Inflammation of the clitoris and labia: symptoms and proper treatment

An acute inflammatory process, which, usually starting from the labia minora or majora, gradually spreads to the clitoris and vagina, is called vulvitis in medical practice. This pathological condition is accompanied by acute symptoms, which can manifest in the fair sex, regardless of age.

Vulvitis requires immediate consultation with a specialist, as it can lead to adhesions in the mucous membranes of the external genitalia, which subsequently causes serious problems in the intimate area, and in the case of the disease in young women, becomes a cause of infertility.

Causes of inflammation of the clitoris and labia

Most often, the pathology is of an infectious-inflammatory nature. Depending on the cause of the development of vulvitis, there are two main forms of the disease.

• Primary vulvitis. This inflammation is somewhat less common than secondary inflammation, and usually affects either patients of a younger age category or women in the postmenopausal period. The cause of the development of primary inflammation of the labia and clitoris is the following factors: failure to comply with the rules of personal hygiene, too tight synthetic underwear, allergic reactions to shower gel or other hygiene products, mechanical damage to the external genitalia and hormonal imbalances. Little girls may experience similar inflammation if they have helminthiasis - infestation with worms.
• Secondary vulvitis . The most common form of inflammatory processes of the clitoris and labia resulting from infectious infection. Nonspecific pathogens of vulvitis include all representatives of opportunistic flora, which are normally natural inhabitants of female microflora - Escherichia coli, staphylococci, streptococci, yeasts, etc. Specific infections include sexually transmitted infections. Secondary vulvitis occurs more often in young patients of childbearing age, as they are sexually active.

Differential diagnosis

Differential diagnosis in the early stages should be carried out with the following diseases [1, 2, 13-15]:
- with neurodermatitis - the epithelium is thickened, compacted, dry, the skin pattern is enhanced with inflammatory papules of a brownish-pink color, the skin is hyperemic, shagreen-like, itching appears and on other parts of the body;

— vitiligo is characterized by a lack of pigmentation, sometimes mild itching, and no atrophic changes;

- for lichen planus - multiple grouped papular rashes with atrophic changes or sclerosis with the formation of keloid-like scars;

- with diabetes mellitus - severe itching of the vulva, the tissues of the external genital organs are swollen, have a “doughy” consistency, and are sharply hyperemic.

As a chronic inflammatory dermatosis with a long course of cycles of “itching-scratching-itching” and the formation of scars, SALV is a triggering factor for carcinogenesis or contributes to it. Apparently, dysregulation of immune processes also predisposes to the development of vulvar malignancy.

Treatment

One of the initial measures is the elimination of irritating factors, careful care of the vulva, treatment of secondary infections, local use of estrogens, which prevents atrophy of the vulva and vagina. This consists of following a diet (excluding spicy, salty, sweet foods, caffeine-containing products, alcohol) and intimate hygiene rules (limiting/excluding soap-containing products, deodorants, synthetic underwear, pads, tampons). For severe manifestations of itching, desensitizing therapy and sedatives are recommended [2].

The most widely accepted and recommended gold standard treatment for PALS is topical application of ultrapotent corticosteroid ointments [16], especially clobetasol propionate 0.05% ointment. The anti-inflammatory properties of clobetasol are most effective in the treatment of SALV, which is reflected in the reduction of inflammation and the prevention of progression of the condition and subsequent scarring. Topical ultrapotent corticosteroids are first-line therapy in the treatment of SALV (mometasone furoate, clobetasol proprionate (Ib, A). Clinical guidelines published in 2014 by the American Association of Child and Adolescent Gynecologists suggest the use of highly active glucocorticoid drugs in the long term as first-line drugs mode.They have the following effects:

- anti-inflammatory effect;

- antihyperplastic effect on the proliferating superficial layers of the skin;

- antiallergic, local analgesic and antipruritic properties;

- inhibitory effect on the functions of cellular and humoral immunity.

Summarizing recommendations for the treatment of SALV in children, taking into account the level of evidence, American colleagues presented them as follows:

1. Therapy in patients with SALV should begin with the use of highly active glucocorticoid drugs. Level II-2 B

.

2. There is limited data justifying the possibility of using immunomodulators both when treatment is ineffective and when patients refuse medications with glucocorticoids. Level II-3 B.

3. SALV should be suspected in children if there are complaints of various disorders of urination and defecation, including dysuria and dyschezia. Level C

.

