Leukoplakia of the external sex organs in women, type. Leukoplakia of the vulva: modern methods of treatment. The main causes of the disease

Leukoplakia is characterized by keratinization and thickening of the multilayer squamous epithelium.

Causes of vulvar leukoplakia

The development of leukoplakia is based on complex neuroendocrine and metabolic processes caused by changes nervous system. Often leukoplakia occurs as a result of dysfunction of the ovaries, adrenal cortex and a number of other glands internal secretion. The occurrence and development of the disease is facilitated by age-related atrophic processes in the vulva, caused by restructuring of the neuroendocrine system.

Although leukoplakia can occur at any age, the disease is most often observed during menopause and menopause. In women with disorders of the gonads, the disease occurs more often than in healthy women.

A certain role in the development of leukoplakia is played by a lack of vitamins, especially A-hypovitaminosis.

Signs of vulvar leukoplakia

The main symptom of leukoplakia is foci of depigmentation - whitish spots, which are usually located symmetrically. Most often they are localized on the labia minora, clitoris, and also on inner surface labia majora (the outer surface, as a rule, is not affected), further spreading to the perineum and inguinal folds.

TO characteristic features The disease also includes itching of the external genitalia, usually occurring at night. There is also a feeling of numbness, burning, tingling and crawling.

Leukoplakia can be limited, that is, consist of individual plaques, or diffuse - in the form of fused lesions. According to the nature of the severity of the thickened layer, 3 forms of the disease are distinguished: flat (simple), hypertrophic (hyperkeratotic) and warty. Hypertrophic and verrucous leukoplakia are characteristic of limited lesions.

Leukoplakia often precedes atrophy of the integumentary stratified squamous epithelium.

With sclerotic changes in the vulva, the clitoris and labia minora are deformed, the labia majora are significantly flattened and thickened, the skin and mucous membranes intimately grow together with the underlying tissue, they narrow the entrance to the vagina, as well as (less often) the external opening urethra. The glossy-pearlescent hue of integumentary tissues that have lost their elasticity resembles a crumpled parchment sheet (a symptom of parchment). The presence of cracks and ulcerations favors tissue infection and the occurrence of inflammatory reaction, which is accompanied by pain, swelling and redness.

Prolonged itching of the vulva contributes to the occurrence of a number of emotional and neurotic disorders in the form of insomnia, increased irritability, depression, and decreased ability to work. Added to this are difficult or painful urination and the inability to have a sexual life.

Diagnosis of vulvar leukoplakia

Areas of leukoplakia are visible to the naked eye. However, the apparent simplicity of diagnosis is dangerous in cases where leukoplakia is combined with vulvar cancer. That is why the doctor complements the visual examination of the vulva with its examination using a colposcope. In doubtful cases, he may resort to a biopsy of a suspicious area of tissue followed by histological examination.

Treatment of vulvar leukoplakia

As therapeutic measures washing and douching with chamomile and other herbs somewhat reduce discomfort, but do not cure this disease. Due to the fact that this is a precancerous disease, observation by a gynecologist is necessary; excision or electrocoagulation of the lesions is possible.

Most effective complex therapy, which is selected strictly individually.

Non-operative treatment of leukoplakia includes the following components: psychotherapy, hydrocortisone phonophoresis on the vulva area, intramuscular injections 5-10% solution of tocopherol acetate in oil, 1 ml, intake ascorbic acid. It is also recommended to carry out daily subcutaneous injections biogenic stimulants (aloe extract, FiBS, suspension or placenta extract - all 1 ml) in order to activate the hormonal function of the adrenal cortex. The course of treatment (30 injections) is repeated after 3-4 months. Simultaneously with the use of biostimulants as local therapeutic agent You can use folliculin ointment (20,000 units) and aloe liniment.

To treat leukoplakia, ointments containing glucocorticoids are used. They have anti-inflammatory and antiallergic properties, and also eliminate or reduce the feeling of itching. The most appropriate use of hydrocortisone (1% and 2.5%), prednisolone (0.5%), fluorocortic (contains 0.1% triamcinolone acetonide) ointments.

