What is vulvar kraurosis? Kraurosis of the vulva, or lichen sclerosus, is a precancerous disease of the external female genitalia, which is partially or completely affected.
Quite often, pathological processes involve the vestibule of the vagina with the clitoris, labia minora, inner surface labia majora and skin in the anal area, like a figure eight.
Externally, local pallor of the skin and mucous membrane of the vulva is noted; thin, wrinkled, whitish plaques are also visible, which subsequently lead to swelling of the vulva and wrinkling of its structure.
Later, the skin becomes marble-white, losing pigmentation, thins and atrophies.
Tissues subject to sclerosis become rigid, thereby narrowing the entrance to the vagina, even narrowing the external opening urethra.
Causes of kraurosis of the vulva
The onset of the disease is noted during hormonal changes: in adolescence or the postmenopausal period. As clinical observations have shown, kraurosis occurs more often during the period or shortly after it, affecting one woman out of a thousand observed.
The pathogenesis of the disease is not fully understood. A significant role is played in this case, accompanied by damage to small blood vessels and deterioration of blood supply to tissues in the periphery; as well as age-related estrogen deficiency.
Clinic and symptoms of kraurosis
The course of the disease is determined by three stages.
initial stage. It is characterized by redness and swelling of the vulva, with unbearable itching in some individuals.
Second stage.
Atrophic - develops after a decrease in inflammatory processes. The mucous membranes and skin become thin, dry, lose their former elasticity, and acquire brown and pinkish-whitish shades.
Third stage. During illness, a woman complains of severe itching, which intensifies with overheating, physical activity and at night. Additionally, unusual sensations occur: burning, numbness and crawling in the genitals.
Long-term, long-term itching becomes so painful that it drives a woman to hysteria, increased irritability, depression, and even suicide attempts. She is sick and her performance is reduced.
Diagnosis of the disease
Kraurosis should be differentiated from other diseases of this group, for example, with others that have a similar clinical picture - scabies, itching of unspecified etiology, vulvar candidiasis, etc.
It is also necessary to exclude diabetes mellitus, in which microcirculation is impaired and any other treatment will not be effective without stabilizing blood sugar levels.
Only the attending physician can make the correct diagnosis using available methods visual and laboratory research.
Conservative treatment of kraurosis
The main direction of treatment is the elimination of psycho-emotional stress, the main symptoms, the sensation of itching, the elimination of the inflammatory process and the improvement of tissue trophism.
Comprehensive treatment of the disease begins only after processing the results of histological, bacteriological and virological studies confirming the diagnosis.
In progress conservative treatment The doctor prescribes a gentle diet, similar to the diet of a patient with diabetes:
» a ban on everything sweet, fatty, salty, flavored with seasonings that increase appetite;
» no more than 2000 kcal should be consumed per day;
» stable drinking regime- at least two liters clean water without gas;
The doctor prescribes hormonal medications containing estriol ( Ovestin) in the form of creams and ointments; vaginal suppositories with anesthesin and menthol, glucocorticoid ointments.
It should be borne in mind that local hormonal therapy can only eliminate the symptoms of the disease and provide temporary remission, but does not lead to complete cure kraurosis of the vulva.
To activate trophic processes and improve microcirculation in problem areas bioactive substances are used - solcoseryl ointment and etc.
You can successfully use physiotherapy, which has an anti-inflammatory, absorbable and mechanical effect: ultrasound, hydrocortisone phonophoresis on the anal, inguinal and vulvar areas.
Traditional methods of treating vulvar kraurosis
The most effective substances for this disease are contained in marigolds () and. Aloe juice contains many enzymes, vitamins, amino acids, polysaccharides, minerals, which have a bactericidal and biostimulating effect on the mucous membrane of the genital organs.
Aloe juice, when taken orally, has an anti-inflammatory and anti-allergic effect, accelerates regenerative processes in tissues, stimulates 
growth of cells in the mucous membrane of internal organs, increases the activity of digestive enzymes, promoting normalization motor function intestines.
How to take aloe juice. You can get aloe juice by squeezing crushed leaves from a three-year-old plant and pre-aging it for two weeks in the refrigerator.
Prescribed orally with a tablespoon after meals three times a day. Treatment should be carried out for three weeks in a row, after which you can repeat the course after a month's break until stable remission is obtained.
Aloe juice is also used to moisten tampons inserted into the vagina and applied to the cervix.
Calendula officinalis It has bactericidal, disinfectant and anti-inflammatory properties, and also reduces reflex excitability and has a calming effect on the central nervous system.
Among other things, calendula preparations are used to treat inflammatory diseases of the female genital organs: fistulas, cervical erosion, leucorrhoea, trichomonas colpitis; as well as from cracked nipples during breastfeeding.
Infusion of calendula officinalis. Brew 20 g of raw flowers with a glass of boiling water until cooled. After filtering, take half a glass three times a day.
A solution for douching can be prepared from an infusion or tincture of calendula: for one liter of boiled water, 200 ml of fresh infusion or 3-4 teaspoons of tincture.
Infusion of calendula mixed in equal proportions with a 3% solution boric acid used to treat fistulas (1-2 times a day).
Be healthy, dear women. God bless you!
Kraurosis in women is a change in the condition of the genital organs associated with age. Satellites of this pathological process- atrophy of the vulvar mucosa, paresthesia (abnormal skin sensitivity), a feeling of dryness and itching.
In advanced cases, a woman may suffer from sclerotic changes in the labia and clitoris. Treatment usually includes hormone therapy, a course of vitamins, and physical therapy. In extreme cases, a vulectomy, or in other words, surgical intervention, is prescribed.
Stages of kraurosis
The sooner the problem is identified and adequate treatment is started, the Great chance exclude progression of pathology. There are several stages of kraurosis in women in their sixties:
- Stage 1. Swelling and redness of the genital organs are observed. This occurs due to impaired microcirculation in tissues.
- Stage 2. Impaired pigmentation, unusual dryness, as well as inelasticity of the mucous membrane. Thin white scales form (a reflection of lichenification), and the labia become flattened.
