Pruritu8 vulvae
posterior part of the labium minus. It causes severe discomfort in walking or sitting.
In the very early stages it may be possible to abort the infection with an antibiotic such as ampicillin but the patients almost always come too late for this. The treatment is then to drain the abscess, and this is best done by excision of an elliptical piece of skin and the abscess wall including the site of the duct. The pus is cultured so that the appropriate antibiotic can be chosen.
Bartholin's cyst The duct of the gland may become blocked. It then becomes distended by the mucoid secretion of the gland, forming a cyst which lies beneath and expands the posterior part of the labium minus. Such a cyst may become infected, but otherwise is painless. If treatment is demanded, the cyst is marsupialized by excision of an elliptical piece of skin with the underlying cyst wall, and then sewing the lining of the cyst to the skin. In a few days the wide opening contracts down. This simple procedure is much easier and more effective than excising the cyst and gland from the vascular field in which they lie.
Pruritus is the term used to describe a sensation of irritation from which the patient attempts to gain relief by scratching. It is a symptom, not a
disease in itself. The irritation often increases when the patient is warm bed, and she may scratch the area during sleep and wake to find that
has made herself bleed.
Physical causes
There is always some underlying cause for the onset of pruritus, b scratching soon damages the skin and causes secondary changes which obscure the primary cause. In addition, the skin may become sensitized some local application prescribed by the doctor or obtained by the pat' herself. In cases of long standing, the diagnosis of both the initial c and also of the reason for the maintenance of the irritation may be extremely difficult, particularly when more than one factor is invol Successful treatment depends on two cardinal principles: (1) to rem any underlying cause, and (2) to stop further damage to the skin scratching or by unsuitable applications.
The causes of pruritus have been described in preceding pages, and be summarized as follows:
1. Vaginal discharge.
2. Urinary conditions, including glycosuria and incontinence. 3. Disease or sensitization of the vulval skin.
4. General diseases. Pruritus is a manifestation of liver d Hodgkin's disease, but is seldom confmed to the vulva.
Pruritus ani can usually be distinguished from pruritus vulvae, bu some cases both areas are involved, and irritation may spread from area to the other. Pruritus ani may be caused by threadworms, espe . in children, or by irritating discharge from the anus, such as samet' occurs with the constant intake of liquid paraffin, with haemorrhoids, the patient neglects to keep this area clean.
Psychogenic causes
While any physical cause must be sought and treated appropriately, patients who complain of pruritus have no identifiable lesion of the Even when there is a simple local initial cause for the irritation, the tom may be increased and maintained almost indefmitely by scratc
Psychological problems may present as pruritus, and when relief is obtained by local treatment a deeper history is required. Sexual anxi -including ideas of menopausal inadequacy and fears of venereal or m nant disease are not unusual, but a wide spectrum of anxiety may
involved.
The fIrst task is to fmd the cause of the disorder and, whenever po to remove it. This may not be easy or immediately possible, and w investigation is in progress it is essential to avoid further damage to skin by scratching. Sometimes admission to hospital is well worth w but in all cases an adequate sedative must be given at night to secure g and stop scratching. Great care should be used in prescribing any of
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