An indispensable prerequisite for the success of treatment is a thorough, systematic toileting of the external genitalia and perineum. For washing, use only boiled water, adding sodium bicarbonate, chamomile or calendula infusion. Use solutions of potassium permanganate and boric acid, like various soaps, is undesirable, so cat. they dry out and thereby irritate the tissues, aggravating the discomfort.

The underwear should be made from natural fabrics; it should not fit tightly to the external genitalia, otherwise the itching may increase.

Smoking and drinking alcohol should be avoided. The basis of the diet should be dairy products, boiled meat (especially liver and kidneys), boiled fish, vegetables, berries and fruits. Dry food, spices, spicy foods, smoking, strong tea and coffee should be excluded.

Traditional medicine offers its own methods of treating vulvar leukoplakia - acupuncture, water treatments using herbs and plants. For example, when lying down before going to bed and immediately after waking up, it is useful to drink a glass of boiled water at room temperature.

Leukoplakia is a disease characterized by keratinization of the mucous membrane and its replacement with tissues similar to the epidermis of the skin. The disease can affect any organs (mouth, tongue, cheeks, cervix, penis). In women during menopause, leukoplakia of the external genitalia most often occurs.

The disease is precancerous, so it is important to diagnose leukoplakia as soon as possible and start adequate therapy.

Reasons for the development of the pathological process

Leukoplakia is a reaction of the mucous membrane to irritants. The following factors lead to its appearance:

neuroendocrine diseases (disorders of the endocrine glands: hypothyroidism, polycystic ovary syndrome, diabetes mellitus, obesity, etc.);
chronic inflammatory processes of the internal and external genital organs (herpes, HPV);
cervical dysplasia;
damage to the external genitalia;
neglect of personal hygiene rules;
stress and psycho-emotional overload;
decreased immunity;
vitamin deficiency (especially vitamin A deficiency);
insolation;
bad habits.

Note! Predisposition to leukoplakia is inherited.

Description of the disease

Leukoplakia in women develops during menopause, i.e. when menstruation stopped. At this time, age-related involution occurs in the body - this is natural process aging.

The level of sex hormones decreases, because the glands and tissues atrophy, the skin and mucous membranes become drier, elasticity is lost, and trauma increases.

Lately doctors notice that this disease is “getting younger”, i.e. Women under 40 years of age present with pathological symptoms.

Leukoplakia of the labia is a chronic, relapsing process. The disease develops slowly, and at first the symptoms are not always noticeable to the woman.

Types of leukoplakia:

flat - the lesion has clear boundaries, practically does not protrude above the surface, looks like a film that cannot be removed with a spatula. Color – white-gray. The surface of the formation is dry and rough;

verrucous - plaques of white-yellow or gray, rise above the mucosa. Or lumpy growths, similar to warts, up to 3 mm in height. This form can develop on flat leukoplakia;

erosive - varied in severity and amount of erosion, developing in place of the two previous forms. Cracks often appear. This form The disease brings pain and discomfort.

Photo of leukoplakia of the external genitalia in a woman

Verrucous or warty leukoplakia Leukoplakia in an advanced stage Multiple flat leukoplakia

The development of leukoplakia can be stopped if treatment is prescribed or the effect of provoking factors is eliminated. IN in this case, the disease is regressing. If the disease is left unattended, the forms of leukoplakia gradually replace each other, and the process develops into cancer.

Symptoms of the disease

Leukoplakia is initially asymptomatic. In the area of the clitoris or labia minora, small multiple white spots appear, similar to plaque.

Gradually, the spots become keratinized, their color changes to gray with a pearlescent tint. The lesion area increases (labia majora, vagina, etc.). The plaques merge with each other and become thicker.

The more the mucous membrane changes, the more difficult the disease progresses. All this leads to the appearance of pathological symptoms:

unbearable itching in the area of the external genitalia, which increases at night and after urination;
burning sensation;
numbness and tingling of the vulva and clitoris;
pain during intercourse.

Gradually, erosions and cracks appear, which become easily infected. When layering bacterial infection foci of inflammation are formed.

Symptoms of the disease change a woman’s life: insomnia, decreased performance, depression and irritability.