In patients with SALV, it is necessary to exclude autoimmune diseases. It should also be noted that the diagnosis of SALV in children and adolescents does not necessarily require a vulvar biopsy. A biopsy of the skin of the vulva can be performed only if there are areas of the skin of the vulva and perianal area suspicious for atypia and/or with persistent resistance to therapy.

Patients with SALV require mandatory monitoring every 6-12 months to assess complaints, exclude changes in the architecture of the vulva and perianal area, and also to prevent the possible risk of malignancy [6].

As already noted, in the treatment of SALV, super-potent corticosteroids clobetasol or halobetasol in the form of 0.05% ointments are used. Because relapses can be frequent, prolonged, and can lead to atrophy and scarring, long-term maintenance therapy is recommended and is considered safer. Since there are no randomized controlled studies comparing the potency of steroids, the frequency of use and duration of treatment for each patient is selected on an individual basis. According to the results of a study by M. Gurumurthy et al. [17] reported that in a trial of clobetasol propionate ointment, complete remission was achieved in 66% of patients and a partial response to treatment was obtained in 30%. The scars did not progress. Conversely, there was no improvement in 75% of patients without treatment, and progression of scars was observed in 35% of women [17].

Depending on the severity of the clinical effect, modern topical corticosteroids (TCS) are divided into four groups [3, 18, 19] (Table 1):

Table 1. Current topical corticosteroids

- weakly active drugs (hydrocortisone 1%, prednisolone 0.5%, fluorocinolone acetonide 0.0025%);

- drugs of moderate action (alclomethasone dipropionate 0.05%, betamethasone valerate 0.025%, clobetasol butyrate 0.05%, deoxymethasone 0.05%, flumethasone pivalate 0.02 and 2%);

- potent drugs (betamethasone valerate 0.1%, betamethasone dipropionate 0.025 and 0.5%, butesonide 0.25%, fluorolorolone acetonide 0.025%, fluorcinoid 0.05%, fluorcinolone acetonide 0.025%, triamcinolone acetonide 0.02, 0 .1% and 2%, methylprednisolone aceponate 0.1%, hydrocortisone 17-butyrate 0.1%, mometasone fluorate 0.1%);

- drugs with very strong activity (clobetasol propionate 0.05%, difluorocortolone valerate 0.05%, galcinonide 0.1%).

Corticosteroids include halogenated (fluorinated) and non-halogenated ones [18-20]. Fluorinated corticosteroids (dexamethasone, betamethasone, flumethasone, triamcinolone, clobetasol, fluticasone, fluocinolone, flumethasone), as a rule, have greater anti-inflammatory activity, but more often lead to side effects. Non-halogenated corticosteroids include prednisolone derivatives (mometasone fuorate, methylprednisolone aceponate, hydrocortisone acetate and hydrocortisone 17-butyrate) [3, 20].

The mucous membranes of the vulva are relatively resistant to steroids, which suggests using ointments with maximum steroid potency to achieve a good effect. For 2-3 months they are applied daily, then 3 times a week in a thin layer on the vulva. In the circumference of the anus, where the skin is thinner, the ointment is applied daily for 4 weeks, followed by a transition to three times a week, and later - once or twice a week. The effectiveness of treatment is evidenced by a significant reduction in the number of cracks, erosions, hemorrhages and thickened white lesions. Even with effective treatment, they do not always disappear completely.

Various dosing regimens can be used. One of the most common is the daily use of high and maximum potency steroids: once a day for 3 months. In children, to avoid skin atrophy, TCS is used weekly for 3 months.

The use of TCS twice daily has additional benefit in the onset of lichen sclerosus. Proactive maintenance therapy with twice-daily mometasone furoate ointment 0.1% is effective and safe in maintaining remission and may help prevent the occurrence of malignant changes (Ib, A). The use of 30 g of the maximum potency steroid should continue for 3 months.

In postmenopause, long-term, for 6 months, use of corticosteroids of maximum activity is necessary. Within 12 weeks, in 77-90% of observations, it is possible to achieve significant improvement and disappearance of complaints, and in 23% of observations, complete disappearance of skin changes. Long-term treatment allows you to maintain remission of the disease for a long time. The patient should be monitored throughout her life. For thickened, hypertrophied, treatment-resistant lesions, administration of triamcinolone into them can be effective [1]. The use of TCS in combination with antibacterial and antifungal agents, such as gentamicin or fusidic acid and nystatin or azole antifungals, may be advisable when a secondary infection occurs. They can be used for a short period of time to eliminate infection (IV, C).