- Stage 3. The genitals atrophy, cicatricial sclerosis progresses. The vulva shrinks, thereby reducing the size of the labia. The vagina narrows.
Kraurosis in women last stage- this is physical discomfort. It causes pain during urination and sexual intercourse. Tissue cracks may form and are susceptible to infection. Kraurosis, together with damage to the mucous membrane, increases the likelihood of the formation of malignant cells. Pathology can occur and progress not only in women after 60.
Causes of the disease
The development of kraurosis is caused by immune, neuroendocrine disorders, and metabolic disorders. Also, the cause may be unsuccessful surgical intervention in the genitals or the use of inappropriate products and solutions for hygienic purposes in the groin area.
Classic diagnostics include:
- Colposcopy. Painless examination with a microscope for the doctor to understand the external side of the problem.
- Biopsy. Examination of a piece of tissue for suspected kraurosis. This is followed by a more accurate histological examination.
- Analysis of flora by smear (urethra, cervix, vagina), microscopic examination.
- Blood test and immunogram.
Treatment is based on identifying the nature of the disease and prescribed by a doctor diagnosis.
However, one should not lose sight of the psychosomatic nature of the occurrence of pathology. Some women are not able to adequately perceive stress and pressure, and this affects the entire body, including the vulva. The answer to psychosomatics is naturopathy.
The causes and course of the disease are individual, but there is a list general recommendations on prevention and primary treatment (naturopathy):
- Schedule. Balance between business and rest, good sleep, at least 1.5 hours in the fresh air, avoiding stress.
- Proper nutrition. Eliminate from your diet following products: coffee, alcoholic drinks, sweets (especially chocolate), bread (white). Fried, fatty and smoked foods are also gone. Remove strong spices, too much salt and sugar. Often these foods lead to itching. But add freshly squeezed juices, protein (lean meat, fish) and herbs. They have an excellent effect on the body and figure in general for women over 60.
- For naturopathy, kraurosis is also a lack of vitamins A and E. Deficiency leads to drying of the vulvar mucosa and the appearance of itching. You can restore the balance with carotene oil (take 1 tablespoon per day, wash down with water or juice).
- Drink at least a liter of water per day. Many people forget about this basic rule of healing, but it’s hard to imagine cleansing the body without water.
- Systematic use of folk recipes. For example, washing with tar soap. After water procedure process sore spot sea buckthorn oil or a good baby cream.
- Medicinal compresses. You will need fresh parsley, salt and one egg white. Grind the parsley and mix with the rest of the ingredients. Apply the resulting mass to the sore spot and hold for 20-30 minutes. Store the compress mixture in the refrigerator.
- Homeopathic treatment is also practiced. But it is important to understand the nature of your symptoms in order to properly carry out therapy. Among the universal remedies to combat itching, Traumeel S gel can be distinguished. It will relieve redness, swelling, and itching. There are no negative side effects.
Each forum on the topic of kraurosis contains real photos, which reflect pathology. But don’t take them personally, because everything happens individually for every woman at 65 years old. And the horrors from the forum (and usually the most neglected states are posted) most likely do not apply to you.
It is generally accepted that such a pathology as vulvar kraurosis is characteristic only of pre- and postmenopausal women. There is a certain part of truth in this conclusion, since among the 2-10% of women with this pathology, about half are elderly.
However, kraurosis can also occur in women 30 years of age and younger, and in some cases even in girls. The disease involves a long process of treatment, which does not always end positive effect, while causing significant inconvenience to patients.
Quick reference to anatomy
Vulva – medical term, which refers to the area of the external genitalia in women, it is limited to the entrance to the vagina from the lower side, the pubis from the upper side, and if the hymen is not broken, then to her. The external genital organs of the fairer sex consist of the urethral outlet (the opening of the urethra from the outside), the clitoris, Bartholin's glands, the vestibule of the vagina, the labia minora and labia majora.
The vulva is covered with mucous membrane and skin. The mucosa contains a large number of blood vessels, nerve endings and glands. The tissues of the vulva are so delicate that they become inflamed and injured at the slightest irritation. Their condition is regulated by the immune and hormonal systems. Estrogens help maintain the tone and elasticity of the mucous membrane and skin of the vulva, blood supply, and also make it possible to resist adverse factors.
However, during premenopausal age there is hormonal changes, the functioning of the hypothalamic-pituitary-ovarian system changes, the secretion of estrogen decreases, which in turn affects the condition of the vulvar tissue. Functional and structural disorders are observed, a predisposition to inflammatory processes occurs, trauma is alleviated, dryness and thinning (atrophy) appear.
Etiology of pathology
Lichen sclerosus, or kraurosis of the vulva, is a disease that is classified as dystrophic lesions of the genitals, characterized by atrophy of their mucous membranes and skin, which is caused by involution of the vulva. Kraurosis is constantly progressive and long-term illness, which is manifested by dryness and itching of the mucous membranes and skin. As noted earlier, this pathology most often occurs in older women.
Causes of occurrence and mechanisms of development
The exact causes of this disease are still unknown. Today there are several theories, but none of them can fully explain the origin and mechanism of development of vulvar kraurosis. Psychogenic factors, infectious and viral agents, autoimmune and neuroendocrine disorders play a certain role in the origin of pathology. A number of factors have been identified that are included in the risk group for the development of kraurosis of the external genitalia in the fairer sex:
constant overheating;
neglect of personal hygiene rules;
emotional lability;
psychogenic factors ( obsessive fears, depression, constant stress);
obesity;
autoimmune diseases and reduced immunity;
herpes or papilloma virus;
permanent vulvovaginitis and vulvitis;
oophorectomy at a young or mature age;
chemical burns of the genitals (for example, due to douching with a solution of potassium permanganate if the concentrations are not observed);
surgery or injury to the external genitalia;
short childbearing period (early onset of menopause indicates severe ovarian hypofunction);
diseases of the hormonal sphere (pituitary gland, thyroid gland, adrenal glands, ovaries).
