Kraurosis of the vulva: diagnosis, causes, symptoms

Kraurosis of the vulva is a pathology characterized by dystrophic changes in the skin and mucous membrane of the external genitalia. The problem often appears due to the natural aging of the body or disrupted processes of the endocrine system.

Some doctors consider kraurosis to be one of the types of lichen sclerosus. However, most scientists are against such a classification, since dystrophic changes have specific symptoms. Moreover, processes leading to oncology often occur in the affected tissue. That is why the disease is considered a precancerous condition.

Pathogenesis of the disease

The pathology begins with atrophy of the papillary and reticular layers of the epithelium and epidermis. Then the elastic fibers die. A fibrillar protein, hyaline, appears in the connective tissue cells, the cell membranes are compressed, the cytoplasm becomes denser, and the function of the cells themselves is reduced to a minimum. Connective tissue disintegrates.

In the affected area, the epidermis first grows, new growths such as warts and foci of inflammation appear, then the volume of the skin of the labia decreases, sometimes the skin completely disappears. The mucous membrane becomes dry, brittle, and the pigment disappears. The passage into the vagina is greatly reduced due to scarring of the tissue of the genital organs.

Vulvodynia

Pain and discomfort in the vulva and vaginal vestibule is called vulvodynia. This may be the first symptom of the onset of atrophy and requires the attention of a gynecologist. Women with vulvodynia describe their experience this way:

• Painful burning sensation.
• Dryness and tension.
• Reduction of the skin of the perineum.

It should be noted that vulvodynia can occur with psychosomatic disorders, in patients with diabetes mellitus, during menopause, and in pregnant women. In these cases, treatment and management tactics will be different, so we urge gynecologists to conduct a thorough differential diagnosis.

Pain during intercourse

Pain during sexual intercourse (dyspareunia) is caused by scleroatrophic and dystrophic changes that occur in the epithelial tissue of the vulva. Against this background, there is deformation and narrowing of the vestibule of the vagina, a reduction in the labia and clitoris. In complex, advanced cases, we also observed patients with a completely closed genital fissure, a narrow urethral opening, and complete atrophy of the labia minora and clitoris. Trauma during sexual intercourse of the thin and depleted epidermis against the background of epidermal disease in the absence of adequate treatment makes intimate intimacy painful and almost impossible.

Painful urination

When atrophic processes spread to the external opening of the urethra, its cicatricial deformation and subsequent narrowing occur. As a result, new suffering associated with painful and frequent urination is added to the main complaints. In addition, the thinned and atrophic skin of this area can become a source of bacterial infection with the development of complications in the form of urethritis and cystitis.

Pain during bowel movements

When the anus is affected, its narrowing and deformation, patients experience a feeling of discomfort and pain both during the act of defecation and in everyday life. Due to the disease, the skin around the anus becomes thinner, easily injured, and painful and bleeding cracks appear. Often such patients mistakenly turn to proctologists, although the reason is gynecological.

Bloody discharge

At the onset of the disease, complaints of bleeding may appear, the cause of which is thinning and ulceration of the outer epithelial layer lining the mucous membrane of the intimate area. In the future, foci of secondary infection may form in these areas, scars and cracks may form, and inflammation may develop.

It is important to understand that timely treatment can relieve the symptoms of the disease, cause long-term remission, localize the process and not lead to its spread to all areas of the perineum.

Causes of kraurosis

Kraurosis of the vulva is a reaction of the surface layers of the epithelium to internal and external factors. At a young age, it occurs in nulliparous patients or women who have undergone surgery on the external genitalia.

Etymology of pathology:

• Endocrine disorders: hypofunction of the adrenal glands, hyperfunction of the thyroid gland, decreased production of sex hormones, diabetes mellitus;
• Central nervous system disorders, especially a decrease in the electrical activity of the cerebral cortex;
• Early menopause;
• Lack of pregnancy and childbirth;
• Infections of the genitourinary system;
• Inadequate response of the immune system to inflammatory processes of the vulva;
• Neoplasms on the genitals.

Kraurosis occurs in patients suffering from chemical burns or other injuries to the vagina and vulva.

Patients who are obese and refuse regular intimate hygiene are also at risk of developing an unpleasant disease.

There is a theory that pathology appears against the background of psychological and mental disorders. More than 60% of women who are diagnosed are dissatisfied with intimate relationships, suffer from depression, and are overly irritable. However, a direct cause-and-effect relationship has not been established.