An allergic reaction to any corticosteroid ointment may occur after prolonged use. It should be taken into account that TCS can change the manifestations of some skin diseases, which can complicate the diagnosis. In addition, the use of TCS may delay wound healing [21].

When carrying out long-term local corticosteroid therapy in the anogenital area, serious side effects are detected:

- skin thinning;

- “rebound” reaction, which occurs when therapy is suddenly stopped and manifests itself in the form of dermatitis with intense redness of the skin and a burning sensation;

- formation of striae;

— development of fungal infections;

- suppression of adrenal function as a result of systemic absorption.

According to research results [2], it has been proven that all side effects resolve quickly as the activity of topical corticosteroids decreases and the frequency of their use.

The selection of treatment tactics for SALV is based on theoretical assumptions. Therapy for patients suffering from SALV is associated with polypharmacy, as it should help simultaneously eliminate the phenomena of atrophy, hyperkeratosis, reduce microcirculatory disorders, inflammation, and improve the healing of erosions on the skin of the vulva and perineum. However, the inappropriate use of antiseptics, antibiotics, antiviral and other groups of drugs often increases the activity of the pathological process and the spread of SALV. In case of lichen sclerosus, long-term observation is necessary to prevent increasing scarring and early detection of malignant neoplasm, the risk of which is not great, but real. As a rule, treatment leads to long-term remission. Its absence is a reason to doubt the diagnosis. A possible complication is contact dermatitis as a reaction to local treatment or excessively careful hygiene, infection, or the development of vulvar cancer. The ineffectiveness of local corticosteroid therapy is often associated with a violation of the patient's regimen, including due to misunderstanding or the inability to fully apply the ointment due to obesity or arthritis. Scars can be painful.

According to the European guideline for the management of vulval conditions 2016, patients with VALV require treatment [21]. About 10% of patients are not pruritic but have clinical signs of lichen sclerosus and should also be treated (IV, C).

In recent years, there has been a debate among specialists about the need to continue further treatment while relieving the initial symptoms. This is due to the fact that there is no data on disease activity at that time. However, it is indicated that SALV can progress further and lead to scarring, despite the lack of symptoms after prophylactic treatment, patients are indicated for continuous therapy for many years to prevent progression (IV, C).

A 5-year follow-up period showed that continuous treatment with an individually selected corticosteroid prevented the progression of symptoms, further scarring and the development of carcinoma, respectively, in 58% of cases versus 93.3%, 40% versus 3.4%, and 0% versus 4. 7% [21].

One of the representatives of the modern generation of TCS is the domestic combination drug for external use - tetraderm (Table 2).

Table 2. Composition of tetraderma cream for external use According to its pharmacological action, it has anti-inflammatory, antibacterial, wound-healing, antifungal, and glucocorticoid effects.

Pharmacodynamics

The activity of the drug is due to the pharmacological properties of the components included in its composition.

Gentamicin is a broad-spectrum antibiotic from the aminoglycoside group. Has a bactericidal effect, active against gram-negative microorganisms: Pseudomonas aeruginosa, Aerobacter aerogenes, Escherichia coli, Proteus vulgaris, Klebsiella pneumoniae

;
gram-positive microorganisms: Staphylococcus aureus
(coagulase-positive, coagulase-negative and some strains producing penicillinase).

Dexpanthenol is a derivative of pantothenic acid. Stimulates skin regeneration, normalizes cellular metabolism, accelerates mitosis and increases the strength of collagen fibers. Penetrates into all layers of the skin. It has a weak anti-inflammatory effect.

Mometasone is a synthetic CS that has a local anti-inflammatory, antipruritic and anti-exudative effect, induces the release of proteins that inhibit phospholipase A2 and lipocortins, which control the biosynthesis of inflammatory mediators (prostaglandins and leukotrienes, cellular inflammatory mediators) by inhibiting the release of their common precursor - arachidonic acid.

