Krauroz of a vulva
Krauroz of a vulva – the chronic progressing atrophic process of skin and mucous vulva connected with involute changes of genitalia. Krauroz of a vulva is followed by a paresteziya, dryness, an itch of mucous; atrophic and sclerous changes small sexual gu6, clitoris, big vulvar lips; dispareuniya, vulvity, vagina stenosis. Krauroz is diagnosed during external examination, a vulvoskopiya, a biopsy of tissues of vulva. Treatment of a krauroz of a vulva includes local and general hormonal therapy, physical therapy, vitamin therapy, according to indications – a vulvektomiya.
Krauroz of a vulva
Krauroz vulvas in gynecology carry to background dystrophic damages of a vulva. The disease is found among patients of different age groups: more rare aged to and 30 years are more senior, it is the most frequent - in the period of a menopause. At a krauroza of a vulva there is an atrophy and a multilayered flat epithelium, growth of rough connecting fabric, leading to deformation and reduction of external genitals, violation of their function. Early identification and adequate therapy of a krauroz of a vulva allows to prevent progressing of a disease.
In development of a krauroz of a vulva allocate three stages. At the first stage of a krauroz of a vulva the hypostasis and reddening of genitals caused by violation of microcirculation and a hypoxia of fabrics are noted. In the second stage of a krauroz of a vulva pigmentation violation, dryness, a roughness, inelasticity of skin and mucous, emergence on them whitish thin scales (likhenifikation) is observed; flattening of small and big vulvar lips.
The third stage of a krauroz of a vulva is characterized by a full atrophy and development of a cicatricial sclerosis of external genitals. Rigidny sklerozirovanny tissues of a vulva are wrinkled, leading to sharp reduction of volume of small and big vulvar lips, a clitoris, narrowing of a vagina, an external opening of an urethra and anus. Krauroz of a vulva in a stage of a sclerosis creates difficulties and causes pain at sexual intercourse, and sometimes an urination and defecation.
Emergence of the deep, badly beginning to live cracks at a vulva krauroza easily can be complicated by accession of an infection. In a combination of a krauroz of a vulva to a leukoplakia danger of malignant transformation increases.
Reasons of development of a krauroz of a vulva
Krauroz of a vulva arises as inadequate reaction of blankets of a multilayered flat epithelium to various external and internal factors. Krauroz vulvas provoke the available neuroendocrine violations: hypofunction of bark of adrenal glands, ovaries, thyroid gland, violation of bioelectric activity of a cerebral cortex. In most cases vulvas arises at the short reproductive period during a climax, and at young age - after surgeries on genitals.
A part in pathogenesis of a krauroz is played by chronic inflammations of a vulva, including is long a persistiruyushchy infection of VPCh, VPG. The immunopathological mechanism of development of dystrophic changes at a vulva krauroza is not excluded. It is noticed what vulvas has psychosomatic roots and is noted at the patients who are suffering from the suppressed mood, a depression, discontent with and surrounding reality, having sexual problems.
The chemical burn of a vulva (for example, potassium permanganate solution) can sometimes be the prime cause of a krauroz. Women, patients kraurozy vulvas, as a rule, have obesity, diabetes, neglect rules of personal hygiene.
Symptoms of a krauroz of a vulva
At the initial stage vulvas it is shown by paresteziya (feeling of an easy pricking) in genitalia or vulvodiniya symptoms (burning, feeling of dryness, tightening) that can not draw to itself due consideration of the patient.
The leading symptom of a krauroz is the intolerable pristupoobrazny itch of a vulva which is becoming aggravated at night after hot bathtubs and physical activity. As the reason of an itch serve the changes in vulva receptors causing violations in carrying out nervous impulses. A persistent itch of a vulva, proceeding for a long time, leads to a sleep disorder and working capacity, a nervous breakdown with development of psycho-emotional and vascular frustration.
Patients with kraurozy vulvas are also disturbed by a dispareuniya - the pains at sexual intercourse disturbing intimate life; sometimes dizuriya and violation of defecation. At a krauroza of a vulva raschesa and grazes, multiple cracks, subepitelialny hemorrhages, inflammations are noted.