In the overwhelming majority of cases, age-related changes at the cellular level play a major role in the development of kraurosis.

Complications

Kraurosis of the external genitalia makes intimate life impossible. A woman's self-esteem decreases and she becomes irritable. Due to changes in the structure of the vulva, there is a high risk of various infections, but oncology is considered the most dangerous complication. Cancer develops in 17% of cases, it is extremely aggressive and difficult to treat. The probability of death within 5 years with proper palliative therapy is 78% of cases.

Stages of development and symptoms

Doctors distinguish between degrees of gradation of pathology, assessing it as the first, second and third stages:

1. Swelling, redness of the genitals. At this stage, a woman may feel tingling in the perineum, burning, itching, and dryness. The vulva seems to be tightening.
2. The disappearance of pigment on the skin and mucous membrane of the vulva, dryness develops. The skin peels off, becomes rough and inelastic. Whitish scales appear on the mucous membrane. The itching becomes unbearable, but paroxysmal. Typically, exacerbation occurs at night or during periods of physical activity. Against the background of itching, cracks appear. Intimate life is reduced to zero due to pain during penile penetration. Sometimes there are problems with bowel movements and urination.
3. The symptoms intensify, and the genitals seem to shrink, the contours of the labia minora and majora are smoothed out, and it is impossible to determine the exact location of the clitoris. The lumen of the vagina decreases until its walls are completely fused. The urethra also narrows.

In the cracks that appear, as well as abrasions from scratching, bacteria and fungi quickly colonize. Infections worsen symptoms.

Differential diagnosis

Differential diagnosis in the early stages should be carried out with the following diseases [1, 2, 13-15]:
- with neurodermatitis - the epithelium is thickened, compacted, dry, the skin pattern is enhanced with inflammatory papules of a brownish-pink color, the skin is hyperemic, shagreen-like, itching appears and on other parts of the body;

— vitiligo is characterized by a lack of pigmentation, sometimes mild itching, and no atrophic changes;

- for lichen planus - multiple grouped papular rashes with atrophic changes or sclerosis with the formation of keloid-like scars;

- with diabetes mellitus - severe itching of the vulva, the tissues of the external genital organs are swollen, have a “doughy” consistency, and are sharply hyperemic.

As a chronic inflammatory dermatosis with a long course of cycles of “itching-scratching-itching” and the formation of scars, SALV is a triggering factor for carcinogenesis or contributes to it. Apparently, dysregulation of immune processes also predisposes to the development of vulvar malignancy.

Treatment

One of the initial measures is the elimination of irritating factors, careful care of the vulva, treatment of secondary infections, local use of estrogens, which prevents atrophy of the vulva and vagina. This consists of following a diet (excluding spicy, salty, sweet foods, caffeine-containing products, alcohol) and intimate hygiene rules (limiting/excluding soap-containing products, deodorants, synthetic underwear, pads, tampons). For severe manifestations of itching, desensitizing therapy and sedatives are recommended [2].

The most widely accepted and recommended gold standard treatment for PALS is topical application of ultrapotent corticosteroid ointments [16], especially clobetasol propionate 0.05% ointment. The anti-inflammatory properties of clobetasol are most effective in the treatment of SALV, which is reflected in the reduction of inflammation and the prevention of progression of the condition and subsequent scarring. Topical ultrapotent corticosteroids are first-line therapy in the treatment of SALV (mometasone furoate, clobetasol proprionate (Ib, A). Clinical guidelines published in 2014 by the American Association of Child and Adolescent Gynecologists suggest the use of highly active glucocorticoid drugs in the long term as first-line drugs mode.They have the following effects:

- anti-inflammatory effect;

- antihyperplastic effect on the proliferating superficial layers of the skin;

- antiallergic, local analgesic and antipruritic properties;

- inhibitory effect on the functions of cellular and humoral immunity.

Summarizing recommendations for the treatment of SALV in children, taking into account the level of evidence, American colleagues presented them as follows:

1. Therapy in patients with SALV should begin with the use of highly active glucocorticoid drugs. Level II-2 B

.

2. There is limited data justifying the possibility of using immunomodulators both when treatment is ineffective and when patients refuse medications with glucocorticoids. Level II-3 B.

3. SALV should be suspected in children if there are complaints of various disorders of urination and defecation, including dysuria and dyschezia. Level C

.

