By clothing-bag, 24/07/2022
Vaginal pruritus
INTRODUCTION AND DEFINITION OF DISORDER
The pruritus or vaginal itching is a symptom that appears in different gynecological conditions and that can be accompanied by ardor, irritation, erythema and pain.These symptoms should never be considered normal, even though the fact that there is a certain disagree in the vulvar area may not be pathological.
In women of reproductive age, Lactobacillus SP is the main microorganism of vaginal flora, and the person responsible for maintaining the pH in a normal range (3,8-4,two), thus preventing the growth of pathogenic pathogens.On the other hand, high estrogen levels maintain the thickness of the mucosa by reinforcing local defenses and allow adequate lubrication.
There are several factors that contribute to the alteration of vaginal flora: • The use of broad spectrum antibiotics.• The elevation of the vaginal pH favored by menstrual bleeding or due to semen.• Bad control of diabetes.• Prolonged administration of corticosteroids or other immunosuppressants.• Hormonal alterations due to pregnancy and menopause.• Inadequate hygiene, both by default and excess.
Etiology based on its origin, pruritus can be classified as infectious and not infectious.
Non -infectious pruritus The non -infectious itching is generally due to vaginal dryness, which appears as a result of a decrease in the secretion of fluids of the female genital apparatus for different causes.
Most common physiological causes is the decrease in estrogen level.
Psychological causes Stress situations entail an increase in plasma cortisol concentration and cause an imbalance in estrogen secretion that can lead to vaginal dryness.Also fear and/or disinterest in maintaining sexual relations can negatively influence the lubrication process.
Pathological and iatrogenic causes certain pathologies, such as Sjögren's syndrome, produce dry mucous membranes.Likewise, diabetic neuropathy, characteristic complication of poorly controlled diabetes, limits the blood flow of vessels that irrigate the vaginal wall, and therefore decreases mucous secretion and vaginal lubrication.
As for medications, there are several pharmacological groups that can cause or aggravate vaginal dryness: anticholinergics, tricyclic antidepressants, antihypertensive, antihistamines, antiestrogens, androgens, androgens...In addition, the use of certain contraceptive methods, such as intrauterine devices (IUD), diaphragms, latex condoms (in allergic people) or spermicides, can cause vaginitis or favor infection of genital tissues.
Other causes also the elimination of mucus due to excessive hygiene or by the use of irritating agents (such as synthetic underwear or washed with certain detergents or some especially aggressive intimate hygiene products) usually produces itching and dry vaginal.
Puritosolos Puritos Pathogenic agents that can alter the vaginal mucosa are Candida spp, vaginalis and gardnerella vaginalis, although mycoplasma hominis infections, ureaplasma urealyticum, Mobiluncus spp, streptococcus pyogenes, Streptococcus agalactiae, Streptoccus aurenus, Haemophilus spp, haymophilla spp, haymophilla spp, haymophilus spp, Haemophilus spp, bee.Shigella, Citomegalovirus, simple herpes virus...
The most frequent condition is candidiasis, and for its treatment there are medications that do not require recipe, so their handling can be addressed from the pharmacy.Characteristic symptoms are intense pruritus, edema and local erythema.Although candidiasis does not usually originate abundant vaginal exudates, if the patient goes to the doctor and is subject to exploration, white-yellow exudates can be observed with cottage cheese that adhere to vaginal walls.One way to differentiate Candida infection from the other two most common is the absence of the bad smell of those produced by Trichomonas and Gardnerella.
Candidiasis can be asymptomatic despite having an obvious infection, and also male sexual couples can remain asymptomatic even if they are infected.
Epidemiologiae calculates that more than half of women have consulted at some point for itching and/or irritation in the vaginal area, and that 75% of the female population suffers an episode of candidiasis throughout their lives and a 40-45% two or more.The probability of recurrence is 10% at two5 years, and two5% at 50 (a recurring candidiasis is considered when the patient has four or more episodes in one year).
Those who present the greatest risk of suffering this disorder are: pregnant, menopausal, consumers of certain medications, diabetics, smokers and women who receive chemotherapy treatments.
Candidiasis is rare in postmenopausal women, except those subject to systemic hormonal treatments.