Econazole is a synthetic imidazole derivative. It has an antifungal and antibacterial effect, inhibits the biosynthesis of ergosterol, which regulates the permeability of the cell wall of microorganisms. It is easily soluble in lipids and penetrates well into tissues; it is active against dermatophytes Trichophyton, Microsporum, Epidermophyton,

yeast-like fungi of the genus
Candida, Corynebacterium minutissimum,
as well as
Malassezia furfur (Pityrosporum orbiculare)
, which causes pityriasis versicolor, and some gram-positive bacteria (streptococci, staphylococci).

Indications for use of the drug Tetraderm

Treatment of dermatoses of inflammatory origin with concomitant bacterial and mycotic infection or a high probability of secondary infection (simple and allergic dermatitis, atopic dermatitis (including diffuse neurodermatitis), limited neurodermatitis, eczema, dermatomycosis (dermatophytosis, candidiasis, pityriasis versicolor), especially when localized in the groin area and large folds of skin; simple chronic lichen (limited neurodermatitis).

Directions for use and doses

Externally.

The cream is applied to the affected areas of the skin in a thin layer, gently rubbing, 2 times a day until a positive clinical result is achieved. The duration of treatment is individual, depends on the size, location of the lesion and the severity of the disease and is usually 1-2 weeks. It is not recommended to use Tetraderm for more than 4 weeks.

Second-line therapy for SALV

Topical calcineurin inhibitors (TCIs) - pimecrolimus, tacrolimus - have a dermatotropic, immunosuppressive, anti-inflammatory local effect, specifically bind to the cytosolic receptor macrophilin-12 of T-lymphocytes and inhibit calcium-dependent phosphatase - calcineurin. Currently, TICs are recommended as second-line therapy for SALV. Pimecrolimus cream 1% is an immunosuppressant that inhibits T cell activation by blocking the transcription of early cytokines, and thus significantly reduces the itching, burning and inflammation associated with SALV. In addition, it prevents the release of pro-inflammatory cytokines, mediators of inflammation from mast cells in vitro

in response to stimulation by IgE antigen, does not affect keratinocytes, fibroblasts and endothelial cells.

Although TCIs can provide effective symptomatic relief, topical clobetasol is superior to pimecrolimus in reducing inflammation and improving clinical symptoms. However, pimecrolimus cream has a more acceptable safety profile and does not cause skin atrophy, although its use is associated with an increased risk of complications due to suppression of local immunity. As a result, TCI should be administered under the supervision of a specialist who can monitor the potential risk of malignancy of SALV. Given the proven effectiveness and safety of topical corticosteroids, experts agree that TICs should be reserved for cases of SALV not responding to topical corticosteroids [2].

TIC is used externally 2 times a day, applied in a thin layer to the affected areas of the skin and gently rubbed until completely absorbed. Treatment is continued until symptoms disappear completely. At the first signs of relapse, therapy should be resumed. If symptoms persist for 6 weeks, the patient's condition should be re-evaluated.

The most famous forms of TEC:

1. Tacrolimus - Protopic ointment 0.03 and 0.1%. Undesirable effects of this drug include: burning and itching sensation, redness, pain, irritation, rash at the application site, development of folliculitis and acne. Isolated cases of malignancy (skin and other types of lymphomas, skin cancer) have been recorded.

2. Pimecrolimus - Elidel cream 1%. Side effects include a burning sensation at the site of application of the cream, the development of impetigo and skin infections, rhinitis, and urticaria.

The most relevant seems to be 0.03% tacrolimus ointment for the effective treatment of children with anogenital lichen sclerosus 2 times a week, while reducing relapses is possible (IIIA, B). A comparison of pimecrolimus (1% cream) and clobetasol propionate (0.05%) cream showed an improvement in the symptoms of itching, burning, pain 12 weeks after the onset of vulvar lichen sclerosus, while clobetasol was used to quickly relieve the inflammatory process (Ib, A) . Other studies of pimecrolimus showed that 42% of patients were in “complete remission” after 6 months of use (IIb, B). Local irritation was the most common side effect with tacrolimus and pimecrolimus. The long-term risks of TIC use still need to be studied, as there are concerns about the possibility of an increased risk of malignancy due to local immunosuppression with long-term SALV therapy [21].

Emollients

One of the important components of SALV therapy are emollients ( eng.

. emollient - emollient) softening and moisturizing agents. These products do not contain potential allergens such as propylene glycol and lanolin, can minimize local inflammation, increase the moisture content of the stratum corneum of the skin, strengthen weakened skin barrier function and reduce subclinical inflammation [2].