Diagnosis of the disease

Colpo- and vulvoscopy

Pathological manifestations force the patient to see a gynecologist. The doctor conducts external inspection and appoints additional methods diagnostics:

Colpo- and vulvoscopy – examination of the mucous membranes of the vagina and cervix under a microscope. This method allows you to exclude malignant neoplasms;
Schiller test - staining the lesion with iodine solution; areas of leukoplakia are not painted over and are clearly visible;
smear for microflora and oncocytology;
biopsy - taking a sample of affected tissue and examining it under a microscope. The most accurate method for diagnosing leukoplakia.

Differential diagnosis is carried out with syphilis, condylomas, papillomas, vitiligo, neurodermatitis, genital itching, diabetes mellitus and etc.

Treatment of pathology

Treatment of the disease is complex. It includes medicinal assistance, physical therapy, diet, consultation with a psychotherapist upon request. The choice of technique is made based on the patient’s age, degree of damage and medical history.

Hormonal ointments with hydrocortisone or prednisolone applied to the affected areas twice a day for 1-2 weeks.
Oral hormonal drugs: estrogen-progestogen (COC) or estrogens and androgens. Such medicines are selected strictly individually. Some of them: Janine, Norkolut, Logest, Tri-Mercy.
Antipruritic ointments are applied topically for no more than a week: Akriderm, Beloderm, Triderm.
Antihistamines can also be taken orally: Suprastin, Claritin, Fenkarol.
If all of the above does not relieve itching and burning, a novocaine blockade is prescribed (in a clinic or hospital setting).
Ointments or suppositories with antibiotics and antiseptics relieve inflammation; they are prescribed if there is an accompanying pathological microflora: Baneocin, Polygynax, Elzhina, Pimafukort.
On the recommendation of a psychotherapist, it is possible to use sedatives and tranquilizers to treat insomnia and irritability.
Complex vitamins and microelements for 2-3 months.

Physiotherapy includes ultraphonophoresis medicines, balneotherapy and oxygen therapy.

If all of the above treatment does not help, surgical treatment is resorted to. For isolated areas of leukoplakia the following is used:

cryodestruction - destruction of lesions liquid nitrogen;
laser therapy - evaporating them using a laser;
radio knife or scalpel - radical excision of the affected areas.

If the damage to the external genitalia is extensive, extirpation of the vulva is resorted to. This operation is performed using a regular scalpel and a radio knife.

General rules of conduct for women with leukoplakia:

need to wash up warm water without soap, you can use decoctions of soothing herbs (chamomile, calendula);
underwear should be made from natural fabrics;
When sleeping, it is better to cover yourself with a light blanket;
do not take hot baths;
engage in physical therapy;
take walks on fresh air;
During treatment, avoid saunas, swimming pools, etc.

Diet for leukoplakia includes low-fat varieties meat and fish, dairy products, vegetables and cereals. It is necessary to completely exclude fried, salty, spicy, as well as alcohol. Consume sufficient quantity liquids (at least 2 liters per day).

Patients with leukoplakia are seen not only by a gynecologist, but also by an oncologist. You definitely need to be examined by a doctor at least 2 times a year, take tests and cytology.

Forecast

Forecast at initial form leukoplakia is considered favorable. This type of disease often undergoes regression. But with the verrucous and erosive form, everything is much more complicated.

They very often become malignant (lead to cancer). Therefore, it is very important to detect as early as possible pathological symptoms and begin treatment of the disease.

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All information is presented for educational purposes. Do not self-medicate, it is dangerous! Accurate diagnosis Only a doctor can diagnose.

Due to the increasing proportion of elderly women among the population, kraurosis and leukoplakia of the external female genitalia have now begun to occur earlier. The significance of these diseases in the pathology of the female reproductive system is determined not only by the persistence of symptoms and ineffective therapy, but also by the fact that in a certain percentage of cases these diseases, especially leukoplakia, can develop into cancer. For many years now, both diseases with with good reason classified as precancerous.
Kraurosis and leukoplakia of the female external genitalia usually occur during menopause (cessation of menstruation), when processes of reverse development occur in the woman’s reproductive system. These physiological changes, found on the external genitalia of a woman, upon microscopic examination are very similar to initial stage of their development are those that are encountered with kraurosis and leukoplakia. Indeed, as you age female body and age-related changes in the tissues of the female external genitalia, atrophy processes begin to predominate, which are manifested by dry skin, hair loss, loss of skin elasticity and mild trauma to the skin.