In patients with SALV, it is necessary to exclude autoimmune diseases. It should also be noted that the diagnosis of SALV in children and adolescents does not necessarily require a vulvar biopsy. A biopsy of the skin of the vulva can be performed only if there are areas of the skin of the vulva and perianal area suspicious for atypia and/or with persistent resistance to therapy.

Patients with SALV require mandatory monitoring every 6-12 months to assess complaints, exclude changes in the architecture of the vulva and perianal area, and also to prevent the possible risk of malignancy [6].

As already noted, in the treatment of SALV, super-potent corticosteroids clobetasol or halobetasol in the form of 0.05% ointments are used. Because relapses can be frequent, prolonged, and can lead to atrophy and scarring, long-term maintenance therapy is recommended and is considered safer. Since there are no randomized controlled studies comparing the potency of steroids, the frequency of use and duration of treatment for each patient is selected on an individual basis. According to the results of a study by M. Gurumurthy et al. [17] reported that in a trial of clobetasol propionate ointment, complete remission was achieved in 66% of patients and a partial response to treatment was obtained in 30%. The scars did not progress. Conversely, there was no improvement in 75% of patients without treatment, and progression of scars was observed in 35% of women [17].

Depending on the severity of the clinical effect, modern topical corticosteroids (TCS) are divided into four groups [3, 18, 19] (Table 1):

Table 1. Current topical corticosteroids

- weakly active drugs (hydrocortisone 1%, prednisolone 0.5%, fluorocinolone acetonide 0.0025%);

- drugs of moderate action (alclomethasone dipropionate 0.05%, betamethasone valerate 0.025%, clobetasol butyrate 0.05%, deoxymethasone 0.05%, flumethasone pivalate 0.02 and 2%);

- potent drugs (betamethasone valerate 0.1%, betamethasone dipropionate 0.025 and 0.5%, butesonide 0.25%, fluorolorolone acetonide 0.025%, fluorcinoid 0.05%, fluorcinolone acetonide 0.025%, triamcinolone acetonide 0.02, 0 .1% and 2%, methylprednisolone aceponate 0.1%, hydrocortisone 17-butyrate 0.1%, mometasone fluorate 0.1%);

- drugs with very strong activity (clobetasol propionate 0.05%, difluorocortolone valerate 0.05%, galcinonide 0.1%).

Corticosteroids include halogenated (fluorinated) and non-halogenated ones [18-20]. Fluorinated corticosteroids (dexamethasone, betamethasone, flumethasone, triamcinolone, clobetasol, fluticasone, fluocinolone, flumethasone), as a rule, have greater anti-inflammatory activity, but more often lead to side effects. Non-halogenated corticosteroids include prednisolone derivatives (mometasone fuorate, methylprednisolone aceponate, hydrocortisone acetate and hydrocortisone 17-butyrate) [3, 20].

The mucous membranes of the vulva are relatively resistant to steroids, which suggests using ointments with maximum steroid potency to achieve a good effect. For 2-3 months they are applied daily, then 3 times a week in a thin layer on the vulva. In the circumference of the anus, where the skin is thinner, the ointment is applied daily for 4 weeks, followed by a transition to three times a week, and later - once or twice a week. The effectiveness of treatment is evidenced by a significant reduction in the number of cracks, erosions, hemorrhages and thickened white lesions. Even with effective treatment, they do not always disappear completely.

Various dosing regimens can be used. One of the most common is the daily use of high and maximum potency steroids: once a day for 3 months. In children, to avoid skin atrophy, TCS is used weekly for 3 months.

The use of TCS twice daily has additional benefit in the onset of lichen sclerosus. Proactive maintenance therapy with twice-daily mometasone furoate ointment 0.1% is effective and safe in maintaining remission and may help prevent the occurrence of malignant changes (Ib, A). The use of 30 g of the maximum potency steroid should continue for 3 months.

In postmenopause, long-term, for 6 months, use of corticosteroids of maximum activity is necessary. Within 12 weeks, in 77-90% of observations, it is possible to achieve significant improvement and disappearance of complaints, and in 23% of observations, complete disappearance of skin changes. Long-term treatment allows you to maintain remission of the disease for a long time. The patient should be monitored throughout her life. For thickened, hypertrophied, treatment-resistant lesions, administration of triamcinolone into them can be effective [1]. The use of TCS in combination with antibacterial and antifungal agents, such as gentamicin or fusidic acid and nystatin or azole antifungals, may be advisable when a secondary infection occurs. They can be used for a short period of time to eliminate infection (IV, C).