The mechanism of development of the disease is also not well understood. In the presence of vulvar lichen sclerosus, a consistent manifestation of certain points is noted. At the initial stage of the disease, there is a violation of microcirculation and blood circulation in the tissues of the vulva, as well as swelling of the mucous membranes and skin, which lead to the development of hypoxia.
Next, atrophic disorders develop, which are manifested by separation of epidermal cells from the basal membrane, swelling of the basal layer, and hyperkeratosis. Swelling of the dermis causes a disruption in the structure of collagen fibers; elastic fibers begin to disintegrate due to increased elastase activity. In addition, the nerve endings are also destroyed. Disturbances occur in the structure of the connective tissue, as a result, the arterioles become clogged and the blood supply to the vulva is disrupted. Thus, the vicious circle closes.
Symptoms
Symptoms of the pathology directly depend on the duration of the process and the degree of its severity (prevalence), as well as on whether any treatment for this pathology has been previously carried out.
Itching is a pathognomic symptom of kraurosis and can be constant or intermittent, localized in the vulva area. This symptom may also be combined with a feeling of skin tightening or burning, a feeling of tightness of the skin after using soap. In most cases, itching intensifies at night or may occur against the background of hygiene procedures or emotional experiences.
Thinning of the mucous membrane and skin leads to the fact that they become vulnerable to mechanical stress, infectious agents, and in places of injury, ulcers and cracks very quickly appear, which in addition to itching cause painful sensations. Narrowing of the vaginal vestibule and atrophy of the labia make sexual intercourse very painful or even impossible. If there is a narrowing of the urethra, pain often occurs when urinating.
Besides local symptoms, patients with vulvar lichen sclerosus have pronounced disorders of the nervous system:
sleep problems;
irritability and aggressiveness;
emotional lability;
depression.
There are also vascular disorders (for example, arterial hypertension) or problems in fat and carbohydrate metabolism(obesity). The pathology has a pronounced clinical picture; only 2% of patients have no complaints. There are three stages of pathology, which are easy to establish during a gynecological examination:
Initial stage.
At this stage characteristic feature pathologies are redness and swelling of the external genitalia. Upon visual examination of the labia, swelling and bright hyperemia are noted, which are more reminiscent of slight inflammation. At this stage, patients' main complaints are moderate or slight itching, tingling sensation or "goosebumps" on the skin.
Atrophic stage.
When examining the patient, a kraurotic triangle is easily identified, with its apex in the pubic area and base at upper third labia The labia minora become thinner and flatter, and the clitoris decreases in size. Quite often there is a change in the color of the soft tissues of the external genitalia: they have a whitish tint (waxy or pale bluish). Hairy part The vulva is not affected, but narrowing of the vaginal opening may be present.
Sclerotic stage.
This stage is characterized by the “disappearance” of the labia minora and clitoris - they atrophy and are almost invisible, at the same time the labia majora flatten and become roll-shaped, sharply limiting the entrance to the vagina, which is already narrowed. The urethral opening also undergoes significant narrowing. Hair loss disappears. The mucous membranes and skin acquire a pearlescent color and become glossy.
The tissue of the vulva undergoes the appearance of many small folds, and it becomes like a piece of crumpled parchment. Also, multiple small hemorrhages, scratches and microcracks form on the mucous membranes and skin. The process continues to progress and spread, affecting the perianal area, inner thighs and inguinal folds. The itching at this stage becomes so unbearable that it is very difficult to resist intensive scratching, as a result, new microtraumas and suppuration are formed.
Diagnosis of kraurosis
At the stage of sclerosis and atrophy, this disease is difficult to confuse with another pathology, but at the initial stage it is necessary to differentiate kraurosis from vulvovaginitis, diabetes mellitus, lichen planus, neurodermatitis, and vitiligo.
Inspection - in order to establish a diagnosis of vulvar kraurosis, only an initial examination of the patient is sufficient. In this case, taking an anamnesis does not affect the final diagnosis, since there are no characteristic data. It is worth taking into account the patient’s complaints and gynecological examination data.
Among the instrumental methods of examination, extended and simple vulvoscopy is used (examination with a colposcope, but only soft fabrics vulva rather than vaginal walls and cervix).
Lab tests involve a blood test for sugar levels (to rule out diabetes), as well as a polymerase chain reaction for HPV. The latter is carried out with soft tissue cells of the vulva in order to determine the presence or absence of HPV. Also perform cytological examination smears from vulvar tissue. If necessary, a histological examination of a piece of vulvar tissue can be performed to exclude the development of a malignant process in them. Material for research is collected using targeted vulvoscopy.
It is also necessary to perform an immunogram to exclude immunological disorders.
Treatment
In the presence of kraurosis, treatment is a very difficult task, since the causes of occurrence and the mechanism of development of the pathology have not yet been studied. Hospitalization in most cases is not required and is only needed if surgery is necessary. Today preference is given conservative methods pathology therapy. First of all, you need to change your lifestyle:
adhere to proper nutrition;
do not use intimate sprays and deodorants, bath foam and shower gels;
It is prohibited to use flavored toilet paper, cotton swabs and pads;
follow the rules intimate hygiene(wash twice a day with liquid soap);
completely give up bad habits (drinking alcohol, smoking);
exclude wearing tight-fitting synthetic underwear.
Diet during kraurosis
There is no special diet for the treatment of vulvar kraurosis. It is necessary to adhere to the rules of a healthy diet and avoid drinking black tea and coffee, since they contain a large amount of caffeine, which has a stimulating effect on an already unstable psycho-emotional background.
In addition, you need to avoid seasonings, spicy foods, smoked foods and pickles, as these foods provoke and aggravate itching in the vulva area. Food should consist of a large amount of vegetable oil, since it is a source of vitamins A and E - natural antioxidants that have a positive effect on the overall condition of the skin and increase its tone and elasticity. Fast food, processed foods, fried and fatty foods should also be excluded, as they contain a large amount of carcinogens, stabilizers and preservatives that provoke the development of malignant tumors.
At the same time, your diet should include enough fresh fruits and vegetables. Green vegetables, as well as juices from them, have particular benefits. If a woman also suffers from excess body weight, then her diet should be free of high-calorie foods - simple carbohydrates(sweet carbonated drinks, confectionery, baked goods).
