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Pruritus Vulva in Adolescent Females in Arar City The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (5), Page 4420-4423 Pruritus Vulva in Adolescent Females in Arar City, KSA Aisha Reja M Alenazi1, Nawal Ahmed M Alshammari1, Batool Abdullah Albahrani2, Abdulaziz Saad M ALShamrani3, Noof Saad M Alruwaili1, Alaa Jameel A Ahmed1, Hajar Moosa Alkhadhabah2, Wafa Hammad Albalawi4, Nour Hamoud Abdullah Alanazi1 1 Faculty of Medicine, Northern Border University, 2 Faculty of Medicine, Emam Abdulrahman Bin Faisal University, 3Faculty of Medicine, AlBaha University, 4 Faculty of Medicine, Tabuk University ABSTRACT Background: Pruritus vulvae or vulvar itch is an unpleasant vulvar sensation that provokes the urge to scratch to obtain relief. It is a common complaint in females of all ages. A pruritus vulva is not a condition. It is the symptom of various -most often benign, sometimes malignant – disorders. The study aimed at investigating the prevalence in valval itching and its manifestations and causes among young females in Arar city, KSA. Methods: This is across sectional study conducted among 300 of the studied women, Arar, KSA. Data were collected by using pre designed online questionnaire which include questions designed to fulfill the study objectives. Results: Pruritus vulvae were found in 30.7% of the studied sample. Most (60.7) of the examined girls age was between 15- 20 years old. 79.3% of the sample was single (unmarried). Manifestations of pruritus vulvae were 43.5% redness, 21.7% edema, 67.4% reported association of pruritus with increased vaginal discharge. 56.5% reported increased pruritus before menses and 37% after. Only 37% of the pruritus cases asked for medical help but only 23.9% got better after treatment. There was a significant correlation between pruritus vulvae and both age group and marital status (P= 0.001). Conclusion: Pruritus vulvae were found in 30.7% of the studied sample. Prevention of genitourinary infection among adolescents regarding personal hygiene is mandatory. Recommendations include counseling during periodic medical examination about personal hygiene, especially during menstruation. Keywords: Adolescents, Female genitourinary tract, Pruritus Vulva, Genitourinary infection, Hygiene, Personal hygiene. Arar City, KSA INTRODUCTION This study aimed at investigating the Itch is the most frequent symptom in prevalence in vuval itching and it's manifestations dermatology and has been intensively studied in and causes among young females in Arar city, KSA. recent years. Nevertheless, there are few true PATIENTS AND METHODS (1) epidemiological studies on itch . Pruritus vulvae Study design and setting: A cross- simply mean itching of the vulva. Most women sectional study was carried out on female experience a slight vulval itch occasionally. population of Arar, Northern Province of Saudi However, pruritus vulvae means the itch is Arabia, KSA. persistent and causes distress. About 1 woman in 10 visits a doctor about a persistent itchy vulva at Sampling: The sample size was some stage in her life. Vulval itching can affect calculated using the sample size equation: n=z2p any woman, at any age. It can lead to scratching (1-p)/e2. Data were collected from Arar general and rubbing which can break the skin and can lead female population. Systematic random sampling to soreness, bleeding and skin infections (2). technique was followed. Vulvo-vaginal pH is high in childhood, but in Data collection: Data was collected by puberty the pH starts to decrease from an average using pre designed online questionnaire which of 7 to an average of 4 in adult women. An include questions designed to fulfill the study increase of pH may activate the proteinase- objectives. Socio-demographic characteristics activated receptor-2 (PAR-2) which is a well- including age, educational level, marital status known itch mediator (3). Unlike other areas of the and occupational status. Questions about itching, skin, the vulva is difficult for the patient to its timing, duration and recurrence. If the case was examine herself. Additionally, genital skin diagnosed and how it was diagnosed. symptoms often trigger concerns of poor hygiene, Statistical Analysis: All the data were sexually transmitted infections, or undiagnosed analyzed using statistical package for social cancer, all of which canelicit embarrassment, fear, (4) sciences (SPSS Inc.) version 20. Descriptive and anxiety . Clinical experience indicates that statistics were done for the prevalence and patients frequently do not consult a doctor for (1) quantitative variables. Risk factors were acute itch, but more often do for chronic itch . determined using logistic regression. A 2-sided p- value of less than 0.05 was considered statistically significant. 