An allergic reaction to any corticosteroid ointment may occur after prolonged use. It should be taken into account that TCS can change the manifestations of some skin diseases, which can complicate the diagnosis. In addition, the use of TCS may delay wound healing [21].

When carrying out long-term local corticosteroid therapy in the anogenital area, serious side effects are detected:

- skin thinning;

- “rebound” reaction, which occurs when therapy is suddenly stopped and manifests itself in the form of dermatitis with intense redness of the skin and a burning sensation;

- formation of striae;

— development of fungal infections;

- suppression of adrenal function as a result of systemic absorption.

According to research results [2], it has been proven that all side effects resolve quickly as the activity of topical corticosteroids decreases and the frequency of their use.

The selection of treatment tactics for SALV is based on theoretical assumptions. Therapy for patients suffering from SALV is associated with polypharmacy, as it should help simultaneously eliminate the phenomena of atrophy, hyperkeratosis, reduce microcirculatory disorders, inflammation, and improve the healing of erosions on the skin of the vulva and perineum. However, the inappropriate use of antiseptics, antibiotics, antiviral and other groups of drugs often increases the activity of the pathological process and the spread of SALV. In case of lichen sclerosus, long-term observation is necessary to prevent increasing scarring and early detection of malignant neoplasm, the risk of which is not great, but real. As a rule, treatment leads to long-term remission. Its absence is a reason to doubt the diagnosis. A possible complication is contact dermatitis as a reaction to local treatment or excessively careful hygiene, infection, or the development of vulvar cancer. The ineffectiveness of local corticosteroid therapy is often associated with a violation of the patient's regimen, including due to misunderstanding or the inability to fully apply the ointment due to obesity or arthritis. Scars can be painful.

According to the European guideline for the management of vulval conditions 2021, patients with SALV require treatment [21]. About 10% of patients are not pruritic but have clinical signs of lichen sclerosus and should also be treated (IV, C).

In recent years, there has been a debate among specialists about the need to continue further treatment while relieving the initial symptoms. This is due to the fact that there is no data on disease activity at that time. However, it is indicated that SALV can progress further and lead to scarring, despite the lack of symptoms after prophylactic treatment, patients are indicated for continuous therapy for many years to prevent progression (IV, C).

A 5-year follow-up period showed that continuous treatment with an individually selected corticosteroid prevented the progression of symptoms, further scarring and the development of carcinoma, respectively, in 58% of cases versus 93.3%, 40% versus 3.4%, and 0% versus 4. 7% [21].

One of the representatives of the modern generation of TCS is the domestic combination drug for external use - tetraderm (Table 2).

Table 2. Composition of tetraderma cream for external use According to its pharmacological action, it has anti-inflammatory, antibacterial, wound-healing, antifungal, and glucocorticoid effects.

Pharmacodynamics

The activity of the drug is due to the pharmacological properties of the components included in its composition.

Gentamicin is a broad-spectrum antibiotic from the aminoglycoside group. Has a bactericidal effect, active against gram-negative microorganisms: Pseudomonas aeruginosa, Aerobacter aerogenes, Escherichia coli, Proteus vulgaris, Klebsiella pneumoniae

;
gram-positive microorganisms: Staphylococcus aureus
(coagulase-positive, coagulase-negative and some strains producing penicillinase).

Dexpanthenol is a derivative of pantothenic acid. Stimulates skin regeneration, normalizes cellular metabolism, accelerates mitosis and increases the strength of collagen fibers. Penetrates into all layers of the skin. It has a weak anti-inflammatory effect.

Mometasone is a synthetic CS that has a local anti-inflammatory, antipruritic and anti-exudative effect, induces the release of proteins that inhibit phospholipase A2 and lipocortins, which control the biosynthesis of inflammatory mediators (prostaglandins and leukotrienes, cellular inflammatory mediators) by inhibiting the release of their common precursor - arachidonic acid.

Econazole is a synthetic imidazole derivative. It has an antifungal and antibacterial effect, inhibits the biosynthesis of ergosterol, which regulates the permeability of the cell wall of microorganisms. It is easily soluble in lipids and penetrates well into tissues; it is active against dermatophytes Trichophyton, Microsporum, Epidermophyton,

yeast-like fungi of the genus
Candida, Corynebacterium minutissimum,
as well as
Malassezia furfur (Pityrosporum orbiculare)
, which causes pityriasis versicolor, and some gram-positive bacteria (streptococci, staphylococci).

