Vulval Itching (Pruritus Vulvae) & Vulval Soreness

A wide number of conditions are included under the umbrella of this term, as follows. Most of these present as vulvitis, vulval itching and or vulval soreness.

Infection

• Candida, trichomoniasis, bacterial vaginosis.
• Pubic lice, threadworm,
• Herpes simplex, urinary tract infection (UTI), vulval vestibulitis.
• Group A beta-haemolytic streptococcal (GAS) infection has been reported in prepubertal girls and, on rare occasions, in adult women.

Dermatological conditions

• Contact or seborrhoeic
• Psoriasis, lichen simplex/planus/sclerosus.
• Squamous cell hyperplasia.

Neoplasia

• Squamous cell carcinoma (90% of cases have vulvitis).

Atrophic

• Atrophic vulvo-vaginitis.
• Breast-feeding can result in lowered oestrogen levels and consequent vulval

Miscellaneous

• Poor hygiene.
• Generalised pruritus.
• Psychological problems.
• Idiopathic – uncommon, and only diagnosed when all other causes have been excluded.
• Vulvitis circumscripta plasmacellularis (Zoon’s vulvitis). This is a distinct entity, presenting as shiny, atrophic, erythematous plaque of the vulva.

Miscellaneous Vulval Pain syndromes

• Vulvar vestibulitis syndrome – thought to be due to nonspecific inflammation of the minor vestibular glands.
• Vulvodynia – causes chronic vulval and pelvic pain, of unknown aetiology.

Conditions causing the vulva to become excessively moist, such as vaginal discharge and urinary incontinence, lower the defences against commensal organisms and make the area vulnerable to infection and inflammation – vulvitis.