced tension, mild fecal incontinence; anal fissure due to atrophy.
2. The main symptoms of hardened mossy malnutrition are itching in the lesion area. The lesions involve the vulva skin, mucous membrane and perianal skin. The clitoris, labia minora, and posterior joint are the most common lesions, and the appearance of the skin mucosa becomes white. Thin, dry and easy to split, lose elasticity, clitoral atrophy, small labia minora, late skin thin like cigarette paper, narrow vaginal opening, resulting in difficulty in sexual intercourse, severe cases like vulva resection, that is, "the vulva dry."
3. The lichen planus is severely itchy, and the umbilical fossa area appears in the brown and moist area. The surface is rough, moist, and scratches are visible. The inner side of the vestibule and labia minora can be seen with reddish plaques, except for the size of the labia, clitoris. And outside the perineum, often involving the vaginal mucosa, often accompanied by severe atrophic changes, but the vaginal opening and vagina without atrophy and stenosis.
4. Vulvar leukoplakia is more common in menopause. The lesions are mostly inside the labia majora, labia minora and clitoris. It can spread the entire labia majora, around the perineum or anus, local itching, dryness, tingling and burning, mucous membrane On the upper part, the thickened tissue with a high surface is visible in white or gray, sometimes with splitting and ulceration.
Typical cases can be diagnosed according to symptoms and signs, but rely on biopsy. Biopsy should be performed at the suspected lesions, and multiple points should be taken to eliminate malignant transformation. If it can be stained with 1% toluidine blue first, then 1% acetic acid. Decolorization of the solution, biopsy in the non-decolorization zone, can improve the positive rate of diagnosis. In recent years, colposcopy has also been applied to the vulvar lesions, which helps to eliminate cancer.
Examine
Examination of senile vulvar atrophy
Hormone level test, vaginal secretion examination. Histopathological examination, colposcopy.
Diagnosis
Diagnosis and diagnosis of senile vulvar atrophy
Should be identified with the following diseases:
1. Vulvar leukoplakia is a proliferative change of the vulvar mucosa, and 10% to 20% of malignant changes occur. It may be formed by long-term stimulation such as trauma, inflammation, allergies, and infection.
2. Lichen planus is caused by chronic stimuli such as vaginal discharge and scratching, and often has severe atrophic changes.
3. Vulvar white lesions are also known as chronic vulvar dystrophy. It is divided into proliferative type, hardened moss type and mixed type. In the case of a hardened mossy type of lesion, the inflammatory lesions cause the dermal elastic tissue to disappear and fibrosis, and the clitoris and labia minora atrophy.