Non-drug treatment of vulvar lichen sclerosus
If a woman has kraurosis, it has worked well non-drug treatment. It consists of physical procedures. They use methods such as:
photodynamic treatment;
mistletoe therapy (administration of a white mistletoe preparation to stimulate the immune system);
X-ray therapy;
ozone therapy;
balneological procedures (irrigation mineral waters, baths, showers, mud treatment);
UV rays of the sacrum and lumbar region;
phonophoresis with glucocorticoids;
ultrasound;
acupuncture;
laser treatment – exposure of the affected area to a laser beam for 4-5 minutes, at several points at once. The course of treatment is 12-16 procedures (normalizes the psycho-emotional state, sleep, effectively eliminates itching).
Photodynamic therapy for kraurosis
Photodynamic treatment of vulvar lichen sclerosus and other diseases is an innovative method that involves the introduction of photosensitizers (Photogem, Photoditazin, Photosens) using intravenous injections, after which the affected areas are irradiated using a low-intensity laser beam. As a result of the photochemical reaction, the photosensitizer is activated, oxygen is released, as well as active radicals. These substances affect altered cells, leading to their death, while healthy cells remain unharmed.
Before undergoing photodynamic therapy, the patient must undergo examination:
blood chemistry;
general blood analysis;
cytological smear from the vulva;
colposcopy.
Phototherapy has a number of advantages and its effectiveness in the treatment of kraurosis reaches 90-95%:
quick recovery and short postoperative period;
affects exclusively atypical cells;
there are no complications or side effects;
good cosmetic effect;
One therapy session is enough;
no hospitalization required;
no scars are formed;
fast healing;
absolute safety.
Drug treatment
In addition to physiotherapy, in the presence of vulvar kraurosis, treatment with medications is also used. Drug therapy can be carried out both systemically and locally. For external treatment, creams and ointments containing hormones are used. Applications of creams to the external genital area are carried out 1-2 times a day, depending on the severity of the pathology. Drugs for local therapy:
ointments with glucocorticoids reduce the susceptibility of skin receptors to histamine, reduce exudation and itching, the permeability of vascular walls, have anti-inflammatory properties, have local immunosuppressive effect(0.5% butesonide, 0.5% prednisolone ointment, 1% hydrocortisone ointment);
ointment with 2% testosterone - has a pronounced antipruritic effect, increases the elasticity of vulvar tissue. Apply twice a day, course duration is 2-3 weeks;
progesterone cream (Crinon, Prajisan) - also applied twice a day for 3-4 weeks, most suitable for treating pathology in young women;
cream with estrogen (Permarin, Estriol) - applied twice a day for 2 weeks (does not stimulate endometrial growth, but should not be used to treat women of reproductive age).
In addition to ointments with hormones, ointments containing vitamin A and diphenhydramine are used for local therapy. If cracks in the skin become infected, antibacterial ointments are used.
Systemic therapy of pathology consists of the use of anti-allergy drugs (Claritin, Tavegil), sedatives (tincture of valerian, peony, motherwort), tranquilizers (Phenazepam, Seduxen), hormonal drugs (progesterone, estrogen), vitamins A and E, biostimulants ( vitreous, aloe extract) and immunomodulators (tactivin, polyoxidion). If necessary (inflammatory processes in areas of microdamage), antibiotics can be prescribed.
Methods of traditional treatment of pathology
When treating kraurosis of the vulva, they also resort to the use of folk remedies, but exclusively as an addition to the main treatment. Many patients experience relief when using warm baths with an infusion of string, chamomile, and calendula flowers (can be brewed either individually or as a collection). Baths are performed at least three times a week.
Applications and compresses made from chopped parsley, chicken egg white and a small amount of salt also have a good effect. You can also take a decoction of the following herbs: burdock root and yarrow, nettle and black currant leaf, horsetail, strawberry leaf, tricolor violet, string. This decoction should be taken three times a day, 100 ml for three months.
Surgery
Today, surgical intervention for vulvar lichen sclerosus is performed quite rarely due to the high risk of relapse of the pathology, as well as the occurrence of space defects and complications. In most cases, surgery is necessary when there is a violation of the anatomical structures (synechia of the labia minora, stenosis of the urethra or vestibule of the vagina). However, if conservative therapy is ineffective, minimally invasive surgical interventions are performed:
cryodestruction of affected areas;
laser ablation;
denervation of the vulva.
If there is a suspicion of malignancy, a vulvectomy can be performed.
Complications and prognosis
The prognosis for the presence of vulvar kraurosis is favorable for life, but unfavorable for the disease, since it is progressive chronic process. Among the complications, malingization (malignancy) of the process should be highlighted, which occurs in 4-8% of cases.
Many women know that as they fade reproductive function Hormonal changes occur in the body, which can lead to the appearance unpleasant dryness, burning sensation in the external or internal genitalia. Itching of the vulva is considered to be one of the manifestations of menopause, although this is far from true. The appearance of itching may indicate the development of a serious illness known as
In women over 45 years of age, the disease most often develops against the background of changes in hormonal levels and hormone deficiency. However, kraurosis, the treatment of which is very important to begin as early as possible, can also appear in young girls.
The causes of the disease are varied:
· Age-related changes provoked by the onset of menopause and lack of hormonal correction.
· Endocrine diseases(especially in women under 40 years of age).
· Impact large doses antibiotics.
· Consequences of chemotherapy, radiotherapy, radiation therapy.
· Chemical burns, in particular, from an excessively strong solution of potassium permanganate, iodine or other chemical substances, which some ladies use to prevent unwanted pregnancy. TO chemical burns may also result in douching not intended for this purpose hygiene products.
· General weakening of the immune system.
· Psychosomatic disorders. Very often, kraurosis, the symptoms of which are the same in all patients, regardless of the cause, is the body’s reaction to stress. The disease can also develop against the background of depression or a nervous breakdown.
