Such a pathology as kraurosis of the vulva is, in essence, a progressive skin atrophy of the mucous membrane caused by involutional changes in the female external genital organs. In addition to atrophic processes, the disease is expressed in progressive dystrophy and sclerotic defects of the reproductive system, which are often associated with leukoplakia. Often, kraurosis of the vulva (photos can be seen in many specialized medical literature sources) is accompanied by psychoemotional and neurovegetative disorders.
The disease mainly develops in patients in menopausal and post-menopausal periods, and therefore the relationship of pathology with a decrease in the production of estrogen hormones is well traced. However, in some cases, the disease can be diagnosed even in women of reproductive age and young girls. The signs of the disease are not just unpleasant, because vulvar kraurosis is a precancerous condition that requiresmandatory therapy.
Anatomical features
Vulva is a concept of medical terminology that defines the area of the female external genitalia. From the upper side it is limited by the pubis, from the lower side by the entrance to the vagina, and also in virgins by the hymen. The external genitalia of a woman includes the labia majora, labia minora, vestibule vaginal and Bartholin's glands, the urethral outlet (the opening of the urethra from the outside), and the clitoris.
The vulva is covered with mucous membranes and skin, in which there are a lot of blood vessels, glands and nerve receptors. The vulvar tissues are so delicate that they can easily be injured and prone to inflammation. The immune and hormonal systems are responsible for their condition. Estrogens help maintain the tone of the mucosa and skin of the vulva, elasticity, normal blood supply, and the ability to combat negative factors. However, in premenopausal age, with hormonal changes and transformations in the functioning of the pituitary - hypothalamus - ovaries, the production of estrogens decreases, which is not able to affect the state of the tissues of the penis. Functional and structural disorders, thinning (atrophy), slight traumatization, dryness, predisposition to various inflammations occur in them.
Description
Kraurosis of the vulva (in other words, lichen sclerosus) is a disease related to degenerative lesions of the external genital organs, which is characterized by atrophy of the mucous membranes and skin, due to their involution. leakingprogresses for a long time and all the time, manifests itself in the form of dryness of the mucous membrane and skin, as well as itching. As already noted, this pathology is especially common in older women (during menopause).
Causes of vulvar kraurosis
The exact causes that lead to the development of the disease are still unknown. At the moment, there are a certain number of theories, while none of them fully explains the development mechanism and etiology of lichen sclerosus. Autoimmune and neuroendocrine defects, psychogenic factors, as well as infectious and viral agents are of some importance in the occurrence of kraurosis and leukoplakia of the vulva.
There are several risk factors in the development of this pathology of the female external genitalia:
- diseases of the hormonal sphere (adrenal glands, ovaries, pituitary gland, thyroid gland);
- small childbearing period (if the menopause is early, then this indicates the presence of pronounced ovarian hypofunction);
- injuries to the external genital organs or operations performed on them;
- ovariectomy at a mature and young age;
- chemical genital burns (for example, after douching with a highly concentrated solution of potassium permanganate);
- autoimmune diseases and reduced immunity;
- obesity;
- permanent vulvovaginitis and vulvitis;
- psychogenic factors (constant depression and stress, obsessive fears);
- neglect of intimate hygiene;
- herpes or papilloma virus;
- emotional lability;
- permanent overheating.
Features of the development of the disease are also insufficiently studied. With kraurosis of the vulva, several moments are distinguished, successively replacing each other. Initially, the pathology is marked by defects in microcirculation and blood supply in the tissues, swelling of the mucous membranes and skin, leading to hypoxia. After that, atrophic disorders of the collagen structure develop, and the elastic fibers disintegrate due to increased elastase activity. In addition, nerve endings are destroyed. The structure of the connective tissue is also disrupted, leading to blockage of the arterioles and an even more severe disruption of blood supply in the external genital organs.
Symptoms of vulvar kraurosis
In case of a disease, the symptoms directly depend on the duration and degree of its prevalence, the severity of the process, as well as the availability of treatment before it. The pathognomic sign of kraurosis is intermittent or persistent itching in the vulva. This symptom can be combined with a feeling of tightening or burning of the skin, as well as a feeling of dryness of the genitals after washing with too harsh soap. Usually, the onset and intensification of itching is characteristic of night time, as well as after hygiene procedures and emotional experiences. Due to the thinning of the mucosa and skin, they are easily injured, sores and cracks appear in these places, complementing the itching with pain. Narrowing of the vaginal vestibule and atrophy of the labia adversely affect sexual intercourse, making it painful orbasically impossible.
According to reviews, vulvar kraurosis is a rather unpleasant pathology. Due to the fact that the opening of the urethra narrows, there are problems with urination, the patient experiences pain. In addition to local manifestations, patients with lichen sclerosus have well-defined defects in the nervous system: emotional lability, depression, sleep problems, irritability, aggressiveness, vascular disorders (arterial hypertension), problems in the metabolism of fats and carbohydrates (obesity). The disease is characterized by a vivid clinical picture, and only two percent of patients have no complaints.
