We characterize the evaluation and initial management of patients with vulvar pruritus, including elements of history-taking, physical examination, laboratory testing, and treatments. We propose an algorithm for approaching this common clinical problem in a systematic way.
A retrospective chart review of patients with vulvar pruritus who presented to Gynecology or Vulvology Clinic at Parkland Health and Hospital System in 2012 informed this descriptive study.
A total of 46 patients aged 19 to 70 years presented with a primary symptom of vulvar itching, of which 41% had additional irritative vulvar complaints. The average duration of symptoms was 24 months; 67% had used at least one self-treatment unsuccessfully prior to their visit. Only 13% of patients received a non-genital skin examination; 46% received a vaginal culture, and 20% underwent vulvar biopsy. The most common diagnoses were "nonspecific" (39%), and "dermatitis" (22%). The most common treatment prescribed was a topical steroid (78%). Vulvar skin care counseling was documented for 67% of patients. At 18 months, 46% were lost to follow up and of those who returned, 48% reported resolution of initial vulvar symptoms.
The assessment and treatment of vulvar pruritus is variable. An algorithm for the evaluation of this common clinical complaint is proposed.