Prevention and non -pharmacological treatment1.Use specific intimate hygiene products.Intimate hygiene is essential to maintain adequate health of the vaginal area.Conventional gels and soaps should be avoided, since they can be too aggressive and unleashed greater vaginal dryness, with the discomfort that this entails.The most appropriate is to resort to products formulated especially for genital area hygiene.The composition and form of use of these preparations allows effectively to eliminate the physiological secretions of the area and the remains of dirt that may accumulate, but at the same time respecting the hydrolypid mantle and the bacterial flora of the genital area.As already indicated, the vaginal pH varies depending on the physiological stage in which the woman is.Currently, different hygiene products adjusted to the pH of the different stages are marketed.During children's age and in menopause, the pH is more basic, so the gels used in these periods must have a pH closer to 7.In the fertile age the pH is more acidic, and the gels used must adapt to a pH not exceeding 5.5.In case of vaginal infections, the pH is more basic and the gels used must acidify the treated area to avoid the overgrowth of infectious microorganisms.It is important to insist on their use, since only one third of the population uses them continuously.two.Avoid excessive washing in the vulvar zone and vaginal irrigations (except if they are carried out under medical prescription).Its abuse can become counterproductive, since they can trigger vaginal dryness problems.3.Maintain adequate hydration.For this, the use of internal and/or external moisturizers is recommended, preferably of aqueous base and, therefore, of easy elimination with daily hygiene.They must have a pH close to that of the vaginal mucosa.On many occasions, lubricating products that are used to facilitate sexual intercourse are used as moisturizers, even though their ultimate purpose is not this.In addition, with these products, compatibility with the use of condoms must be ensured, so it is convenient to avoid olive excipients.4.External moisturizers can be used daily or occasionally, depending on the needs.Internal lubricants should be used two or three times per week, depending on the intensity of the symptoms.Its application should always be recommended at night, once lying down, to favor its complete absorption.5.Do not use cellulose compresses continuously, because they can aggravate the symptoms of dryness and itching.6.Avoid synthetic tissues and clothes too tight.7.In case of having sex, using condoms.8.In women with recurring candidiasis or who are in antibiotic treatment, it is recommended to use prebiotics and probiotics.Preparations containing probiotics favor recurring vulvovaginitis and genital ecosystem recovery.In the available preparations, microbial strains of Lactobacillus are selected.Sometimes, these bacterial strains are accompanied by micronutrients and/or elements such as zinc, vitamins, inulin, etc.., in order to generate an adequate means for bacterial growth and/or stimulate the patient's immune system.Today we do not have comparative studies between the different strains of Lactobacillus used in the different preparations, so to choose between one or the other responds, on many occasions, to the security and trust provided by the manufacturer himself.Although there are clinical trials that have shown favorable results in the treatment and prevention of recurrences of candidiasis with the use of probiotics, more studies are needed to establish what would be the most appropriate strains.
| Criterios de derivaciónSe debe remitir al médico a:• Las niñas menores de 1two años, ya que los medicamentos sin receta disponibles para la candidiasis no están indicados para este grupo de población.• Las embarazadas, especialmente en el primer trimestre de gestación.• Las pacientes con trastornos en la inmunidad o con diabetes mellitus.• Las pacientes que presenten síntomas y signos fuera del área genital.• Las que refieran sangrado vaginal irregular o anormal o flujo vaginal hemorrágico.• Aquellas que comenten que tienen úlceras o ampollas en la zona vulvo-vaginal.• Las que tengan compañeros sexuales sintomáticos. En estos casos, deben ser derivados al médico ambos miembros de la pareja. Además, deberán remitirse también los casos en que se produzca un empeoramiento o los síntomas persistan a pesar de seguir el tratamiento recomendado desde la farmacia, o aquellas personas en las que, a lo largo de los two meses siguientes a la finalización del tratamiento, se produzca una recurrencia. |
Pruritus pharmacological treatment caused by candidiasis should be treated with antimicotics.The only antifungal authorized for the treatment of vaginal candidiasis that does not need a medical recipe is topical clotrimazole (in tablet/vaginal capsule or vaginal cream).La pauta de administración es la siguiente:• Crema al two%: aplicar 5 g al día durante 3 días en el interior de la vagina.• Comprimidos vaginales de 100 mg: introducir en la vagina 1 comprimido al día durante 6 o 7 días, o bien two comprimidos al día durantes 3 días.• 500 mg vaginal tablets or capsules: 1 tablet in a single dose.Unique dose treatment is as effective as those administered in several successive days.The adverse effects of clotrimazole are generally mild and transient.Occasionally it can cause urethral burning, and rarely (0.01-0.1%) vaginal pruritus, vaginitis, urinary incontinence and cystitis.It is also rare that exantematic eruptions and digestive or sexual alterations occur.In case of suffering any of these symptoms, the treatment must be immediately suspended.Clotrimazole is contraindicated in allergic people to Azolic antifungals.No harmful effects have been observed, neither for the mother nor for the fetus, during pregnancy.In this period it has been observed that there is a higher risk of vaginal candidiasis and less response to treatment.Therefore, the duration of treatment in pregnant women has to be 6 days.Oral antifungals (ketoconazole, fluconazole and itraconazole) can only be used under medical prescription.No evidence is available to determine which is the most appropriate.In addition, the oral antifungal administration has a slower response than intravaginal treatment, and greater risk of producing adverse effects (such as hepatotoxicity) and interacting with other drugs.In any case, the suitability of its use must be assessed by the doctor who has carried out the prescription.
