Pruritis Vulvae

Question 1

What are the causes of pruritis vulvae?

Answer 1

• Vulvovaginitis - e.g. vulvovaginal candidiasis, atrophic vaginitis, vulvar vestibulitis and contact dermatitis → infection, eczema, contact dermatitis
  
  • Candidiasis
  • Atrophic vaginitis = 10-40% of post-menopausal women

Question 2

What are the signs and symptoms of vulvovaginal candidiasis pruritis vulvae?

Answer 2

• Vulvar pruritus
• Burning
• Erythema and oedema of the vestibule and labia
• Thick white curd-like PVD
• Chronic
  
  • Grey-sheen of epithelial cells
  • Severe pruritus
  • Irritation and pain
  • Lichenification of vulva

Question 3

What are the signs and symptoms of atrophic vaginitis pruritis vulvae?

Answer 3

• Soreness
• Dyspareunia
• Burning leucorrhoea (white mucous discharge)
• Occasional spotting

Question 4

What are the signs and symptoms of vulvar vestibulitis pruritis vulvae?

Answer 4

• Primary (20%) = introital dyspareunia
• Secondary = introital dyspareunia that develops after period of comfortable sexual relations
• Pain, soreness, burning, rawness

Question 5

What are the signs and symptoms of contact dermatitis pruritis vulvae?

Answer 5

• Pruritus
• Can get burning
• Pain
• Erythema/red
• Ulcerative skin following contact

Question 6

What are the appropriate investigations for pruritis vulvae?

Answer 6

• Vulvovaginal candidiasis = wet-mount test or KOH preparation
• Atrophic vaginitis = vaginal pH and wet-mount test (often shows white blood cells and paucity of lactobacillus)

Question 7

What is the management of vulvovaginal candidiasis pruritis vulvae?

Answer 7

• Ketoconazole (400mg/day) for 6 weeks
• Fluconazole (100mg/week) for 6 weeks
• Clotrimazole 500mg suppositories once per week

Question 8

What is the management of atrophic vaginitis pruritis vulvae?

Answer 8

• Topical vaginal oestrogen or HRT

Question 9

What is the management of vulvar vestibulitis pruritis vulvae?

Answer 9

• Pain management with sex therapy
• Behaviour modification
• Topical steroid
• Anaesthetic
• Petroleum jelly
• Anti-inflammatories
• Surgical excision as last resort → success rate of 60-80%

Question 10

What is the management of contact dermatitis pruritis vulvae?

Answer 10

• Remove itching agent
• Mild CD → 1% hydrocortisone cream
• Moderate CD → betamethasone
• Severe CD → wet compresses of aluminium acetate
• Triamcinolone ointment applied BD
• If seborrhoeic dermatitis → consider ketoconazole shampoo body wash

Question 11

What are the complications of pruritis vulvae?

Answer 11

• Atrophic vaginitis → super infection due to raised vaginal pH
• Candida → disruption to social and sexual life
• Prognosis:
  
  • Atrophic vaginitis = substantial relief with treatment
  • Candida = good with treatment but frequent recurring attacks in 5%