According to the results of a study conducted by T. Simonart et al. [22], it was found that more than 50% of women who used a daily moisturizer along with topical corticosteroids maintained remission for 58 months. And more than 2/3 of women stopped using topical corticosteroids while remaining on emollients for a long time.

Based on their source of origin, emollients are divided into plant (natural), chemical and synthetic. Plant emollients are, first of all, natural oils. They soften the skin and protect it, making it elastic. They are absolutely harmless. These include popular cosmetic oils: peach, olive, jojoba. Chemical emollients include paraffin, petroleum jelly and ointments based on it (“Propolisnaya”, “Calendula”), and mineral oils. Synthetic emollients are produced industrially by carrying out various reactions and mixing fatty acids, esters and other components. These are cyclomethicones, dimethicones and synthetic oils. The most well-known and studied are the products from the Emolium, Locobase Ripea, and Lipikar line.

Effects of emollients:

— begin to act immediately after application to the skin, reducing moisture evaporation due to the occlusion effect;

— with further penetration into the stratum corneum, the lipids replace the missing lipids of the epidermis and maintain skin moisture for several hours (medium-term effect);

- lipids reach the deeper layers of the skin and enter the empty “storage areas” - lamellar bodies; if necessary, they are released to maintain the water-lipid balance of the skin (long-term effects).

Estrogen-containing drugs

This group of funds

has a proliferative effect without having a systemic effect on the endometrium and mammary glands [23, 24]. Orniona cream is one of the most modern domestic preparations that contains estriol, an analogue of the natural female hormone. Estriol is used to correct estrogen deficiency in pre- and postmenopausal women. Effective in the treatment of urogenital disorders. In the case of atrophy of the epithelium of the vagina and cervix, which occurs with SALV, estriol stops these disorders, helps restore normal microflora and physiological pH of the vagina, thereby increasing the resistance of the vaginal epithelium to infectious and inflammatory processes. Unlike other estrogens, estriol interacts with the nuclei of endometrial cells for a short period of time, so that with daily use of the recommended daily dose, endometrial proliferation does not occur. Thus, there is no need for cyclic additional administration of progestogens, and “withdrawal” bleeding is not observed in the postmenopausal period.

Indications for use:

- hormone replacement therapy (HRT) for the treatment of atrophy of the mucous membrane of the lower urinary and genital tract associated with estrogen deficiency in postmenopausal women;

— pre- and postoperative therapy in postmenopausal women who are about to undergo or have already undergone surgery via vaginal access;

- for diagnostic purposes in case of unclear results of cytological examination of the cervical epithelium against the background of atrophic changes (as an adjuvant).

Contraindications for use:

- established hypersensitivity to the active substance or to any of the excipients of the drug;

- untreated endometrial hyperplasia;

- established, known or suspected breast cancer;

- diagnosed or suspected estrogen-dependent tumors (for example, endometrial cancer);

- bleeding from the vagina of unknown etiology;

- thrombosis (venous and arterial) and thromboembolism currently or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders;

- conditions preceding thrombosis (including transient ischemic attacks, angina) currently or in history;

- congenital or acquired predisposition to the development of arterial or venous thrombosis, for example deficiency of protein C, protein S or antithrombin III;

- liver disease in the acute stage or a history of liver disease, after which liver function tests have not returned to normal;

- porphyria;

- pregnancy and breastfeeding.

Directions for use and doses

Ornion cream should be inserted into the vagina before bed using a calibration applicator. One dose (when filling the applicator to the ring mark) contains 0.5 g of Ornion cream, which corresponds to 0.5 mg of estriol. The course of treatment consists of prescribing estriol at a dose of 500 mcg per day for 2-3 weeks daily, then switching to a maintenance dose 1-2 times a week. A small part of a single dose is applied directly to the vulva, and the rest into the vagina with a dispenser. With the detachment of hyperplastic plaques, there is increased pain that passes quickly.

Ornion cream can be used both in women with a history of hysterectomy and in women with an intact uterus. When carrying out HRT for the treatment of atrophy of the mucous membrane of the lower urinary and genital tract associated with estrogen deficiency in postmenopausal women, one intravaginal cream is administered daily for no more than two weeks until symptoms alleviate. Then the dose is gradually reduced to a maintenance dose depending on the clinical picture (for example, one injection 2 times a week).

