Treatment of Vulvar Edema in pregnancy
Physiological causes of vulvar edema in pregnancy
A body of a pregnant woman is predisposed to various pathological conditions. The most common complaints among pregnant women are edema, itching and pain in the vulvar area.
Vulvar edema in pregnancy may be caused by the disorders of the outflow of blood in the major vessels or infections in the pelvic area.
Vulvar edema in pregnancy may be caused by physiological factors:
- Uterus enlargement and compression of the veins which leads to venous outflow obstruction;
- Vulvar enlargement in pregnancy also relates to fat accumulation in the pelvic to facilitate baby’s movement through the birth canal;
- Hormonal imbalance.
If the condition is caused by the physiological factors, i.e. is a norm, then discomfort disappears shortly after a childbirth and no complications are observed.
Pathologic causes of vulvar edema in pregnancy
However, vulvar edema in pregnancy may occur as a result of the following disorders:
- Varicose veins. Owing to the changes in the local circulation system, in the pelvic appear varicose nodules appear; additionally, veins in the vulva in pregnancy lose their elasticity. In varicose veins vulvar edema, redness and discoloration of the skin are observed as well as pain which is aggravated during urination, defecation and in a sexual intercourse.
- Vulvovaginitis is a pathologic inflammation affecting the vagina and female external sex organs. The symptoms of vulvovaginitis are vulvar edema, pain in the groin (which is aggravated during walking and a sexual intercourse), vaginal dryness and serous and purulent discharge.
- Bartholinitis is an inflammation of a Bartholin’s gland (it is located in the vaginal opening on the vaginal wall). This pathologic condition is accompanied by an evident edema of the gland and the vulva, hyperemia and skin erythremia.
- Candidiasis (vaginal thrush) is a mycotic lesion of the mucous membranes. The causative agent is a conditionally pathogenic fungus Candida albicans. Candida activation may be triggered by the immunity decrease, disorders of mineral metabolism and dysbacteriosis. Candidiasis is accompanied by edema and vulvar enlargement, itching and copious white thick discharge.
Treatment of pathologies causing vulvar edema in pregnancy
The treatment of conditions as a result of which vulvar edema in pregnancy occurs requires an individual approach and careful diagnostics of the reasons of discomfort.
If vulvar edema and swelling relate to varicose veins, any special treatment is not required. Only in case with a severe course of the disease, the use of the medications to enhance local circulation is recommended (ointments “Troxevasin”and “Heparin”). In uncomplicated cases it is necessary to observe the rules of intimate personal hygiene and avoid any mechanical traumas.
The treatment of vulvovaginitis is oriented towards the elimination of inflammation and microbial causative agent. The procedure of irrigation is indicated (medicinal herbal blends: bur marigold, marigold, celandine, and chamomile), ointments (containing tetracycline). Antibiotics are rarely used, owing to negative influences on the fetus. Penicillin and its derivatives are used only when it is really necessary.
If bartholinitis is diagnosed, surgical intervention is needed (oncotomy) or the use of local action antibiotics. Systemic antibiotics are used only when the benefits for a mother are significantly higher than the risks for a fetus.
To treat candidiasis, it is recommended to use “Fluconazole” and “Clotrimazole” having topical action; vitamins; immunostimulators; eubiotics; probiotics.
Prevention of vulvar edema
Prevention of vulvar edema includes:
- Wearing relaxed fit underwear made from cotton, linen;
- Following the rules of intimate hygiene;
- The optimal combination of rest and activity.
Etiology of itchy vulva in pregnancy
Itchy vulva in pregnancy is also one of the most common complaints. Typically itching is a concomitant symptom of some condition. There are the following etiological factors causing itching in pregnancy:
- Impact of the environment on the genitals (infections, improper personal hygiene such as irregular bathing, use of allergic gels or creams of bad quality; mechanic irritation and thermal influence, for example, excessive loss of heat or excessive heat exposure);
- Urogenital system disorders (discharge in cervix inflammation; genitourinary fistulas);
- Pathologic processes in other body systems (anemia, hepatorenal diseases, thyroid pathologies, pancreatic glands disorder, i.e. diabetes);
- Psychological factors (stress, depression);
- Use of medications;
Conditions causing itchy vulva
Typically itchy vulva in pregnancy is a result of the following conditions:
- Gardnerellosis. This disease relates to the disturbed microflora in the genital area and the population of Gardnerella vaginalis on the vaginal mucous membrane. The pathology is accompanied by a copious foul-smelling discharge, intensive itching and the sensation of burning;
- Vulvitis is an inflammatory disease of the female external genitalia. Most often the causes of vulvitis are infectious agents such as streptococci, staphylococci, gonococci, chlamydia, viruses and fungi; urethritis and cystitis; allergic reactions on various chemical substances; uncontrolled use of antibiotics and hormonal medications; improper personal hygiene. Vulvitis has the following symptoms: hyperemia; itching and burning; pain which is aggravated during walking and urination; plaque on the inner side of the large pudendal lips; sometimes a subfebrile temperature may be observed. The treatment of vulvitis depends on its etiology.
- Genital herpes (caused by the simplex herpes virus type 2). The first signs of the disease are itching, hyperemia and rash with filled bubbles;
- Trichomoniasis is and infectious sexually transmitted disease. The causative agent is Trichomonas vaginalis. The symptoms of the disease are yellow vaginal foul-smelling discharge; hyperemia of the pudendal lips mucous membrane; mild bleeding from the mucous membrane, if there are erosion or ulcers; pain during urination or a sexual intercourse; burning and intensive itching;
- Pediculosis pubis;
- Helminth infestation – itching and burning in the anal area, groin and external genitalia.
Diagnosis, principles of therapy and prevention
The main methods of diagnostics are:
- Gynecological examination;
- Blood tests (clinical and biochemical);
- Smear for pathogenic bacteria;
- Clinical urine analysis;
- Stool test;
- Scrape and stool ova and parasites test;
- Consultation of a thyroid specialist (to exclude thyroid disorders), a urologist (to excluded diseases of the urogenital system) and a general practitioner.
To prevent the development of pathologies, a pregnant woman should take measures to avoid vulvar pain and itching:
- Regular visits to gynecologist;
- Diagnostics and treatment of sexually transmitted disease when planning pregnancy;
- Strict observance of personal hygiene;
- Immunity stimulation.
If a pregnant woman has complaints on pain and discomfort, the therapy in this case is oriented at eliminating the process causing itching. It is important to note that the treatment of vulvar inflammatory conditions in pregnancy involves the use of light medications to avoid a negative influence for a woman and a fetus.
The prescription is given only by the consulting gynecologist.