Unfortunately, even after making a diagnosis, doctors cannot always determine the cause of the disease, which sometimes complicates treatment and makes it longer. Moreover, the symptoms are usually similar in all cases. Women initially feel an ever-increasing itching of the vulva, turning into a severe burning sensation. Somewhat later, the mucous membrane swells, acquires an unnaturally red color, and becomes drier. This is the first stage of a disease called kraurosis. Treatment at this stage is not difficult and usually comes down to treating the affected areas hormonal ointments. It is at this stage that women often scratch the affected areas until abrasions and wounds appear. Scratching quickly becomes infected, which complicates the course of the disease.
At the second stage, kraurosis, the treatment of which must be comprehensive, leads to the fact that the external and internal genital organs shrink and “shrink out.” Their volume decreases, the mucous membranes turn pale, acquiring a greenish or gray color.
At the third stage, the organs finally atrophy and cease to perform their functions. The mucous membranes take on the appearance of crumpled paper, urination and sexual intercourse are difficult, sometimes almost impossible. In the third stage of the disease, kraurosis treatment is often useless.
That's why it's so important when the first ones appear discomfort in the vulva area, you must immediately consult a specialist to establish a diagnosis and prescribe treatment. Kraurosis of the vulva involves hormonal correction with the help of special drugs, psychocorrective therapy to normalize the psyche, and the use of drugs to strengthen the immune system.
One of the most modern methods of treating kraurosis is photodynamic therapy, in which patients are administered drugs that begin to work under the influence of certain light waves. With their help, you can improve blood supply and stop organ atrophy.
Ozone therapy, warm baths of chamomile or string, parsley compresses, treatment of affected areas with hormonal ointments or syntomycin liniment are also indicated. However, it should be remembered that self-medication is unacceptable, as it can only increase damage to the mucous membranes.
Kraurosis of the vulva is a pathology that is characterized by pronounced atrophic processes of the skin and mucous membranes of the vagina, which occurs due to the action of external and internal factors. This problem This applies mainly to postmenopausal women, which is due to the peculiarities of hormonal regulation, but also occurs in young women. The possibility of an increased risk of developing cancer pathology in women with vulvar kraurosis proves the need for early diagnosis and correction of this pathology.
ICD-10 code
N90.4 Leukoplakia of the vulva
Epidemiology
The epidemiology of vulvar kraurosis is characterized by a predominant distribution among women during menopause, which is associated with etiological and pathogenetic factors. Among young women this pathology occurs in no more than 5%, and of these women, more than 85% of cases are secondary kraurosis, that is, post-traumatic or postoperative.
Causes of kraurosis of the vulva
Speaking about the prevalence of this problem in women over 50 years of age, the reasons for the development of this pathology can be generalized. But if we are talking about women 30 years old, then there are some features in the etiology and pathogenesis of the disease.
The exact cause of the development of vulvar kraurosis cannot be established even in women in individual cases, since there are often many causes.
One of the most common reasons development of kraurosis are hormonal disorders that concern not only female sex hormones, but also the general hormonal background under the influence of the work of others endocrine glands. The pathogenesis of the development of such a process strongly depends on the regulation hormonal balance. During menopause, kraurosis develops most often, as the level of estrogen, which plays a role in important role in the female body. They ensure the division and differentiation of body cells, primarily skin and epithelium. This provides a woman with youth and a healthy, fresh appearance. With a lack of estrogen, the division of vaginal skin cells is disrupted, which leads to a decrease in their number and normal function. At the same time, blood circulation in the pelvic area is also disrupted, ischemia occurs not only of internal organs, but also of the skin - this further disrupts the differentiation of the endothelium. Thus, the changes intensify and skin atrophy gradually occurs, the amount of endothelium decreases, which leads to secondary processes in the form of cracks and dysplasia in such cells. Therefore, kraurosis is initially only superficial process with skin atrophy, but subsequently disturbances in the mitotic activity of such cells occur, and dysplasia develops, which is dangerous in terms of a precancerous condition.
But a number of other factors may also be the cause of such changes. As for hormonal levels, the direct cause is also diseases of other endocrine glands. Such pathologies include insufficiency of the adrenal cortex, which also disrupts the blood circulation of the vulva, innervation, and cell division due to a lack of catecholamines. Also one of the reasons is hypothyroidism in women. This is a pathology in which the level of thyroid hormones of the thyroid gland, which also regulate the process of tissue regeneration and cell growth, decreases. In this case, the lack of such hormones leads to inhibition of active mitosis and atrophy occurs with further replacement by connective tissue. Insufficiency of ovarian function can also cause the development of atrophy of the vulvar mucosa.
Such reasons can be called endogenous general reasons that can be inherent in every woman. But there are some local reasons for the development of vulvar kraurosis, which include chronic inflammatory diseases internal and external genital organs, chronic foci of infection of the ovary or uterus, frequent surgical interventions on the uterus, as well as burns of the mucous membrane of chemical etiology. If there are primary foci of infection or viruses in the vaginal area, then this only enhances the effect etiological factors, which contribute to the development of dysplastic disorders and atrophy.
Risk factors
Considering everything possible reasons kraurosis, it is necessary to identify the main risk factors for this pathology in order to limit the group of women who need more careful monitoring. Risk factors for the development of this pathology include:
- women with concomitant hypothyroidism;
- women who are obese – in this case, there is a dysregulation of hormonal levels at the level of target cells;
- active hepatitis or cirrhosis of the liver at a young age - this disrupts the exchange of many hormones and their regulation, which occurs mainly in the liver;
- women with frequent vaginitis, colpitis or chronic adnexitis are a springboard for the action of other etiological factors;
- women with disorders of the neurovegetative system - this is closely related to hormonal regulation body functions, as well as with local blood circulation (psychosomatic disorders);
- women with pathological course menopause and its various manifestations.
These risk factors must be taken into account not only to identify sick patients, but first of all, in order to primary prevention development of kraurosis of the vulva.
Symptoms of vulvar kraurosis
Clinical picture of the disease depends on the stage at which the disease is detected and at which treatment begins. Often the symptoms are not so pronounced that a woman should consult a doctor about this problem, but this is only initial stages, and later the symptoms become more pronounced.
