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What to consider when treating patients with vulval itching

Vulval itching (pruritus vulvae) is a common symptom and can be caused by many different conditions: infections, urinary or faecal incontinence, menopause, pregnancy, medications and underlying medical condition such as diabetes, anaemia, thyroid problems, kidney or liver disease.

Within dermatology, vulval itching is often the main symptom for women presenting with a vulval skin condition. Studies have shown that many women often treat this symptom with over-the-counter products or seek medical advice, with many often not having an examination to determine the underlying problem.

The products generally used include anti-thrush and anti-itch medications, with the perception being that any itching is due to thrush (Lawton and Littlewood 2013).

The prevalence and impact of vulval skin conditions is underestimated, and exact figures are not known. Many women delay seeking medical advice because they are embarrassed or concerned about a possible infection or malignancy  (Lawton and Littlewood 2013).

A recent survey by the British Association of Dermatologists showed that 44 per cent of women with a vulval skin condition stated that it was difficult to access medical treatment for their condition because of misdiagnoses, waiting times, not knowing who to speak to and embarrassment (BAD 2015).

Previous studies have also highlighted delays in seeking help between 18 months and 11 years (Lawton and Littlewood 2013), two months to 40 years (Bellman 1998) and five to ten years (Wojnarowska et al 1997) before their vulval skin condition was diagnosed and a management plan was put in place (Lawton 2016).

In addition, vulval skin is irritated by excessive washing with everyday products eg soaps, bubble baths, shower gels, talcum powder, baby/hygiene/feminine wipes, perfumes, personal deodorants and antiseptics, which are now widely available and marketed to attract women to use them (Lawton 2013).Products such as wipes do not come without problems. See this Nursing in Practice article for more details.

Vulval itching and skin conditions need a higher profile both from a clinical and research perspective. Women should be encouraged to seek medical help, not self-treat, and gain an appropriate diagnosis and management plan to care for their vulval skin condition appropriately.

 

References

Bellman B (1998) Quality-of-life study in patients with chronic vulvar dermatoses. In Rajagopalan R, Sheretz EF, Anderson RT (Eds) Care Management of Skin Diseases: Life Quality and Economic Impact. Marcel Dekker, New York NY.

British Association of Dermatologists (2015) One in five women with a vulval health condition contemplate self-harm or suicide bad.org.uk/media/news

Lawton, S (2016) Vulval skin conditions: assessment and advice. Dermatological Nursing.15: 3:18-23

Lawton, S and Littlewood, S (2013) Vulval Skin Conditions- Disease activity and Quality of Life. Journal of Lower Genital Tract Diseases.17: 117-124

Lawton, S (2013) Eczema in sensitive areas (Vulval Eczema) Exchange.150: 14-16

Wojnarowska F, Mayou R, Simkin S et al (1997) Psychological characteristics and outcome of patients attending a clinic for vulval disease. Journal of the European Academy of Dermatology Venereology. 8, 2, 121-129.