Vulvar pain
Introduction
Introduction to vulvar pain Vulvar pain is chronic genital discomfort characterized by burning, stinging, tenderness or irritation. Although the current symptoms of this group of symptoms are collectively referred to as vulvar pain regardless of the cause, it is generally believed that vulvar pain refers only to those whose causes are unknown. Vulvar pain without obvious infection or organic disease is called vulvar pain syndrome (VPS), including vulvar vestibulitis (VV), annular vulvitis, paresthesia vulvar pain. basic knowledge Sickness ratio: 0.1% Susceptible people: women Mode of infection: non-infectious Complications: vestibular gland inflammation vulvar ulcer vestibular gland cyst
Cause
Cause of vulvar pain
(1) Causes of the disease
Vulvar pain is a group of heterogeneous diseases. The cause may be multifactorial. There are many studies on vulvar vestibulitis, and there are few reports of annular vulvitis and paresthesia.
Candida infection (28%):
The history of vulvovaginal candidiasis is the only constant feature of patients with vestibulitis, but inappropriate topical antifungal drugs can also cause these symptoms. In addition, the rate of Candida colonization in patients with vestibulitis is not higher than that of the control group. The etiology of vulvitis is unknown, but Candida albicans may be a potential cause, and anti-candida treatment is usually effective.
Iatrogenic factors (15%):
Patients with vulvar pain often have a history of using topical drugs many times. Because the protective barrier function of the stratum corneum of the vulva skin is not as good as that of other parts of the skin, vulvar stimulation caused by topical drugs is more common, and stimulation may not be the cause of the initial symptoms. However, it may prolong the symptoms associated with vulvar pain, the incidence of priming sensitization in this lesion does not increase, and there is no histological evidence to confirm or rule out the occurrence of allergic contact dermatitis.
Psychological factors (12%):
Patients with vulvar pain have obvious psychological and sexual psychological morbidity, but whether it can cause symptoms is still controversial. Insufficient sexual arousal during sexual intercourse can cause less lubrication and cause vulvovaginal stimulation, while periodic vulvar irritation can cause vulvar pain, but Several studies did not show that the patient's unpleasant experience or sexual promiscuity rate was higher than the control group, and there was no obvious sexual psychological disorder in the sexual partner.
Genetic quality (10%):
Vulvar pain occurs in whites, blacks and Asians are rare, and this is the true genetic predisposition or the impact of sociodemographic factors.
Dietary factors (15%):
Some scholars speculate that vulvar pain is associated with high oxalic aciduria. Sharp oxalate crystals are in contact with the epithelial surface causing severe burning. However, the patient's 24h urinary oxalate excretion is not higher than the control group, and calcium citrate is low. The oxalate diet was treated for 3 months, and only 10% of cases recovered. Therefore, urinary oxalate could not be the cause of vulvar pain, but it can be used as a non-specific stimulator to aggravate vulvar pain.
Estrogen effects (12%):
The effects of estrogen are reflected in:
(1) The symptoms of many patients are aggravated during menstruation.
(2) Serum estrogen levels are low, which is often the case after childbirth (relative estrogen), even in cesarean section.
(3) The relative risk of oral contraceptives and vulvar pain increased by 11 times. Although estrogen may contribute to the symptoms, its role needs further evaluation. There is no control study showing estrogen replacement therapy (topical or oral). effective.
(4) Human papillomavirus infection: It is currently considered that the relationship between vulvar pain and human papillomavirus is a coincidence, because the infection rate is not significantly higher than that of the control group, and the human papillomavirus is not a neurotropic virus.
(5) pelvic floor muscle tension: Most patients with vestibulitis have unstable levator ani muscles, poor recovery after muscle contraction and elevated resting tension. Although the pelvic floor muscle tension is the cause of symptoms persisting, it still needs to be clarified. Biofeedback therapy with excessive levator muscle tension is indeed a promising therapy.
(6) Neurological factors: vulvar pain is similar to reflex sympathetic dystrophy, and there is persistent pain in the absence of tissue damage. Animal experiments have shown that repeated activation of skin nociceptive sensor (C fiber) leads to the peripheral nervous system. With changes in the central nervous system, increased sensitivity to skin nociceptors is caused by release of neuropeptides such as substance P, calcitonin gene-regulating peptide, endorphin, serotonin and other catecholamines; these neuropeptides have a vestibular effect, It can increase the inflammatory process. The level of substance P in the vestibule of patients with vestibulitis is higher than that of the control group, and the density of nerve fibers in the epithelium is also increased. The sensitivity of the central and peripheral nerves may be the reason for the persistence of symptoms after the initial tissue trauma has subsided.
(two) pathogenesis
Patients with vestibulitis and annular vulvitis may have pathological changes in non-specific inflammation, such as hyperkeratosis, parakeratosis, acanthosis, and dermal telangiectasia.
