. Although micro-organisms abound in the vulval and perineal regions, normal skin is resistant to invasion by most of these. However, if the skin is continually moist because of vaginal discharge or urinary incontinence irritation may occur, which leads to scratching and damage to the macerated skin. Resistance of the skin to infection is also reduced if there are atrophic or degenerative changes as a result of disease or reduced oestrogen levels after the climacteric.
Specific organisms may also cause infection; for example, staphylococci may infect sebaceous glands or hair follicles, Candida albicans The skin covering the vulva may be involved in any generalized derma- tological disorder but its special anatomical situation makes it liable to a number of inflammatory conditions which are confmed to the genital areamay grow freely if there is glycosuria, and treponemata or other organisms may be transmitted at coitus.
In addition, non-infective dermatitis may be caused by sensitivity reactions to chemical agents such as medicinal applications or toilet preparations.
Because there are so many causes of vulvitis, careful investigation is always necessary. A full gynaecological history and examination are required. Special attention must be paid to any skin disorders elsewhere. The urine must be tested for sugar and examined bacteriologically. Any vaginal discharge must be investigated. On occasion rectal swabs should be examined and proctoscopy may be required. The skin may be examined bacteriologically and by histological examination of scrapings or a biopsy .
Vulvitis may be acute or chronic, but such a classification helps little, and an aetiological one is more satisfactory:
1. Vulvitis due to specific infections. 2. Vulvitis due to sensitivity reactions. 3. Vulvitis secondary to vaginal discharge or urinary disorders. 4. Vulval dystrophies.
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