PRURITUS VULVA.
Itching may result from a number of causes, and in the vast majority of cases pruritus vulvas is only a symptom of one or another affection. There are cases enough, however, where we may search in vain for the special affection causing the symptom. As to whether we should here consider the itching as a neuralgia or not is very questionable. Beigel thinks that the term should only be applied to those cases where the sensation of itching is of central rather than of peripheral origin. While in the majority of instances we are able to find local explanation for the symptom, there is still a minority wherein we can detect no local changes, and we must consider the cause as lying in the nervous centres.
Itching compels scratching, and even if the patients try to Yesist the desire they cannot. Friction by the clothing, etc., adds to the itching a burning sensation. The pruritus is most frequently seated around the clitoris, and next the mons veneris and the origin of the labia majors. There are cases recorded where the clitoris alone was affected (Kuchen meister). The pruritus, however, may invade the vestibule and even extend into the vagina. The manipulation of the itching part may have a bad effect on the health, since it may lead to masturbation. All women suffering from pruritus are nervous. When the itching obtains mastery over the individual, the entire force of the will is necessary to effect a cure, and this force the patients have ordinarily lost. They seek solitude, and not infrequently end in an insane asylum. Onanism may be the cause of pruritus, since young girls so irritate their genitals as to cause abrasions which in healing cause itching (Carl Mayer); but ordinarily it is rather the pruritus which leads to masturbation.
Pruritus and the resultant onanism, are to be carefully differentiated from nymphomania, which is over a disease of nervous origin, leading the patient to seek in the most shameless way the normal gratification of her sexual appetite. Women who masturbate, on the other hand, rather shun than seek sexual intercourse.
The pruritus is not constantly present, but recurs at intervals. The attacks are most intense at night, the increase being due to the warmth. In certain patients long sitting, in others walking, with the consequent friction of the genitals by the clothing, in others still irritation by the urine, cause an attack. Hildebrandt claimed that great congestion of the genitals may cause pruritus vulvre. The following facts speak in favor of this view; many patients have to beware of alcoholic drinks, lost there result pruritus; in others long retention of urine or obstinate con stipation brings on an attack. The most intense attacks frequently pre cede by a longer or shorter interval the menstrual period; and, finally, pregnancy is in many women the cause of pruritus, in these instances the attacks either accompanying the beginning or the end of pregnancy, that is to say, at the periods of greatest congestion, the result of increase of abdominal pressure through the enlarged uterus. (Hildebrandt) The changes which we find on the genitals in case of pruritus are, in an early stage, very red, slightly edematous spots on the nymplice, and red, shiny isolated spots deprived of epithelium, and secreting a watery product. On the labia majora the same appearances are found, and later on the results of scratching. The skin is then moist, thickened and cov ered with furuncles. When eczema, herpes, intertrigo, etc., are found on the external genitals, we may justly consider these at:Notions the cause of the pruritus, and cure the latter by treating the former.
If by pruritus vulvte we mean an affection in which itching is a con stant symptom, then is it a very frequent one both in adults and in maid ens. In children a very common cause is the oxyuris vermicularis, which travels from the anus into the vagina, and irritates the canal. Additional causes are dirty habits or vaginal and cervical catarrh accom panying scrofula.