notes by dr Claudio Italiano
Vulvitis is the inflammation of the external female genitals (vulva). It
includes the lips or folds of the clitoris, and the openings for the urethra and
vagina. Incidence Vulvo-vaginal flogosis is a progressively increasing condition
especially in women of childbearing and postmenopausal age and is one of the
most frequent causes of medical consultation. Over two million a year in Italy.
The etiologic agents of vulvitis are essentially represented by streptococci,
staphylococci, diplococci, etc. as well as from Trichomonas and mycetes.
Gonococcal etiology is rarer today.
The simplest form of vulvitis is erythematous vulvitis, in which there is redness and swelling of the tissues with burning and itching. Serum serum secretion may also be present, but it is not a mandatory feature. The erythematous vulvite can also be determined by a reaction to a persistent leuco-xanthorrhea or an allergic reaction (synthetic fiber laundry, detergent residues used for laundry, cosmetic products and deodorant can occur on a traumatic basis (too tight pants, etc.) .)
The therapy consists in eliminating the root cause, whether due to inflammation or general diseases or local irritative factors.
Other to this, it is naturally necessary to
establish a thorough cleaning of the part and apply locally powder or ointments
based on cortisone or nonspecific antibacterial substances with no allergic
action The erythematous vulvite is sometimes triggered by irritants, linked to
incorrect habits both hygienic and behavioral.These chemical or physical agents
damage the vulvar skin, more susceptible than that of other body districts to
such agents , and can cause an allergic reaction that leads to a chronicization
of the pathology. In addition to the irritants responsible for the vulvitis
there are endogenous factors that can contribute to triggering contact
dermatitis.
• Implied factors
• Suits and body too tight
• Synthetic linens
• (Nylon, lycra)
• Use of oily or perfumed toilet paper
• Use of synthetic or low-breathable absorbers or protectors
• (Containing cellulose)
• Abuse of topical substances (deodorant sprays, depilatory waxes, aggressive
detergents)
• Barrier contraceptives
Follicular vulvitis is characterized by the presence of papules with a
diameter of a few millimeters which sometimes go to a process of suppuration. In
this case there is the formation of pustules. This form of vulvitis is localized
to the areas covered by the hairs, ie the labia majora and is rarer than the
erythematous vulvite.
The therapy consists of the local use of disinfectant but
non-irritating solutions (boric acid, lactic acid, polyvinylpyrrolidone
complexes and iodine and aspersor dust) Diabetic vulvitis is a frequent form in
patients suffering from this disease and is characterized by a reddening of
large and small lips with swelling and edema of the tissues.
The therapy of
diabetic vulvitis consists of the same antidiabetic treatment and local
treatment with disinfectant solutions of the type already mentioned and with
antibacterial powders.Frequently, especially on this dystrophic soil,
particularly fungal infections overlap
The Trichomonase vulvites are those
micetisarran treated in the paragraph edited to the vaginitis, because they are
generally secondary to these.The inflammation of the vulva is often associated
with the inflammation of the urethra, sometimes the infection of the urethra is
secondary to a vulvitis, while other times it is the vulvite that compar and
during an urethritis. 'The urethra is indeed one of the points of choice for the
localization of Trichomonas and other pathogens (streptococcus, staphylococcus,
bacterium coli, gonococcus).
They are distinguished:
1) an acute urethritis
2) a chronic urethritis.
see also >>Infections of the lower genital and urinary tract in women
1)
Acute urethritis in women is more favorable than men's prognosis. The
symptomatology is represented by more or less continuous pain, both spontaneous
and pressure, by urination and sometimes by itching.
Often there is also the
involvement of the skeletal glands of Skene, whose outlets appear surrounded by
a reddish halo. This sign was once considered almost pathognomonic of a
blenorrhagic infection, but in reality it may also be present in other forms of
infection. The diagnosis must be directed to the identification of the agent c
ausa. The treatment must be general and local.
The best results are obtained with
the general treatment: administration of antibiotics, sulfonamides or
disinfectants that are eliminated mainly through the urinary tract (nalidixic
acid, nitrofuran). Many germs, however, are insensitive to various types of
antibiotics and therefore it is the rule to isolate the germ in culture,
identify it and then start a treatment based on the data of the antibiogram.
2. The urethritis and / or chronic skenitis may be the consequence of an acute form
not perfectly healed, or arise primarily after an infection that evolves in an
attenuated way. The symptomatology is characterized by pain and burning during
urination.
Objectively, it is noted that the mucous membrane of the urethra is
red, edematous and sometimes presents granulations. The therapy can still
provide for the use of local instillations with disinfectant solutions or with
silver nitrate at the concentration of 2% but also in this case it is appropriate
to establish an adequate antibiotic therapy based on the data of the culture and
of the antibiogram.
Bartolite, which is sometimes independent of vulval
inflammation, is most often due to the germs usually found in genital infections.
Generally, the germs of the vulva pass into the excretory conduit of Bartolini's
gland, thus giving rise to an inflammatory process, first of a phlegmonic
character and subsequently of an ascetic nature. In this case the glandular
cavity is invaded by purulent material, which can be emptied through the
excretory conduit of the gland.
The pus can also make its way to the inner face
of the labia or, more rarely, to the vagina. Bartolinite mostly affects women of
childbearing age. It can sometimes be bilateral, but it is generally one-sided.
Initially we notice a swelling of the gland with hyperemia of the surrounding
tissues. The tumefaction has a variable volume, with diameters ranging from 1 to
5-6 cm and sometimes even more. The symptomatology is subjectively characterized
by a sense of tension at the level of the gland and pain, which is accentuated
with the progressive relaxation. Fever is present in the acute stage. Frequently
the form becomes chronic and the gland becomes a cyst. Diagnosis is generally
easy. At the physical examination we notice an evident swelling of the big lip,
very painful to the pressure.
The differential diagnosis should examine forunculosis, elephantiasis
of the labia majora, the cysts of the duct of Nuck. The treatment of the acute
form consists in emptying the abscess by incision with the scalpel or by suction
with syringe, following the introduction into the abscess of antibiotics.
Emptying must be associated with general antibiotic treatment. Vulvar
forunculosis is an infection usually determined by Staphylococcus aureus.
It is
mostly located at the labia majors, less frequently on the mountain of Venus.
Generally it is not a single boil but more boils that can evolve to poussèes and
recidivate for many months. The therapy consists in the administration of
antibiotics in the acute phase, possibly associated in the chronic forms to the vaccinotherapy (autovaccino) and to hepatoprotective or antidiabetic therapy, if
necessary.