Indications for use of the drug Tetraderm

Treatment of dermatoses of inflammatory origin with concomitant bacterial and mycotic infection or a high probability of secondary infection (simple and allergic dermatitis, atopic dermatitis (including diffuse neurodermatitis), limited neurodermatitis, eczema, dermatomycosis (dermatophytosis, candidiasis, pityriasis versicolor), especially when localized in the groin area and large folds of skin; simple chronic lichen (limited neurodermatitis).

Directions for use and doses

Externally.

The cream is applied to the affected areas of the skin in a thin layer, gently rubbing, 2 times a day until a positive clinical result is achieved. The duration of treatment is individual, depends on the size, location of the lesion and the severity of the disease and is usually 1-2 weeks. It is not recommended to use Tetraderm for more than 4 weeks.

Second-line therapy for SALV

Topical calcineurin inhibitors (TCIs) - pimecrolimus, tacrolimus - have a dermatotropic, immunosuppressive, anti-inflammatory local effect, specifically bind to the cytosolic receptor macrophilin-12 of T-lymphocytes and inhibit calcium-dependent phosphatase - calcineurin. Currently, TICs are recommended as second-line therapy for SALV. Pimecrolimus cream 1% is an immunosuppressant that inhibits T cell activation by blocking the transcription of early cytokines, and thus significantly reduces the itching, burning and inflammation associated with SALV. In addition, it prevents the release of pro-inflammatory cytokines, mediators of inflammation from mast cells in vitro

in response to stimulation by IgE antigen, does not affect keratinocytes, fibroblasts and endothelial cells.

Although TCIs can provide effective symptomatic relief, topical clobetasol is superior to pimecrolimus in reducing inflammation and improving clinical symptoms. However, pimecrolimus cream has a more acceptable safety profile and does not cause skin atrophy, although its use is associated with an increased risk of complications due to suppression of local immunity. As a result, TCI should be administered under the supervision of a specialist who can monitor the potential risk of malignancy of SALV. Given the proven effectiveness and safety of topical corticosteroids, experts agree that TICs should be reserved for cases of SALV not responding to topical corticosteroids [2].

TIC is used externally 2 times a day, applied in a thin layer to the affected areas of the skin and gently rubbed until completely absorbed. Treatment is continued until symptoms disappear completely. At the first signs of relapse, therapy should be resumed. If symptoms persist for 6 weeks, the patient's condition should be re-evaluated.

The most famous forms of TEC:

1. Tacrolimus - Protopic ointment 0.03 and 0.1%. Undesirable effects of this drug include: burning and itching sensation, redness, pain, irritation, rash at the application site, development of folliculitis and acne. Isolated cases of malignancy (skin and other types of lymphomas, skin cancer) have been recorded.

2. Pimecrolimus - Elidel cream 1%. Side effects include a burning sensation at the site of application of the cream, the development of impetigo and skin infections, rhinitis, and urticaria.

The most relevant seems to be 0.03% tacrolimus ointment for the effective treatment of children with anogenital lichen sclerosus 2 times a week, while reducing relapses is possible (IIIA, B). A comparison of pimecrolimus (1% cream) and clobetasol propionate (0.05%) cream showed an improvement in the symptoms of itching, burning, pain 12 weeks after the onset of vulvar lichen sclerosus, while clobetasol was used to quickly relieve the inflammatory process (Ib, A) . Other studies of pimecrolimus showed that 42% of patients were in “complete remission” after 6 months of use (IIb, B). Local irritation was the most common side effect with tacrolimus and pimecrolimus. The long-term risks of TIC use still need to be studied, as there are concerns about the possibility of an increased risk of malignancy due to local immunosuppression with long-term SALV therapy [21].

Emollients

One of the important components of SALV therapy are emollients ( eng.

. emollient - emollient) softening and moisturizing agents. These products do not contain potential allergens such as propylene glycol and lanolin, can minimize local inflammation, increase the moisture content of the stratum corneum of the skin, strengthen weakened skin barrier function and reduce subclinical inflammation [2].

According to the results of a study conducted by T. Simonart et al. [22], it was found that more than 50% of women who used a daily moisturizer along with topical corticosteroids maintained remission for 58 months. And more than 2/3 of women stopped using topical corticosteroids while remaining on emollients for a long time.