In an initial stage of a krauroz of a vulva big and small vulvar lips look hyperemic and edematous. Then skin and mucous covers become dry and rough, with a whitish-gray shade, take the wrinkled form, on them hair vanish. Gradually the clitoris and small vulvar lips cease to be defined, big vulvar lips take a form of the flattened rollers; sharply the gleam of a vagina, urethra decreases (sometimes to a full obliteration).
Diagnostics of a krauroz of a vulva
Diagnostics of a krauroz of a vulva includes fizikalny, laboratory and tool inspection. Krauroz of a vulva is found in the patient usually already at gynecologic survey on a chair. One of the main methods of diagnostics of a krauroz of a vulva - a vulvoskopiya (kolposkopiya) allowing to see pathological changes mucous and skin.
Krauroz of a vulva in a stage of a full atrophy and a sclerosis does not demand differential diagnostics, but at early stages he needs to be distinguished from neurodermatitis, red flat depriving, leukoplakias, a dysplasia, a vulvit, a vaginit, the diabetes having similar genital symptomatology.
At a krauroza of a vulva the laboratory research on existence of VPCh by the PTsR method with typing of a virus, definition of an immunogramma, blood sugar is recommended. Detection of the epitelialny cages and existence of an atrophy or an atipiya affected with a virus requires a cytologic research of dabs and prints from a mucous vulva.
To exclude a possible malignization, at a krauroza of a vulva carry out a biopsy of tissues of vulva with histologic studying of material. The Patomorfologichesky picture at a krauroza of a vulva is characterized by a depigmentation, giperkeratozy an epithelium, a sclerosis and an atrophy terms and connecting fabric, total or partial loss of elastichesky fibers, collagen homogenization, inflammatory infiltrates in fabrics.
Treatment of a krauroz of a vulva
Krauroz of a vulva - a disease hard to cure which reasons and a current at different patients can differ; it demands long-term, complex, adequate treatment. The main emphasis in treatment of a krauroz of a vulva is placed on conservative therapy (local and general pathogenetic) focused on reduction of an itch, elimination of an inflammation, improvement traffic of fabrics and removal of psycho-emotional pressure.
Purpose of antihistamines (, , ), and also sedative medicines is expedient (diazepam, ). Some therapeutic effect at a persistent itch can be gained from spirtonovokainovy blockade of a sexual nerve. Local treatment of a krauroz of a vulva includes the hormonal ointments containing estrogen (, an estradiola dipropionate), progesterone, androgens, corticosteroids.
Estrogen is not shown to young patients, in the second phase of a menstrual cycle recommends them cream with progesterone; to patients of advanced age – appoint orally or in oil, and then gestagena - oxyprogesterone in oil or orally. At a krauroza of a vulva ointments with androgens have more expressed protivozudny effect.
Rather widely in treatment of a krauroz of a vulva apply kortikosteroidny ointments with a hydrocortisone, Prednisolonum, betametazony, rendering strong anti-inflammatory, the desensibilizing and stabilizing action. At accession of a microbic infection antibacterial ointments are shown.
In treatment of a krauroz of a vulva use local laser therapy, reflexotherapy, balneoprotsedura, X-ray therapy (Bukki's beams), photodynamic therapy. Vitamin therapy (vitamins A, E, C, groups B, PP), reception of immunoproofreaders, biostimulators are obligatory. At inefficiency of conservative therapy of a krauroz of a vulva apply invasive methods of treatment: a vulva denervation, a laser ablyation of a vulva and cryodestruction of the struck fabrics, at suspicion on a malignization - superficial surgical excision of skin of a vulva (vulvektomiya).
Forecast and prevention of a krauroz of a vulva
Treatment at a krauroza of a vulva is ineffective also an absolute recovery it is impossible to achieve. Malignant transformation of a krauroz of a vulva can be observed at is long not healing erosion, cracks, at a combination to a dysplasia and a leukoplakia.
Krauroz of a vulva demands constant observation from the gynecologist and treatment. Individually picked up diet, absence of stresses, intimate hygiene, a right choice of underwear are important. For decrease in oncological risk to patients with kraurozy vulvas it is necessary to pass 1 time in half a year a vulvoskopiya, and at suspicious results - cytologic and histologic researches.