4420 Received:29/4/2018 Accepted:8/5/2018 Pruritus Vulva in Adolescent Females … Ethical considerations: Permission to Table (2): Manifestations, diagnosis of the cause and conduct the study was obtained from the Research treatment of pruritus vulvae among the studied cases, and Ethics Committee at the College of Medicine, Arar, 2018 (N=92). Northern Border University, Saudi Arabia. The Percent Variable (No.) questionnaire had a brief introduction explaining (%) the aims and significance of the study. All Redness of the vulva answers were kept confidentially and safe. Yes 40 43.5 No 52 56.5 RESULTS Edema of the vulva Table 1 shows that most (60.7) of the Yes 20 21.7 studied girls age was between 15- 20 years old. No 72 78.3 79.3% of the sample was single (unmarried). Scratching makesitching worse 30.7% of the studied sample had pruritus vulvae. Yes 80 87.0 No 12 13.0 Table 2 reports manifestations of pruritus Increased pruritus in relation to menses vulvae as shown (43.5% had redness, 21.7% had After 52 56.5 edema). 87% reported that scratching makes Before 34 37.0 itching worsen. 67.4% reported association of No relation 6 6.5 Association of pruritus with increased vaginal pruritus with increased vaginal discharge. 56.5% discharge reported increased pruritus before menses and Yes 62 67.4 37% after. Only 37% of the pruritus cases asked No 30 32.6 for medical help but only 23.9% got better after Discharge color treatment. Colorless 44 47.9 As shown in table 3; there was a Whitish 38 41.3 significant correlation between pruritus vulvae Yellowish 16 17.4 Smell of the discharge and both age group and marital status (P= 0.001). Non-offensive 34 37.0 Offensive 58 63.0 Table (1): Age group, marital status and Increased discharge in relation to menses prevalence of pruritus vulvae among the studied After 46 50.0 women, Arar, 2018(N=300). Before 44 47.8 No relation 2 2.2 Frequency(No.) Percent (%) Dysuria Yes 28 30.4 Age group No 64 69.6 15-20 182 60.7 Seeking medical advice for pruritus vulvae Yes 34 37.0 21-25 82 27.3 No 58 63.0 26-35 24 8.0 Diagnosis of the cause of pruritus vulvae Bacterial infection 44 47.9 >35 12 4.0 Fungal infection 20 21.7 Marital status Sexually transmitted infections 4 4.3 Not diagnosed 24 Single 238 79.3 Medical treatment Married 62 20.7 Yes 32 34.8 No 60 65.2 Pruritus vulvae Improvement on medical treatment Yes 92 30.7 Yes 22 23.9 No 70 76.1 No 208 69.3 Recurrent infection after treatment Yes 20 21.7 No 72 78.2 4421 Aisha Reja et al. Table (3): Relationship between pruritus vulvae and burning; 41 women (44.1%) experienced vulvar age group and marital status among the studied discomfort: 18 (19.4%) reported itching, 10 (10.8%) women, Arar, 2018(N=300). burning, and the remaining 13 (14.0%) both itching (12) Pruritus vulvae Total and burning . Another study was done on 76 P value Yes (n=92) No (n=208) (n=300) women with vulvodynia. It was found that vulvar Age group burning is the most commonly reported symptom by 34 148 182 (13) 15-20 37.0% 71.2% 60.7% (88.2%) followed by vulvar itching (60.5%) . 38 44 82 Across sectional study conducted among women 21-25 41.3% 21.2% 27.3% 0.001 reporting a history of chronic vulvovaginitis 16 8 24 26-35 candidiasis (VVC) classified to 48 cases with C 17.4% 3.8% 8.0% 4 8 12 albicans vulvovaginitis candidiasis from them 88.4% >35 4.3% 3.8% 4.0% reported vulvar itching, 29 cases with C glabrata Marital status vulvovaginitis candidiasis; itching reported in 85.2% 60 178 238 Single case and no-candida controls (n = 64) from them 65.2% 85.6% 79.3% 0.001 (14) 32 30 62 72.2% reported itching . Another study was Married 34.8% 14.4% 20.7% undertaken among 120 female patients with non- venereal dermatoses of external genitalia reported DISCUSSION itching in 61.7% of cases (15). Pruritus vulvae or vulvar itch is an Another study was conducted among 143 unpleasant vulvar sensation that provokes the urge to pregnant women having symptoms of vaginal scratch to obtain relief. This symptom is present in infections; complaint of itching was present in (17) 36–45 % of the patients consulting in a vulvar clinic 51.04% patients . Another study conducted among (5, 6). It is a common complaint in females of all ages. 338 females. Bacterial vaginosis (BV) was diagnosed A pruritus vulva is not a condition. It is the symptom in 72.5% of female participants, among women with of various -most often benign, sometimes malignant – BV, 33.1% were colonized with yeast, vulvovaginal disorders (7). This is across sectional study conducted candidiasis was observed in 15.7% of participants among 300 of the studied women, Arar, KSA. The irrespective of BV status, “vulvar pruritis” is more study aimed at investigating to examine the likely to be reported among women colonized with prevalence in valval itching and its manifestations yeast (colonized and/or diagnosed with VVC) (P < (18) and causes among young females in Arar city, KSA.
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