Based on their source of origin, emollients are divided into plant (natural), chemical and synthetic. Plant emollients are, first of all, natural oils. They soften the skin and protect it, making it elastic. They are absolutely harmless. These include popular cosmetic oils: peach, olive, jojoba. Chemical emollients include paraffin, petroleum jelly and ointments based on it (“Propolisnaya”, “Calendula”), and mineral oils. Synthetic emollients are produced industrially by carrying out various reactions and mixing fatty acids, esters and other components. These are cyclomethicones, dimethicones and synthetic oils. The most well-known and studied are the products from the Emolium, Locobase Ripea, and Lipikar line.

Effects of emollients:

— begin to act immediately after application to the skin, reducing moisture evaporation due to the occlusion effect;

— with further penetration into the stratum corneum, the lipids replace the missing lipids of the epidermis and maintain skin moisture for several hours (medium-term effect);

- lipids reach the deeper layers of the skin and enter the empty “storage areas” - lamellar bodies; if necessary, they are released to maintain the water-lipid balance of the skin (long-term effects).

Estrogen-containing drugs

This group of funds

has a proliferative effect without having a systemic effect on the endometrium and mammary glands [23, 24]. Orniona cream is one of the most modern domestic preparations that contains estriol, an analogue of the natural female hormone. Estriol is used to correct estrogen deficiency in pre- and postmenopausal women. Effective in the treatment of urogenital disorders. In the case of atrophy of the epithelium of the vagina and cervix, which occurs with SALV, estriol stops these disorders, helps restore normal microflora and physiological pH of the vagina, thereby increasing the resistance of the vaginal epithelium to infectious and inflammatory processes. Unlike other estrogens, estriol interacts with the nuclei of endometrial cells for a short period of time, so that with daily use of the recommended daily dose, endometrial proliferation does not occur. Thus, there is no need for cyclic additional administration of progestogens, and “withdrawal” bleeding is not observed in the postmenopausal period.

Indications for use:

- hormone replacement therapy (HRT) for the treatment of atrophy of the mucous membrane of the lower urinary and genital tract associated with estrogen deficiency in postmenopausal women;

— pre- and postoperative therapy in postmenopausal women who are about to undergo or have already undergone surgery via vaginal access;

- for diagnostic purposes in case of unclear results of cytological examination of the cervical epithelium against the background of atrophic changes (as an adjuvant).

Contraindications for use:

- established hypersensitivity to the active substance or to any of the excipients of the drug;

- untreated endometrial hyperplasia;

- established, known or suspected breast cancer;

- diagnosed or suspected estrogen-dependent tumors (for example, endometrial cancer);

- bleeding from the vagina of unknown etiology;

- thrombosis (venous and arterial) and thromboembolism currently or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, stroke), cerebrovascular disorders;

- conditions preceding thrombosis (including transient ischemic attacks, angina) currently or in history;

- congenital or acquired predisposition to the development of arterial or venous thrombosis, for example deficiency of protein C, protein S or antithrombin III;

- liver disease in the acute stage or a history of liver disease, after which liver function tests have not returned to normal;

- porphyria;

- pregnancy and breastfeeding.

Directions for use and doses

Ornion cream should be inserted into the vagina before bed using a calibration applicator. One dose (when filling the applicator to the ring mark) contains 0.5 g of Ornion cream, which corresponds to 0.5 mg of estriol. The course of treatment consists of prescribing estriol at a dose of 500 mcg per day for 2-3 weeks daily, then switching to a maintenance dose 1-2 times a week. A small part of a single dose is applied directly to the vulva, and the rest into the vagina with a dispenser. With the detachment of hyperplastic plaques, there is increased pain that passes quickly.

Ornion cream can be used both in women with a history of hysterectomy and in women with an intact uterus. When carrying out HRT for the treatment of atrophy of the mucous membrane of the lower urinary and genital tract associated with estrogen deficiency in postmenopausal women, one intravaginal cream is administered daily for no more than two weeks until symptoms alleviate. Then the dose is gradually reduced to a maintenance dose depending on the clinical picture (for example, one injection 2 times a week).

