A Lecture ON PRURITUS VULVAE: ITS ETIOLOGY AND TREATMENT: Delivered at the Medical Graduates' College and Polyclinic, December 13th, 1911
Authors: R. A. Gibbons
Journal: BMJ (1912)

I HAVE chosen the subject of pruritus vulvae for our lecture this afternoon because I think that a careful study of the etiology and treatment will be of the greatest possible value to any who are attending a post-gradutat course with a view of benefiting themselves by practical work hereafter.PrPritus of the vulva is far more common than is generally supposed, because in the milder forms, on account principally of natural modesty, advice is not sought from the family physician, and whien the maladl y has increased, the case may be seen only for the first time by a gynaeco- logist.It is an affection whichb, in its severe form, short of jeopardizing life, may be considered one of the most terrible with which any woman may be afflicted, for it gives no peace-no lengthened freedom from irritation or itching.When a paroxysm comes on or passes off there is always the mental strain and anxiety concerning the next which may occur, and in cases which have lasted some time the apparent hopelessness of cure is ever present.In some, unquestionably, death is looked forward to as a happy release, and occurs by suicide.It may truly be said that amongst those who have suffered severely, andhlave been cured by judicious treatment, will be found the most grateful patients.It is a disease whlichl, once established, is exceedingly difficult to cure thoroughlly and com- pletely, whilst the milder forms readily yield to proper management. SYMPTOMS.It will be most simple to divide the subject into (1) synmptomatic and (2) essential pruritus vulvae.The latter must be considered a neurosis.The word "pruritus" merely means itching, and of course must be therefore symptomatic of something else.It is a subjective symptom, and may be present in a varying degree.Sometimes it feels as if there AN-ere sliglht smarting accompanying the itching, and sometimes a tingling, burn- ing, or pricking, sensation.Perlhaps the variety termed " formication," where the sensation is that of thousands of insects crawling over the skin, is the most terrible to bear.The objective signs are usually those of someinflammatory disturbance, as a rule confined at the commencement to tIme neighbourhood of the clitoris and nymphae, and gradually involve the whole region of the vulva.In an ordinary slight case of pruritus vulvae there nmay be little or nothing to observe; but even in the slight cases there is usually some form of irritation about tlle mucous surfaces of the labia majora, or on the nymphae or vestibule, to be detected if carefully looked for.The amount of itching may be quite trifling, and only occurring occasionally during theday, and especially at night, when the patient is in bed.In the more severe cases of symptomatic pruritus tlie paroxysms of itching are more pronounced but longer, and are accompanied by well-marked changes locally.The parts feel lhot and burning, and, if much scratclhing has taken place they mnay be swollen, raw, and bleeding.After a paroxysm is over the surfaces are exquisitely tender in the early stag'es, and the patient cannot bear the least touclh witlhout pailn.The attack may begin by a slight point of itching in the nieighbourhood of the clitoris or in the vestibule, and very slight friction may for the moment give relief.But the itching recurs and the scratclhing is repeated, the area of irritation growing larger and requiring more friction to give relief, until finally the field ofirritation, whiich started about the size of a pea, grows sufficiently large to include the whole of the vulva, and sometimes the pabes, leading to gradual wearing away of the hair and clhanges in the skin of the lower abdomen.As the irritation increases in direction the amount of friction grows in proportion, until finally what has been aptly termed " hysteria of the skin" is developed, and the poor woman scratches herself until she is quite exhausted and the paroxysm is over.It is in these severe cases that so much harm is done to the delicate mucous membrane, for thle scratching leads to changes in the tissues which keep up abnormal irritation.ETIOLOGY.