The disease has three stages, easily determined during a gynecological examination.
- Initial stage. At this stage, redness and swelling of the external genital organs appear. If you look at the labia, you can see a pronounced swelling and hyperemia, resembling a simple inflammation. Patients at this stage complain of goosebumps, tingling, mild to moderate itching.
- Atrophic stage of vulvar kraurosis in women. During the examination, it is very easy to determine the kraurotic triangle, in which the top goes to the pubis, while the base is located in the upper third of the labia. The labia minora become thinner, become flat, and the size of the clitoris decreases. The color of the soft tissues of the external genital organs also changes, acquiring a whitish hue (waxy or pale blue). The hairy area is not affected, but narrowing of the vaginal opening may also be observed.
- Sclerotic stage. DuringAt this stage, the labia minora and the clitoris "disappear", that is, they atrophy, they are practically invisible, while the labia majora become flat and resemble rollers, while limiting the suddenly narrowed vaginal entrance. In addition, the opening of the urethra is greatly reduced. The hairy part disappears. Mucous membranes and skin get a pearlescent shade, become glossy. At the same time, many small folds appear on the tissues of the external genital organs, while they resemble a sheet of crumpled parchment. In addition, there are numerous small hemorrhages, scratches and microcracks on the mucous membranes and skin. The process progresses more and more and at the same time captures the inguinal folds, the perinatal area and the inner femoral surfaces. At this stage, the itching is unbearable to such an extent that the woman is unable to resist constantly scratching the inflamed surface, which causes microtraumas to form again and suppurate.
Diagnosis of disease
Kraurosis of the vulva (ICD code N90.3) at the stage of sclerosis and atrophy is not easy to confuse with any other pathology. However, at the initial stage, the disease should be distinguished from neurodermatitis, vitiligo, lichen planus, vulvovaginitis and diabetes mellitus. Diagnosing lichen sclerosus of the external genital organs is quite easy already during the initial examination of the patient. However, taking anamnesis is unlikely to help make a diagnosis, as characteristic data are not available.
Complaints of the patient and information aftergynecological examination. Instrumental research methods are simple as well as extended vulvoscopy, that is, examination through a colposcope not only of the vaginal walls and uterine neck, but also of the soft tissues of the external genital organs.
Laboratory tests include a blood sugar test to rule out diabetes, and an HPV polymerase chain reaction performed on vulvar tissue cells to determine the presence or absence of HPV. In addition, cytology of smears from the tissues of the genital organs is also carried out.
In especially dangerous cases, a histological analysis of a section of the mucosa or skin of the vulva is also carried out in order to exclude a malignant process. It is better to take the material aimingly, that is, under vulvoscopy. In addition, immunogram information should be examined to rule out immunological defects.
How is vulvar kraurosis treated?
Treatment
Treatment is a rather difficult task, since the causes and features of the development of this pathology have not been studied so far. Patients most often are not subject to hospitalization, it is provided only for surgical intervention.
Conservative therapies are now preferred. Of course, first of all, a change in the habitual way of life is required:
- synthetic underwear is completely excluded, especially light ones;
- giving up bad habits (alcohol abuse and smoking);
- compliance with the norms of intimate hygiene (you need to wash yourself twice a day using a softsoap);
- not allowed to use cotton swabs and pads, as well as scented toilet paper;
- do not use intimate sprays and deodorants, bath foams and shower gels;
- proper nutrition - a he althy lifestyle plays a significant role in the treatment of vulvar kraurosis.
Features of food
There is no special diet for lichen sclerosus of the external genitalia. You just need to follow the rules of a he althy diet. First you need to give up black tea and coffee, because they contain a high degree of caffeine, which has an exciting effect on the psycho-emotional unstable background. In addition, you need to exclude smoked meats, pickles, seasonings and spicy foods, since these foods will only aggravate the itching in the vulva. The diet should contain as many vegetable oils as possible as sources of vitamins A and E - natural antioxidants that have a beneficial effect on the condition of the skin and increase its tone and elasticity. It is also necessary to refuse fried and fatty foods, fast food and semi-finished products, since they contain a lot of preservatives, carcinogens and stabilizers, and this causes the appearance of malignant neoplasms. The diet should be dominated by fresh fruits and vegetables. In particular, green vegetables and juice cocktails made from them will benefit. Overweight patients should limit their intake of high-calorie foods such as simple carbohydrates (sweetened carbonated drinks, confectionery, baked goods).
How else is vulvar kraurosis treated? Photo therapy methods are also found in the medical literature.
Non-drug therapy
Women with kraurosis are often helped by non-drug treatment, which consists in prescribing physiotherapy. The following methods apply:
- laser therapy - exposure to a laser beam on the inflamed area for up to five minutes at a number of points, one course - from 12 to 16 procedures (it eliminates itching well, improves the psycho-emotional state and sleep);
- ultrasound;
- acupuncture;
- glucocorticoids and phonophoresis;
- UVR of the lumbar region and sacrum;
- ozone therapy;
- balneological procedures (baths, showers and irrigation using mineral waters, mud treatment);
- photodynamic therapy;
- Mistletoetherapy (drugs with white mistletoe are administered to stimulate the immune system);
- radiotherapy.