For pre- and postoperative therapy in postmenopausal women who are about to undergo or have already undergone surgery via vaginal access,

• Magazines
• Subscription
• Books
• For advertisers
• Delivery / Payment
• About the publishing house
• Contacts
• Privacy Policy

• Publishing house "Media Sphere"

Registration

• Telephone
• +7 (495) 482-4118
• +7 (495) 482-0604
• +8 (toll-free number for subscription questions)

• Mailing address
• Publishing house "Media Sphere",
• PO Box 54, Moscow, Russia 127238

• Email
• [email protected]

• © 1998-2021

+7 (495) 482-4118, +7 (495) 482-0604

• PO Box 54, Moscow, Russia 127238 "Media Sfera Publishing House"
• [email protected]

© 1998-2021

• Publishing house "Media Sphere"

Email confirmation

An email has been sent with a link to confirm your email. Follow the link from the email to complete registration on the site.

Email confirmation

Log in to the site using your account in one of the services

Registration for legal entities

To come in

Register

Diagnosis of kraurosis

Pathology requires differentiation from other diseases only at the first stage, when swelling and redness can be mistaken for ordinary vulvovaginitis or another problem.

A gynecologist examines a patient on a gynecological chair. It is important to assess the degree of kraurosis and identify additional pathologies. During the examination, the specialist takes smears for cytology and microflora. Colposcopy will help determine the condition of the mucous membrane and skin: magnifying the image of the areas being examined allows you to give an accurate answer.

To determine the possible cause of the disease, as well as the general state of health, the gynecologist prescribes laboratory diagnostics:

• General and biochemical urine tests;
• Blood analysis;
• Blood glucose level;
• Hormonal composition of blood;
• Immunogram;
• PCR with virus typing;
• Bacterial culture of urine.

Additionally, instrumental examination methods are prescribed: ultrasound of the pelvic organs, radiography, vaginal endoscopy, if possible.

To exclude or confirm a malignant process, doctors must take pieces of the modified epithelium and mucous membrane for microscopy.

Prevention of the disease and further prognosis of vulvar disease

Further prognosis and prevention for kraurosis consists of long-term, comprehensive recovery, because a relapse of the disease is possible. But a complete cure for kraurosis is impossible. The development of disorders of the internal genital organs, the presence of abrasions and wounds leads to constant infection, which may result in the transformation of kraurosis into a malignant tumor.

Preventive methods for kraurosis are aimed at daily activities, both external and internal, and include:

• proper nutrition - fractional, mainly vegetable and protein in nature, as well as the consumption of fermented milk products;
• the right choice of underwear - it should be elastic, breathable, and not restrict movement;
• psychological balance - absence of depression, stress, dissatisfaction, etc.;
• proper hygiene of external organs - special soaps and gels for use in intimate hygiene.

Constant monitoring by a gynecologist is mandatory for kraurosis. It is also necessary to perform vulvoscopy and colposcopy to monitor the disease once every 6 months.

Treatment of kraurosis of the vulva

Gynecologists work in a team with other specialists: it is important to eliminate the cause of the pathology or minimize its effect. Then you can begin to reduce symptoms and restore the normal state of the vulva.

Endocrinologists, immunologists or neurologists eliminate the factors that led to kraurosis. Gynecologists relieve general symptoms. They usually choose conservative methods of therapy at the initial stage of the problem.

Doctors choose oral medications, ointments, gels and other drug formulations:

• Antipruritic;
• Anti-inflammatory steroidal and non-steroidal;
• Antihistamines;
• Hormonal ointments based on synthetic hormones;
• Immunocorrectors;
• Biostimulants;
• Vitamin complexes.

Intimate lubricants are indicated in the second half of the menstrual cycle.

Novocaine blockade helps reduce unpleasant symptoms: doctors inject an anesthetic along the pudendal nerve. Gynecologists also prescribe physiotherapy:

• Photodynamics;
• Balneotherapy;
• Laser therapy;
• Reflexology;
• Magnetotherapy.

If the patient is admitted with already developed kraurosis, doctors choose surgical intervention: surgeons excise the affected tissue with a laser or radioknife. Sometimes cryodestruction is effective. If malignant cells are detected during diagnosis, doctors completely remove the affected areas; in difficult situations, they excise the labia majora and minora.

After the operation, which takes place under general anesthesia, the woman recovers within a month. Patients are advised to take hormonal medications, as well as therapy for the underlying disease. It is impossible to completely get rid of the problem; it is important to see a gynecologist and other specialists and undergo regular examinations.