For pre- and postoperative therapy in postmenopausal women who are about to undergo or have already undergone surgery via vaginal access,

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Symptoms of inflammation of the clitoris and labia

The symptoms of the pathological process are vivid, so it is impossible not to notice it, and includes the following signs:

• itching, burning and soreness of the affected area;
• tissue swelling;
• hyperemia (change in color) of the skin;
• development of small ulcerative lesions;
• discomfort during sexual intercourse.

All of the above symptoms usually intensify during urination and during intensive walking. Lack of rational and timely treatment can lead to the spread of an infectious and inflammatory process to the tissue of the inner thighs and vagina.

External reasons for the appearance

Foreign factors are safe for health. After identifying the main cause of irritation of the vaginal mucosa, its solution, the cracks go away on their own, without special treatment.

Third-party reasons include the following:

• Mechanical injuries to the labia - often serious injuries to the labia minora and vaginal mucosa appear after childbirth and abortion. Cracks may also appear as a result of harsh sexual contact, inaccurate depilation of the skin, or damage due to exposure to latex.
• Incorrect and untimely personal hygiene of the body - infrequent washing leads to the accumulation of discharge and urine residues between the labia in women. This causes bacteria to multiply, irritate delicate skin and lead to cracks.
• Wearing tight underwear made of synthetic materials - artificial fabrics impede the penetration of oxygen. As a result, the skin of the labia does not breathe, which causes microcracks to appear. A similar situation is sometimes observed with panty liners or tampons.
• Excessive use of cosmetics - constant use of intimate hygiene gels, creams and other scented products leads to dry skin. This invariably causes irritation and cracks on the labia.

What types of cracks are there?

There are two main types of pathology: chronic and acute cracks. The first ones appeared in women a long time ago, but there was no treatment, so the wounds became calloused. They cause pain even if you don't touch them.

Sharp cracks are microtraumas that have appeared recently. They cause discomfort when touched. Pathology indicates the onset of an inflammatory process in the body.

Diagnosis and treatment of inflammation of the external genitalia

The diagnosis can only be made by a gynecologist. At the same time, no special diagnostics are needed at the first stage. The doctor will immediately notice inflammation during a routine gynecological examination. Next, the doctor determines the cause of the inflammation, after which a treatment regimen is selected.

Depending on the cause of the development of the pathology - an allergic factor, injury, incorrectly selected underwear - it is enough to simply limit the direct contact of the provoking agent with the organs and apply symptomatic therapy (local treatment that relieves unpleasant symptoms). You can easily identify this cause by donating blood for allergies. The analysis will show the cause due to the presence in the blood of special antibodies that are formed only during allergic reactions.

When diagnosing the infectious nature of the disease, microbiological culture is carried out on nutrient media in order to identify the causative agent and the correct selection of antibiotic therapy. To do this, the gynecologist takes swabs from the genital tract and sends them to the laboratory.

There, they first determine the type of infection, and then test different drugs on the samples. Since almost all pathogens of sexual diseases easily adapt to medications, choosing pills that will help you completely recover is not easy. Sometimes specialists go through up to a dozen different medications.

Unfortunately, inflammation is rarely caused by a single pathogen; more often, the cause is a whole bunch of infections, starting with thrush and ending with gonorrhea. In such cases, it will not be enough to simply take smears - the examination will continue further. You will have to donate blood for syphilis, hepatitis and undergo a pelvic ultrasound, as the process quickly spreads through the genital tract, affecting internal organs.

What are the internal reasons

1. The influence of medications - taking a number of medications leads to the formation of a crack between the labia or on them. Both the use of topical ointments and the oral use of tablets can cause this. These include hormonal medications, antibiotics, and pharmaceuticals for the treatment of viral infections. Some herbal preparations also provoke microtraumas (for example, daily lubrication of the intimate area with tea tree oils). After the woman stops taking the pills or replaces them with other medications, the cracks will go away.
2. Vaginal candidiasis - thrush is known to every woman. This disease causes the active growth of Candida fungi. They begin to multiply when the immune system is weakened. With thrush, women complain not only about painful cracks in the intimate area. The disease is characterized by severe itching of the genitals and burning sensation. Copious white discharge, the consistency of which resembles cottage cheese, pain during urination and sexual intercourse.
3. Hormonal disorders in the body - upon the onset of menopause, the skin and mucous membranes dry out significantly, as women have a reduced amount of estrogen in the blood. This provokes the formation of cracks. This group also includes diseases of the endocrine system. Thus, severe itching and cracks in the intimate area are caused by diabetes.
4. Sexually transmitted diseases – each sexually transmitted infection has its own symptoms. Often, in addition to discharge with an unpleasant odor and unbearable itching, women’s delicate mucous membranes are injured, microtraumas and cracks appear. If there is no therapy, the situation gets worse.
5. Ringworm is a fungal infection of the skin. It appears on different parts of the skin, often localized on the labia. Cracks in the mucosa are one of the signs of the disease.