The stages of vulvar kraurosis are sequential and if left untreated, the changes become more serious.
The first stage of kraurosis is characterized by initial changes in blood circulation and innervation of the mucosa, which are transient in nature. At the same time, the first signs of the disease appear in the form of severe itching and burning in the vagina. As a rule, this is the first and only symptom in the initial stages. Itching can only occur during the day, it is provoked physical activity or occurs after sexual intercourse. There is also a feeling of dry mucous membranes, which requires the use of moisturizers. But such symptoms at the beginning of the disease are not constant, and the woman does not pay much attention to these signs.
The second stage develops when there are not only persistent changes in blood circulation, but also when initial changes in nerve endings and mosaic endothelial atrophy appear. Then cell division is also disrupted and cracks and erosions occur, which adds more discomfort and forces you to seek help. At the same time, the symptoms of burning and itching of the vagina intensify and are constantly disturbing. Vaginal dryness increases, which also causes another symptom - dyspareunia. In this case, the woman does not receive pleasure from sexual intercourse and the process itself is disrupted - due to dryness and burning, pain occurs. This greatly affects the general psychological state of a woman and, against the background of accompanying hormonal disorders there is a regulatory deficit nervous activity. This is manifested by increased nervousness, bad mood, sleep disturbance, nervous excitability, hyperestrogenism.
The third stage of kraurosis is final in terms of profound changes not only in the vagina, but also in the surrounding tissues. In this case, blood flow disturbances are irreversible, atrophy has diffuse character and the proliferation of endothelium and other cells is completely impaired. This is accompanied by complete atrophy and sclerosis of the vaginal mucosa, which leads to a significant narrowing of the vaginal lumen. This also has a significant effect on the mucous membrane of the urethra - urination becomes painful and burning, discomfort, and itching intensify. Cracks and erosions of the mucosa can be accompanied by contact bleeding, which is difficult to treat. Swelling of the labia, their hyperemia and signs of inflammation in secondary infections are pronounced, because there are entrance gates for various infectious agents. Signs of atrophy of the skin and its appendages also appear - loss pubic hair, dry skin, peeling. All this significantly affects not only the severity of local symptoms, but also the general condition of the woman.
Speaking about the symptoms of vulvar kraurosis, you need to know that already with initial manifestations similar changes It is necessary to consult a doctor for treatment, since this pathology is dangerous in terms of complications.
Diagnosis of kraurosis of the vulva
Diagnosis of kraurosis should be carried out in a timely manner, before the onset of complications and possible malignancy, and all complex methods research. To do this, a physical examination, instrumental and laboratory diagnostics are performed.
Diagnosis begins with a thorough collection of anamnesis of life and illness. It is necessary to find out the characteristics of the menstrual cycle, especially if a woman is in menopause, then it is necessary to determine how this period proceeds and the connection of complaints with the onset of menopause. As a rule, the symptoms of kraurosis develop gradually, which needs to be clarified from the woman with details of all complaints. Next, you need to examine the woman on the chair. A simple vaginal examination of a woman in the mirror is very informative, since many symptoms are visually determined and the stage of the disease can be judged by their severity. Upon examination, you can see pronounced dryness of the vaginal mucosa, cracks and surface erosion, which may make inserting the speculum difficult. You can also see hyperemia of the labia, swelling, a whitish tint of the mucous membrane and areas of atrophy or even sclerosis. For a more informative diagnosis, it is necessary to carry out additional methods research. Since kraurosis is a precancerous condition, a biopsy is a mandatory stage of diagnosis. For this purpose, as well as for the purpose of differential diagnosis, instrumental diagnostics are performed using colposcopy. This is a research method that involves using a special device - a colposcope. This allows you to see the vaginal mucosa at a magnification of several tens of times. In this case, it is possible to visualize those changes that are not visible during normal examination. The advantage of this method is also the possibility of parallel biopsy. It can be performed with special forceps, which are located at the end of the colposcope. The mucosal material is sent for histological examination to identify the degree of changes and exclude malignant transformation.
Smears for bacterial flora and the degree of vaginal cleanliness are also a mandatory method of examination, since they allow us to exclude bacterial inflammation or a specific infectious process.
The tests that must be carried out for kraurosis are tests for HPV, which is associated with cervical cancer in women. Therefore, given the precancerous condition, this study allows you to study the risk of malignant transformation and determine the prognosis of the pathology. To do this, a blood test is performed using polymerase chain reaction and determining the virus antigen. A positive reaction allows you to more accurately determine treatment tactics and use specific methods. If there is a suspicion of kraurosis of the vulva in a woman of menopausal age, then a hormonal panel with a study of the level of essential hormones is required, since complex treatment may require the use of replacement therapy.
Differential diagnosis
Differential diagnosis of vulvar kraurosis should be carried out at the initial stages of the disease, when the symptoms are not specific. Differential diagnosis is especially important in young women, since this is a rare pathology in them. Therefore, it is necessary to carry out differential diagnosis with vulvitis, vulvovaginitis, vaginosis, neurodermatitis, and lichen planus. With vulvitis, vulvovaginitis also has a burning and itching of the vaginal area, there may be dryness of the mucous membrane, but this is a bacterial inflammation, so specific symptoms are discharge of white, green or yellow color. Main diagnostic sign pathology is the determination of a specific pathogen in a vaginal smear. With kraurosis, the symptoms of dryness, burning, cracks are not accompanied by any discharge, but on the contrary, their amount decreases. Also, with primary kraurosis there are no bacterial pathogens. Lichen planus is a dermatological pathology that primarily affects the skin of the genital organs, and secondarily the vagina. Therefore, with lichen, there may be redness and atrophy of the skin, and only then atrophy of the mucous membrane. In contrast, kraurosis is accompanied by atrophy of the mucous membrane, and the skin is affected already at the third stage of the disease.
This diagnostic program for vulvar kraurosis is the most complete and necessary for timely diagnosis and treatment.
