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Pruritus vulvae - Management
What hormonal changes can cause pruritus vulvae?
- Atrophic vulvovaginitis
- In peri- and postmenopausal women, declining oestrogen levels may contribute to vaginal and vulval changes that result in vulvovaginal itching, dryness, and sometimes burning, although the natural aging process may be a key factor in this change. The vulva will look atrophic, pale, and dry, and if irritated may show erythema, petechiae, telangiectasia, or fissuring (these signs and symptoms are similar to the features of lichen sclerosus). The vaginal epithelium will be dry, pale, thin, and smooth owing to the loss of rugae. Cessation of menstruation and other symptoms, such as hot flushes, may indicate that the cause is the menopause.
- In breastfeeding women, elevated prolactin levels can have an antagonistic effect on oestrogen production, and may result in low oestrogen levels. This can lead to vaginal dryness, itching, burning, and irritation.
- Pregnancy
- Pregnancy can cause perineal pruritus through vulval engorgement. Pregnancy is also associated with increased vaginal discharge as a result of increased hormone levels, and an increased incidence of candidal vulvovaginitis.
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