Prevention
Vulvar pain prevention
Try to introduce patients to known knowledge of vulvar pain. Patients need to understand that their own problems are not caused by sexual transmission, nor are they signs of malignancy or their own faults. It is also necessary to understand that stimulation is not chronic recurrence. Intractable fungal infections, and although symptoms cannot be quickly controlled, it is still possible to treat and achieve satisfactory sexual intercourse.
Complication
Vulvar pain complications Complications vestibular gland inflammation vulvar ulcer vestibular gland cyst
1. Vestibular gland inflammation: The complications caused by this vulvitis are more common in women of childbearing age. It is because the vestibular gland is infected by bacteria such as Staphylococcus, Streptococcus, Escherichia coli, etc., causing acute inflammation.
2, acute vulvar ulcer: caused by vulvitis of various reasons, generally a manifestation of vulvitis lesions, is also one of the complications caused by vulvitis.
3, infertility: due to vulvitis can cause a variety of gynecological inflammation, which also includes inflammation of the ovary and inflammation of the uterus, ovarian inflammation can cause non-ovulation or the egg can not pass, thus affecting conception.
4, vestibular gland cysts: due to chronic inflammation for a long time, the vestibular large gland duct obstruction, accumulation of glandular fluid, cystic dilatation caused by glandular; or due to acute vestibular gland inflammation subsided, pus was absorbed.
Symptom
Vulvar pain symptoms Common symptoms Dull pain Vulvar pain Feeling allergic Herpes Tongue pain Neuralgia
Vestibular inflammation
It is a vulvar pain characterized by pain in the vestibular area. It often has a history of irritating pain, such as superficial pain, menstrual tampon intolerance and pain during gynecological examination, or pain when wearing tight pants or cycling. The medical history lasts for several months to several years. The patient is often a woman before menopause. The pain may occur during the first sexual intercourse or after undergoing normal sexual activity, often under the influence of some stimulating factors (such as surgery, childbirth, infection). Acute attack, vestibular area has different degrees of erythema, light touch can cause acute pain; hyperesthesia is located in the entire vestibular area, or limited to the vestibular gland opening or labial ligament, generally the most obvious anterior chamber gland opening is tender. About 30% of cases resolved spontaneously, and half of them occurred within 1 year.
2. Annular vulvitis
Symptoms of annular vulvitis are intermittent and related to the menstrual cycle, often occurring in the menstrual period, irritation after sexual intercourse, and many patients with erythema and mild desquamation can be found in the examination.
3. Feeling abnormal vulvar pain
Also known as idiopathic vulvar pain, occurs in menopausal women, without sexual pain, symptoms are persistent, non-irritating vulvar pain and dull pain, occasionally involving the perianal, perineum and inner thigh, the characteristics of pain are often similar Other neuropathic pain syndromes such as postherpetic neuralgia, no abnormalities in the vulva, occasional erythema may be normal anatomical variation, no obvious tenderness or tenderness, and a history of other chronic pain (such as tongue pain) is not uncommon.
Examine
Vulvar pain check
At the time of initial diagnosis, patiently listen to the patient's complaints and carefully examine the vulva, vagina and oral cavity; microscopic examination and PCR detection of vaginal secretions; first of all, to eliminate various vulvar painful diseases with clear etiology. Usually a routine, brief dermatological outpatient examination does not fully understand the symptoms of patients with chronic genital pain. Vestibular inflammation is mainly characterized by sexual pain, vestibular erythema and irritation pain; annular vulvitis is more common in young women. There is a ring-shaped erythema in the vulva and a little desquamation. The abnormal vulvar pain has no obvious signs, but it can be diagnosed according to persistent dull or non-irritating pain in women who are in menopause.
Laboratory inspection:
Direct microscopic examination of vaginal secretions: polymerase chain reaction (PCR) detection of fungal human papillomavirus: Human papillomavirus can be detected in some patients.
Other auxiliary inspections:
No abnormal performance.
Diagnosis
Diagnosis of vulvar pain
Should be differentiated from cancer pain:
The occurrence of cancerous pain is the result of multiple factors. In the course of its pathogenesis, there are pathological changes and psychological factors; that is, there are pathogenesis of "not glory but pain" and "pain caused by reality" The pathology, etc., therefore, when clinical application of the above rules, we must pay attention to the combination of syndrome differentiation, comprehensive analysis, reasonable compatibility, in order to play a better therapeutic effect. Cancer pain affects mood and confidence affects all symptoms. However, some patients express negative emotions through physical symptoms and enclose themselves in the great pain of recurrence. In fact, they have unresolved fear, unexpressed anger and Problems common to patients with emotional conflicts. Functional abdominal pain (intestinal irritation syndrome) may be the way in which a patient expresses negative emotions throughout life. There is no doubt that it is impossible to change the way behaviors that have been established for a long time.