Treatment of kraurosis of the vulva
Treatment of kraurosis is not very successful, which depends not only on timely diagnosis, but also on an integrated approach to such treatment. It is very important to use not only local symptomatic remedies, but also systemic pathogenetic ones. Therefore, first of all, treatment should begin with dietary recommendations, because the condition of our cells directly depends on the energy material that we give to our body. Therefore, it is necessary to exclude spicy foods, fried foods, and hot spices from the body - this will help reduce the severity of subjective symptoms of the disease. It is also necessary to exclude bad habits, because nicotine constricts blood vessels and further disrupts the trophism of the mucous membranes.
Speaking about drug treatment, it is necessary to distinguish between systemic and local treatments. Among the system tools you must use integrated approaches to treatment using the following medications:
- Estrogen replacement therapy if kraurosis develops against the background of menopausal changes. In this case, estrogens restore the normal function of endothelial cells and relieve general symptoms of the disease.
Ovret- it is a hormonal agent, active substance which is norestrel from the group of gestagens, which allows it to be used on initial stages treatment of kraurosis during menopause. The method of administration of the drug is in tablets at the same time of day, preferably before meals. The dosage of the drug is one tablet per day throughout the entire period without interruption. Side effects are possible from the gastrointestinal tract in the form of stool disturbances, nausea, and a feeling of bitterness in the mouth. Fluid retention and headaches are possible, so the drug is not recommended for concomitant hypertension. Jaundice and uterine bleeding are also possible, which requires dose adjustment. Contraindications to taking the drug are pathology of the blood coagulation system, pathology of the coronary vessels and veins, diabetes, a history of cerebral hemorrhage or ischemic stroke. Precautions – if antibiotics are used, the effectiveness of the drug is reduced, so you need to dose the drugs correctly and take into account their interactions.
- Antihistamines are used for the purpose of general desensitization, as well as reducing the severity of itching and having a calming effect. For this purpose, first or second generation drugs are more recommended.
Diazolin is an antihistamine that has a pronounced effect on the symptoms of itching and burning during vaginal atrophy. The drug also has a sedative effect, which improves the woman’s general condition and normalizes sleep. Directions for use: one tablet per day at night. Treatment can be carried out throughout the week, when symptoms are most pronounced. Side effects are possible in the form of apathy, drowsiness, irritation of the gastric mucosa and epigastric pain. Nausea and pain in the liver area are also possible. Precautionary measures - do not use when driving a car or operating other vehicles, as the drug may cause decreased attention.
- Antidepressants or anxiolytics - these are used for severe symptoms kraurosis of the vulva, which disrupts the general condition of a woman and affects the mental sphere. In complex treatment, they are mandatory in cases of severe depression and depressed mood, as well as to improve sleep if the symptoms of kraurosis bother you at night.
Cipralex is an antidepressant that is often used in the treatment of menopausal mental changes. This therapy is explained by the fact that it is often necessary to take these drugs in combination with hormonal drugs to relieve anxiety and fear. For kraurosis of the vulva, the drug relieves the increased excitability of the nervous system caused by the symptoms of the disease. This drug increases the number of molecules that are responsible for transmitting a nerve signal, and increases the number of excitatory mediators that relieve depression and fear. The drug is available in tablet form and it is recommended to take one tablet with meals as an initial dose. Dosage – 10 milligrams per day. Side effects of the drug can be expressed in the form of changes in the nervous system - dizziness, drowsiness, increased excitability, as well as in the form of lack of appetite, nausea, vomiting, diarrhea, increased sweating or dry mouth, palpitations and tremors in the limbs. The drug is contraindicated in cases of liver and kidney pathology, hypersensitivity to the components of the drug, and concomitant treatment with monoamine oxidase inhibitors.
- Vitamin preparations must be used to improve trophism, improve the condition of the vascular wall, normalize nerve conduction, which contributes to the resumption of normal proliferative activity of cells during kraurosis. Multivitamins containing ascorbic acid, which affects the vascular wall.
Supradin is a complex vitamin preparation that is recommended for pregnant women as a preventive and therapeutic vitamin preparation. Given its rich composition, the drug replenishes not only vitamins, but also microelements, which allows it to be used as vitamin preparation For complex treatment various pathologies. Thanks to complex action vitamin C and magnesium, an effect on the vascular wall and nerve endings is detected simultaneously with restoration normal level electrolytes in tissues. The drug is available in the pharmacological form of tablets and effervescent tablets. Take one tablet once a day, dissolving in a small amount of water. Side effects are not detected if the dose is observed; changes in the color of urine are possible due to the composition of the drug. Contraindications to taking the drug are increased level any hormones, serious impairment of kidney and liver function. Precautions - do not combine with other vitamins.
- Local remedies for restoring microflora and improving the function of local immunity are also used to reduce the severity of symptoms. This is achieved due to the moisturizing effect and by normalizing the function of endothelial cells.
Gynoflor is a drug from the group of combined probiotics and hormonal drugs, the main active ingredients of which are lactobacilli and estriol. Thanks to this composition, a two-way effect of the drug is manifested - normalization of the vaginal microflora and increased proliferation of epithelial cells due to the local effect of estrogens. The drug is available in the form vaginal tablets and dosage – one tablet per day. Method of use: vaginally, you need to insert the suppository not too deep into the vagina after all hygienic measures and without taking others local funds. Side effects are rare; allergic reactions to the components of the drug are possible. Precautions – tablets must be used for the entire course and that’s it; long-term storage and incomplete courses reduce the effectiveness of the drug.
You can also use other local products based on antiseptic ointments with vitamins, oils, antihistamines. Sea buckthorn suppositories, ointments with a testosterone base, as well as ointments with vitamins A, C, and E have a good effect.
Surgical treatment of vulvar kraurosis can be used if conservative therapy is ineffective or as a combination therapy. Minimally invasive interventions are used only if there are results of histological examination and there are no atypical cells. Then use the methods laser coagulation, cryodestruction or cauterization liquid nitrogen affected areas of the mucous membrane, which are visible to the naked eye or with the help of a colposcope. In this case, the upper layer of atrophic cells is destroyed, which improves blood circulation in the deep layers and their innervation, and thus increases the proliferative activity of other cells. In case of presence of atypical cells in histology conservative therapy do not use it, but immediately perform a vulvectomy.