Treatment with folk remedies

• Sitz baths with chamomile, calendula, celandine, string. You can use both herbs or choose one of the herbs that best relieves inflammation, itching and promotes healing. It is recommended to do them every evening before bed for 10 minutes.
• Washing with tar soap and subsequent treatment of the affected areas with baby cream, sea buckthorn or fir oil.
• Drinking an infusion of herbs - wormwood, oregano, boron uterus, which must be prepared by mixing plant materials in equal proportions, 1 table is enough for 200 ml of boiling water. collection spoons. Leave for an hour and drink throughout the day for at least 3 months.

Prevention

It is important to follow measures to prevent kraurosis of the vulva and its transition to oncology:

1. Be examined and examined by a gynecologist twice a year.
2. Do not neglect intimate hygiene.
3. Do not abuse a large number of sexual partners, especially without barrier contraception.
4. Follow your doctor's recommendations for the treatment of chronic pathologies.
5. Monitor hormonal balance.

Kraurosis must not be allowed to progress into the second and third stages, otherwise the consequences will be irreparable. Returning to a normal rhythm of life without long-term medication is extremely difficult.

The information is provided for informational purposes only! If you have questions, we recommend making an appointment with a gynecologist.

Our doctors

General Director Anshina Margarita Beniaminovna Make an appointment
Director of the Rizhinashvili clinic Semyon Iosifovich Make an appointment

Obstetrician-gynecologist-reproductologist Zhordanidze Diana Omarovna Make an appointment

Obstetrician-gynecologist-reproductologist Torchinov Aslanbek Ruslanovich Make an appointment

Obstetrician-gynecologist, reproductive specialist. Efimova Maria Sergeevna Make an appointment

Obstetrician-gynecologist, reproductive specialist Khubonshoeva Leila Yuryevna Make an appointment

Obstetrician-gynecologist-reproductologist Anna Sergeevna Fedorova Make an appointment

Obstetrician-gynecologist, reproductive specialist Shagunova Marina Olegovna Make an appointment

Obstetrician-gynecologist Samoilova Tatyana Evgenievna Make an appointment

Urologist-andrologist of the highest qualification category Gablia Mikhail Yurievich Make an appointment

Obstetrician-gynecologist-endocrinologist Sharyafetdinova Failya Abdulkhaevna Make an appointment

Obstetrician-gynecologist Pushkina Valeria Vadimovna Make an appointment

Obstetrician-gynecologist Margarita Yuryevna Skvortsova Make an appointment

Obstetrician-gynecologist Slobodchikova Valeria Yuryevna Make an appointment

Obstetrician-gynecologist Peskova Irina Evgenievna Make an appointment

Perinatologist Nelly Idrisovna Kokhno Make an appointment

Obstetrician-gynecologist Olga Borisovna Kuharkina Make an appointment

Obstetrician-gynecologist Pitskhelauri Elena Germanovna Make an appointment

Obstetrician-gynecologist Abdullaeva Adilya Akhmadovna Make an appointment

Hemostasiologist Lopukhin Vadim Olegovich Make an appointment

Oncologist-mammologist Victoria Borisovna Akimova Make an appointment

Ultrasound diagnostics doctor Olga Ivanovna Babaeva Make an appointment

Ultrasound diagnostics doctor Brilliantova Nadezhda Nikolaevna Make an appointment

Ultrasound diagnostics doctor Natalya Sergeevna Gorovaya Make an appointment

Vascular ultrasound diagnostics doctor, vascular surgeon Anna Mikhailovna Nikitina Make an appointment

Cardiologist Maria Viktorovna Cherkasova Make an appointment

Endocrinologist Anzhelika Vladimirovna Manovitskaya Make an appointment

Gastroenterologist Golysheva Svetlana Valerievna Make an appointment

Obstetrician-gynecologist-reproductologist Olga Aleksandrovna Iskorostinskaya Make an appointment

Urologist-andrologist Iskorostinsky Evgeniy Vladimirovich Make an appointment

Psychologist Barskaya Ekaterina Sergeevna Make an appointment

Therapist Alexandra Vladimirovna Kabakova Make an appointment

Anesthesiologist-reanimatologist Isaev Oleg Vladimirovich Make an appointment

Psychiatrist, sexologist Teona Otarievna Kacharava Make an appointment

Head of the Embryology Laboratory. Ph.D. Sergeev Sergey Alexandrovich Make an appointment

Embryologist Kalinina Irina Ivanovna Make an appointment

Embryologist Kalyuzhny Sergey Andreevich Make an appointment

Embryologist Matveeva Elona Olegovna Make an appointment

Embryologist Vladimir Viktorovich Ovsyankin Make an appointment