Vulvar atrophy

Introduction Vulvar atrophy refers to a group of diseases in which women's skin and vulvar mucosal dystrophy cause tissue degeneration of skin pigmentation. For a long time, clinicians have been accustomed to whitening, thickening or shrinking vulvar skin and mucous membranes, collectively referred to as "vulvar atrophy." Senile vulvar atrophy is atrophic change caused by skin dystrophy caused by all or part of the vulvar skin mucosa with different degrees of skin tissue reduction and dysfunction. Senile vulvar atrophy due to aging, endocrine disorders, malnutrition, chronic infection, poisoning, congenital anomalies or neurotrophic dysfunction, can also be mechanical long-term compression, traction or physical factors such as radioactive damage or chemical stimulation Caused. It usually appears after the age of 50. It is characterized by thinning and dry skin, reduced elasticity and relaxation, wrinkles on the surface, atrophy of sweat glands, decreased sweat, decreased secretion of sebaceous glands, and thinning of hair. In addition, there may be pigmentation and hypopigmentation spots, telangiectasia, fine scales and ecchymoses, often accompanied by seborrheic keratosis, senile keratosis, senile hemangioma, purpura, skin sputum, senile elastic fiber Diseases and other diseases.

Cause

Causes of vulvar atrophy:

(1) Causes of the disease

The causes of vulvar skin atrophy are as follows:

1. Primary vulvar atrophy: Older women after menopause, ovarian function declines, estrogen levels decrease, and their target organs also shrink.

2. Vulvar white lesions: also known as chronic vulvar dystrophy. It is divided into proliferative type, hardened moss type and mixed type. In the case of a hardened mossy type of lesion, the inflammatory lesions cause the dermal elastic tissue to disappear and fibrosis, and the clitoris and labia minora atrophy.

3. Lichen planus: caused by chronic stimuli such as vaginal discharge and scratching, often accompanied by severe atrophic changes.

4. Vulvar leukoplakia: It is a proliferative change of the vulva mucosa, and 10% to 20% of malignant changes occur. It may be formed by long-term stimulation such as trauma, inflammation, allergies, infection, etc., and finally it may cause atrophy of the vulva.

(two) pathogenesis

1. Primary vulvar atrophy: the epidermis becomes thinner and the stratum corneum becomes thinner. The leather has a glassy change. Subcutaneous elastic fibers are reduced.

2. Sclerotic moss-type malnutrition: pathological features are hyperkeratosis of the epidermis and even horn plugs, epidermal atrophy and thinning with basal cell liquefaction and degeneration, melanocytes decreased. Shallow edema of the dermis, loss of collagen fiber structure and homogenization, lymphatic infiltration in the middle layer of the dermis.

3. Lichen planus: Granular layer hyperplasia, hyperkeratosis and acanthosis. The superficial dermis has banded inflammatory infiltration and invades the epidermis. The basement membrane often has liquefaction and degeneration, and epithelial cells degenerate to form a gelatinous body.

4. Vulvar leukoplakia: In the hypertrophic period, the epithelial layer is thickened, keratinized, and the nipple is hypertrophied and often falls into connective tissue. During the atrophic period, chronic inflammation changes significantly, with varying degrees of edema, and the elastic fibers under the epithelial layer almost completely disappear. There is no clear boundary between the hypertrophy period and the atrophic period, the epithelial layer may be significantly thicker at one place and thinner at the other.

It has been suggested that vulvar leukoplakia can be divided into three levels according to the degree of epithelial cell hyperplasia:

Grade I: Epithelial spine cells thickened, the nipples were trapped in connective tissue, but the cells showed no atypical changes.

Grade II: Atypical cells appear, with scattered nuclear division and epithelial bead formation.

Grade III: Cells have variability, inconsistent size, and mitotic division, with similar changes to carcinoma in situ.

an examination

Related inspection

Gynecological routine examination of genital gynecological routine examination of estrogen

Typical cases can be diagnosed according to symptoms and signs, but rely on biopsy, biopsy should be performed at the suspected lesions, and multiple points should be taken to eliminate malignant transformation. If it can be first stained with 1% toluidine blue, and then decolorized with 1% acetic acid solution, biopsy in the non-decolorization zone can improve the positive rate of diagnosis. In recent years, colposcopy has also been applied to genital lesions, which helps to eliminate cancer.

Differential diagnosis

Differential diagnosis of vulvar atrophy:

1. Primary vulvar atrophy: the vulvar subcutaneous fat disappears at the beginning, the labia majora is flat, and then the pubic hair falls off, the epidermis withers, the surface is smooth, dry and shiny. It has a waxy luster and sometimes has small red spots. The labia minora and clitoris may eventually disappear. The vulva has itching, burning or tingling sensation. If there is a secondary infection, it is also painful to urinate. The vaginal opening is narrowed due to atrophy, making it difficult for sexual intercourse. The range of atrophy can be extended to the perineal body, around the anus, and the anal sphincter tension is reduced, mild fecal incontinence occurs, and anal fissure can also be caused by atrophy.

2. Sclerotic moss-type malnutrition: The main symptoms are itching in the lesion area, and the lesions involve the skin of the vulva, mucous membrane and perianal skin. The clitoris, labia minora and posterior joint are the most common lesions. Appearance Skin mucous membrane becomes white, thin, dry and easy to split, loses elasticity, the clitoris shrinks and the labia minora is flat. Late skin is thin like cigarette paper, and the vaginal opening is narrow, which makes it difficult for sexual intercourse. Severe cases like postoperative vulvar resection, that is, "the vulva is dry."

3. Lichen planus: local intense itching. In the brown and damp area, the umbilical fossa area appears, the surface is rough, moist, and scratches are visible. The red reticular plaque is visible on the inner side of the vestibule and labia minora. In addition to invading the labia majora, clitoris and perineum, it often involves the vaginal mucosa. Often, there is a severe atrophic change, but there is no atrophy and stenosis in the vaginal opening and vagina.

4. Vulvar leukoplakia: more common in menopause. The lesions are mostly inside the labia majora, labia minora and clitoris, which can affect the entire labia majora, perineum or anus. Local itching, dryness, tingling and burning sensation. Small pieces of thickened tissue on the surface of the mucous membrane are visible in white or gray, sometimes with cleft palate and ulcers.

5. Vulvar sclerosing moss: Vulvar sclerosing moss is a skin disease characterized by atrophy and thinning of the vulva and perianal skin. Because skin atrophy is a characteristic of this disease, dermatologists still call this disease "hardened atrophic moss". The lesion mainly invades the clitoris and its foreskin, labia minora, posterior labial joint and perianal, and is the most common white lesion of the vulva. A preliminary diagnosis can be made based on clinical manifestations, and biopsy is the only final diagnostic method.

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