Physiotherapeutic treatment of vulvar kraurosis can also be used as local therapy, which is highly effective in combination with other methods. Laser therapy, iontophoresis and electrophoresis with glucocorticoids, as well as therapeutic mud are used. This methods can be used outside the period of exacerbation.
Traditional treatment for kraurosis of the vulva
Traditional methods of treatment are aimed at reducing the severity of symptoms and are highly effective along with medications. Use local lotions and baths that help moisturize dry skin and have an antibacterial and protective effect. Basic Recipes traditional medicine the following:
- Need to do sitz bath from calendula and string leaves. To do this, brew two bags of calendula herb and several stems with leaves or flowers of calendula in a liter of water, leave until the solution becomes warm. Then you need to add a few drops of olive oil and take such a bath, sitting in it for at least ten minutes. After the procedure, you need to lubricate the vagina with a few drops of olive oil. Repeat the procedure for ten days.
- Washing with a solution of egg and chamomile at night will help relieve itching and burning. To do this, you first need to take chamomile leaves, pour boiled water over them. hot water and leave until the solution becomes slightly warm. After this, you need to add the whites of two eggs and carry out evening hygiene procedures with this solution. The course of treatment is at least five days.
- The use of sea buckthorn is recommended as an antibacterial and regenerating agent. To do this you need to take sea buckthorn oil, which can be purchased at the pharmacy in a jar, then make a gauze tampon, apply oil to the tampon and insert it into the vagina for twenty minutes. This product has excellent moisturizing properties, which will relieve irritation and reduce symptoms.
- A good remedy for the treatment of kraurosis is the use of a solution of soap and kefir as a means for washing. To do this you need to do soap solution from laundry soap and add three teaspoons of kefir there. Use in the evening before bed for a week.
Medicinal herbs are also widely used in the treatment of this pathology, which has both a positive local and systemic effect.
- Red brush is a plant that helps stimulate the function of vaginal endothelial cells and their proliferation, has an anti-inflammatory effect and prevents the development of secondary bacterial infections against the background of mucosal cracks. For medicinal infusion you need to take three tablespoons of the herb, add boiling water and simmer over low heat for another five minutes, this infusion needs to be covered and left for three hours. It should be taken warm five times a day, two tablespoons. The course of treatment is one month.
- Parsley has an affinity for vaginal tissue and helps reduce the severity of itching and dryness by improving blood circulation. Parsley infusion also has a calming effect. To prepare the medicine, you need to take parsley leaves, pour alcohol into them and leave for at least three days. You need to take this solution one teaspoon in the morning and evening for two weeks.
- Very good remedy local treatment- this is celandine. Five tablespoons of celandine herb are poured into a liter of hot boiled water, and then infused for ten minutes. You need to wash with a warm solution twice a day. It is better to prepare a fresh solution each time, since when stored in the refrigerator, celandine loses its healing properties.
Homeopathic remedies have a good effect in the case of severe kraurosis during menopause, which is accompanied by an effect on the nervous system. For this purpose, specific means are used, which are selected individually. The main groups of drugs that can be used in this case are as follows:
- Carbo vegetabilis is homeopathic remedy, which has a composition of organic products and helps normalize hormonal levels during menopause due to acoustic and magnetic resonance with the organs and systems of the body. The drug also reduces proliferative processes at the cellular level and improves the processes of cellular differentiation in kraurosis. The drug is used in pharmacological form homeopathic drops and dose three drops three times a day, half an hour before meals or an hour after. The course of treatment with the drug is long - about two months. No side effects were identified. Contraindications to taking Carbo vegetabilis are hypersensitivity to the components of the drug and use for men.
- Sepia is a homeopathic remedy of inorganic origin. The drug has a regenerating effect, which has a good effect on the restoration of atrophic cells during kraurosis and age-related changes. The drug also improves local blood circulation and lymphatic drainage, which increases the effectiveness of the drug for concomitant pelvic pain. The drug is available in pharmacological form homeopathic granules and drops, three granules are dosed three times a day, half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and do not drink with water. Side effects are not common, but stool disorders, dyspepsia and allergic reactions may occur. Precautions – the drug should not be used in women with an asthenic physique and a depressed mood.
- Strontiana is a plant that improves tissue trophism, reduces the severity of burning and vaginal dryness due to its softening properties. The drug is available in granules and its dosage is eight granules once a day. Side effects are rare, possible skin rash on hands. Precautions - the drug should not be used for acute inflammatory processes in the small pelvis.
These are the main non-drug drugs that can be used in the treatment of kraurosis not only as local remedies, but also as systemic drugs.
Prevention
Why is kraurosis of the vulva dangerous? This question should be asked before any complications arise and at the stage of diagnostic measures, when adequate treatment can improve the prognosis. First of all, kraurosis is dangerous for the development of endometrial cancer or cervical cancer. This is the most terrible complication that should be feared, since kraurosis can be considered a precancerous process. Other complications that may arise with this pathology are secondary and are caused by atrophy of the mucous membrane, which entails cracks, erosions and deeper lesions with the addition of a secondary bacterial infection. The consequence of improper treatment of kraurosis or the absence of any measures to treat this pathology may be the progression of changes with the development of sclerosis and narrowing of the vagina, secondary changes in the urethra. Therefore, it is very important not only to consult a doctor on time, but also to receive proper comprehensive treatment.
Forecast
The prognosis for recovery of vulvar kraurosis is relatively positive, and the prognosis for further progression is favorable in the case of adequate treatment measures. With this pathology, the decisive place in preventing the malignancy of this process belongs to secondary prevention, which involves timely treatment not only medicinal, but also surgical if indicated.
Kraurosis of the vulva is a pathology that is more common in women during menopause, when changes occur at the level of vaginal cells with their atrophy and further sclerosis. This process develops over some time, so it is important to seek help from a doctor at the first stage. After all, the risk of malignancy of kraurosis is very high, and timely treatment can prevent the development of complications.