If cracks appear in the intimate area, this is caused by helminthic infestation, lack of vitamins, allergies and other infectious diseases.

Home methods

You can relieve inflammation and cure cracks in the labia majora using folk methods.
But they must be agreed with the attending physician. Expert opinion

Sakania Luiza Ruslanovna

Dermatovenerologist, cosmetologist, trichologist

Ask a Question

Home methods cannot replace primary drug therapy. They should be considered as additional treatment.

• The most common and effective remedy is considered to be calendula lotions. To prepare the solution, take a tablespoon of dry herb. Brew it with 70 milliliters of boiling water, then evaporate over low heat until half the broth remains in the saucepan. Then cool and strain. Make lotions from the resulting product once a day. The solution quickly heals small cracks.
• Infusion of yarrow and dandelion. Take a teaspoon of yarrow and brew it with a glass of boiling water. Add a small spoonful of dried dandelion root. Take the product twice a day before meals.
• It is recommended to treat the affected areas of the labia with a weak solution of Chlorhexidine. An antiseptic with 2% active substance content helps well.

Before using decoctions of medicinal herbs, you need to check whether you are allergic to them. If you have allergic reactions, then you should not use this product.

How is diagnostics carried out?

To find the reason for the appearance of cracks on a woman’s labia, it is necessary not only to conduct an external examination, but also to do a series of laboratory tests:

1. examination for urogenital infections;
2. vaginal culture;
3. general blood analysis;
4. blood test for hepatitis;
5. blood for sugar;
6. blood for HIV;
7. examination of stool for the presence of worms and others.

Only after a thorough examination and diagnostics, the doctor will be able to find the factor that provoked the appearance of cracks and select effective therapy.

Etiology of vulvitis

The vulva is a thin and sensitive epithelial lining of the labia majora. Folds of tissue surround the clitoris and extend to the hymen. On the surface of the membrane there is a healthy vaginal microflora, a natural acidic environment is formed, which provides local immunity. Infectious agents, once on the mucous membrane, die under the influence of acids or are inhibited by lactobacilli.

In childhood, the environment of the epithelial membrane is closer to the alkaline spectrum. There are no lactobacilli in girls yet. There is also no hormonal protection against infections, since estrogen production is still at a minimum level. During this period, the genitals are vulnerable to pathogenic microbes. The infection does not encounter natural barriers on its way and actively develops on the mucous membranes, moving further and further.

The risk of inflammation also increases during menopause. The female body produces less estrogen during menopause. The secretion of the internal genital organs decreases, the mucous membranes become dry, and part of the beneficial microflora dies. If an infectious agent enters, acute vulvitis can quickly develop with further transition to a chronic form.

Complications of vulvitis

Treatment of vulvitis in girls and women must be supervised by an experienced doctor. There is a mistaken ease in relation to the disease, which will go into the chronic stage after 7-10 days. Chronic vulvitis is characterized by disturbing symptoms and constant relapses of exacerbations. Inflammation is also dangerous for girls. It is fraught with deformation of the external genital organs, anorgasmia, infertility and miscarriages if the process spreads to the vagina, uterus, and ovaries.

As inflammation develops, purulent processes occur. The woman cannot have a full sex life, experiences pain, and has a high fever. Ulcers appear on the mucous membranes. Purulent vulvitis threatens sepsis. This is a serious complication with a high risk of death.

Vulvitis during pregnancy is no less dangerous. Ascending inflammation spreads to internal organs: uterus, ovaries. There is a risk of intrauterine infection of the fetus, spontaneous abortion, perinatal or neonatal death.

If you go to the clinic in a timely manner, vulvitis responds well to treatment.