Pruritus due to estrogenic deficit for the treatment of this disorder, no medicines that can be recommended without recipe are available.If the patient goes to the doctor, he can prescribe estrogens.Estradiol and Promestriene are usually used in intravaginal topical application preparations.It is advisable to apply them once a day, preferably at night before bedtime.The security of the topical use of estrogens is not known prolonged, so it is recommended to use them with the lowest possible frequency to be effective and thus minimize their systemic absorption.Promestriene occasionally produces a sensation of vaginal stinging.Estrogen use is contraindicated in patients with non-diagnosed vaginal hemorrhage, with estrogen-dependent or hypersensitivity neoplasms to the active substance or excipients.The action of striol is of short duration, so that it produces estrogenic effects without causing endometrial changes, as long as it is administered in a non -fractionated daily dose.It is common for vaginal pruritus.Other rare adverse reactions (0.1-1%) are: candidiasis, headache and urticaria, pelvic pain or genital eruption.This drug is contraindicated in breast cancer, endometrial hyperplasia, vaginal hemorrhage, thromboembolia, pulmonary embolism, thrombophlebitis, porphyria, herpes virus infection, severe liver insufficiency and jaundice.It is also contraindicated during pregnancy (it is classified as FDA category X).Estrogens are enzymatic inhibitors that can increase plasma levels of various drugs.There is clinical evidence of interaction with tricyclic antidepressants, benzodiazepines of liver metabolism, beta blockers, corticosteroids, theophylline and cyclosporine.It also interacts with:
Pruritus due to the use of irritating agents for treatment, local anesthetics can be used.Both lidocaine and benzocaine are indicated in the symptomatic and local treatment of external vaginal pruritus caused by the use of irritating agents such as soaps, underwear, etc..
They must be applied up to a maximum of 3-4 times a day. Su efecto aparece rápidamente, tras two-3 minutos en el caso de la lidocaína y 1 minuto en el de la benzocaína, aunque es muy limitado en el tiempo, ya que puede durar unos 30-45 minutos la primera de ellas y 15-two0 minutos la segunda. La lidocaína puede emplearse a partir de los 1two años de edad, y la benzocaína desde los 6 años.Its use is not recommended in case there are wounds or the skin is eroded, nor for more than 7 days in a row except medical criteria.
Its use is contraindicated in hypersensitive people at active substance or excipients, and in general in allergic women to local anesthetics, amida type.It should be used with special caution in patients with renal and liver failure.
Systemic lidocaine is cardiotoxic, but the efficacy and safety of its administration has not been evaluated topical.Its use in the mucous membranes and irritated skin should be avoided, with injuries or inflamed, since it could increase its absorption.In pregnancy, it is classified as FDA category B.
As adverse reactions it can cause a sensation of irritation, pruritus or burning.These reactions are usually due to the anesthetic effect on blood vessels, and are mild and transitory.Lidocaine rarely produces contact dermatitis, and it is also very unusual that hypersensitivity occurs.
| FitoterapiaExisten algunas plantas (como la caléndula, el árbol del té o la lavanda) que, por sus propiedades calmantes y/o antisépticas, se han empleado como coadyuvantes en tratamientos del picor vaginal por vía tópica.El uso de plantas con fitoestrógenos (como la soja o la cimífuga) se ha generalizado en los últimos años, aunque no pueden extraerse conclusiones sobre su eficacia debido a la escasez de estudios bien controlados y diseñados. Además, los extractos de plantas no son comparables, por no estar estandarizados y presentar distintas titulaciones. Debido a su capacidad de interactuar con los receptores estrogénicos, no se recomienda su uso concomitante con el tratamiento hormonal sustitutivo. Dada la ausencia de estudios que avalen su seguridad, no deben administrarse en caso de tumores hormonodependientes. Del mismo modo, no se recomienda su administración conjunta con tamoxifeno, ya que podrían reducir la eficacia de éste al actuar sobre los mismos receptores estrogénicos. Además, la cimicífuga se ha relacionado con posibles problemas hepáticos.No se recomienda el uso de isoflavonas durante el embarazo. |
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