It's good that vulvar kraurosis is not very common among female diseases.
Photodynamic treatment
An innovative method is photodynamic therapy of kraurosis, which consists in the introduction of photosensitizers (photohem, photoditazine, photosens, etc.) into the patient's body intravenously, after which the inflamed areas of the external genital organs are irradiated with a low-intensity laser beam. Thanks to the photochemical reaction that occurs after this, the photosensitizer is activated, after which active radicals and oxygen are released, affectingatypical cells, as a result of which their necrosis occurs, while he althy cells become intact. The patient is pre-assigned to such examination methods as:
- colposcopy;
- complete blood count;
- Vulva cytology;
- biochemical blood test.
Phototherapy has many benefits, ranging from 90% to 95% effective in treating kraurosis. Its virtues are as follows:
- perfect safety;
- painless method;
- healing is fast;
- does not leave scars;
- hospitalization not required;
- only one session is enough;
- beautiful cosmetic effect;
- complications and adverse reactions are absent;
- effect exclusively on atypical cells;
- small postoperative period and fairly quick recovery of the ability to work.
Which ointments are effective for vulvar kraurosis?
Medicated treatment
Physiotherapy is not the only method. Kraurosis is also treated with medication. Treatment with drugs for this disease is carried out not only locally, but also systemically. For external treatment, creams and ointments are used, which include hormones. The vulva area is lubricated with creams once or twice a day. How to treat vulvar kraurosis is of interest to women who have undergone this disease. Means for local therapythe following:
- cream containing estrogens ("Permarin", "Estriol") - it is applied twice a day, the duration of the course is 2-3 weeks (endometrial growth is not stimulated, but is not indicated for patients of reproductive age);
- progesterone cream ("Krynon", "Pragisan") - also applied twice a day for 3-4 weeks, is optimal for the treatment of young patients;
- ointment containing 2% testosterone - has a bright antipruritic effect, enhances the elasticity of the tissues of the external genital organs, is applied twice a day, the duration of the course is from two to three weeks;
- glucocorticoid ointments that reduce the susceptibility of skin receptors to histamine, relieve itching, exudation, permeability of the vascular walls, tone the vessels, have an anti-inflammatory effect, produce an immunosuppressive local effect (butesonide 0.5%, prednisolone ointment 0.5 %, hydrocortisone ointment 1%).
In addition to hormonal ointments, ointments containing diphenhydramine and vitamin A are also used, and when cracks and infection appear, antibacterial ointments are used.
In systemic treatment, antiallergenic, sedatives and tranquilizers, hormonal drugs, biostimulants, vitamins A and E are prescribed. If necessary, antibiotics are prescribed if inflammatory processes develop in the area of microtraumas.
Folk therapeutic methods
In the treatment of kraurosis and vulvar leukoplakia, folk remedies are used as additional to the main treatment method. Often womenprescribe warm baths infused with calendula, string and chamomile flowers (herbs can be brewed both simultaneously and separately). Baths should be taken at least three times a week. Also effective are compresses made from chicken egg protein, chopped parsley with the addition of sea s alt in small quantities. In addition, the use of a decoction of such herbs as tricolor violet, succession, field horsetail, strawberry leaf, nettle and black currant, burdock root and yarrow is prescribed. This decoction is taken three times a day, one hundred milliliters for three months.
Surgical methods
Currently, surgery for vulvar kraurosis disease is performed infrequently, since the risk of recurrence of the disease and the appearance of cosmetic defects and complications is high. Most often, surgery is prescribed for violations of the anatomical structures (synechia of the labia minora, stenosis of the urethra or vaginal vestibule, etc.). In the absence of the expected result from conservative therapy, minimally invasive surgical procedures are performed: laser ablation; denervation of the vulva; cryodestruction of inflamed areas. If there is a suspicion that the process has become malignant, a vulvectomy is performed.
Prevention
In the prevention of vulvar kraurosis (ICD N90.3), a number of significant conditions must be observed. However, even this will not help to heal completely.
- Personal hygiene. A patient with such a diagnosis must painstakingly monitor the cleanliness of her body every day. Wash intimateplaces are needed systematically - in the mornings and evenings. Soap is not allowed, a decoction of calendula or chamomile is better.
- Prevention of stress. With frequent depression and nervous disorders, sedatives are recommended if you can’t cope on your own.
- Timely treatment.
- Proper underwear. Synthetic fabrics are excluded because they do not allow enough air to pass through and further increase itching in the groin area. Cotton underwear recommended.
Reviews
Reviews of the treatment of vulvar kraurosis are in large quantities, both positive and negative. If the pathology is not too advanced, then the use of ointments will be effective. In severe cases, complex treatment, physiotherapy, phototherapy is necessary. If the disease is not treated at all, then the risk of developing oncology is high.