Clinical picture of kraurosis and leukoplakia female external genitalia is quite characteristic. Usually the disease develops gradually and is hardly noticeable to patients. Initial symptom(sign) – itching in the area of the external genitalia, to which at first the woman does not attach much importance. Itching most often appears at night and subsides during the day. The processes of atrophy begin with a symmetrical lesion of the labia minora, clitoris, after which the disease spreads to other areas of the external genitalia, without moving to scalp. In the future, the process may spread to the perineum, the area near the anus and inguinal folds.
The picture of the atrophic process is quite characteristic. Depigmentation of the skin and adjacent mucous membranes is observed, they become whitish and shiny. These changes are most pronounced in the area of the clitoris and labia minora, while at the beginning of the disease the labia majora retain their original shape and appearance. Later, the pathological process also affects the labia majora, while the hairline noticeably thins. The skin and mucous membranes lose their normal pattern, become smooth, their elasticity is impaired, they become thinner, and become easily vulnerable. The color of the skin of the external genitalia also changes noticeably, acquiring a characteristic whitish-gray or pale pink color. Wrinkling of the tissues of the external female genitalia leads to a narrowing of the vaginal opening. These phenomena are accompanied by constant painful itching, as a result of which many patients experience a variety of neurotic reactions.
About the further progression of the disease and the phenomena of sclerosis pathological changes on the part of the external genitalia become more pronounced. The clitoris and labia minora completely atrophy, the labia majora, covered with sparse hair, become significantly thicker and flattened. There is not only a narrowing of the entrance to the vagina, but also the external opening of the urethra.
The kraurosis described above is often combined with leukoplakia. Less commonly, leukoplakia is the only manifestation of a disease of the external genitalia.
In contrast to kraurosis, leukoplakia is characterized by processes of hyperkeratosis (excessive keratinization). And on the external genitalia, typical whitish plaques appear, surrounded by a cushion. The size of the plaques can range from a millet grain to a five-kopeck coin. Leukoplakia can be isolated or diffuse (widespread). In the diffuse form of the disease, the appearance of confluent lesions is observed, involving the skin of the external genital organs over a significant area.
The visible picture of kraurosis and leukoplakia of the external female genitalia changes significantly with the addition of a secondary infection that penetrates the surface layers of the skin during scratching. In these cases, pronounced redness, plaque and cheesy films are observed, after removing which with a cotton swab a bleeding, erosive surface is exposed.
Kraurosis and leukoplakia are characterized by a chronic, long-term course with numerous repetitions.

Treatment treatment of patients with leukoplakia and kraurosis of the external female genitalia is a complex and not yet fully resolved problem. Therapy should begin with general effects, which are widely combined with local procedures. Psychotherapy is of great importance, aimed primarily at developing in the patient confidence in the possibility of a cure for this long-term and painful disease. It is recommended to maintain a rational regime of work and rest; widely used gymnastic exercises, walks in the open air. Sleep should be normalized if you have insomnia. Diet therapy plays a significant role. Rational diet therapy plays an essential role. Nutrition should be complete, sufficient in calories and vitamin content. Carbohydrate intake should be somewhat limited. Irritating dishes and spices are excluded.
Compliance with the necessary hygiene regime is of great importance. Underwear should not fit tightly to the body, so as not to cause an additional feeling of itching. You should completely avoid wearing underwear made from synthetic fabrics. The patient should systematically wash the external genitalia with solutions of chamomile infusion or baking soda.
Drug treatment includes the purpose of general and local impact, it is advisable to combine it with novocaine blockade and physiotherapy. In some extremely severe cases, if conservative therapy is unsuccessful, surgical treatment must be resorted to.

Leukoplakia is a disease in which the mucous membranes undergo changes in the form of keratinization of the integumentary stratified epithelium(phenomena of dyskeratosis). In gynecology, leukoplakia of the vagina, labia and vulva, cervix, and clitoris is more common, with white or grayish spots appearing on the surface of these organs. Treatment of leukoplakia should begin as early as possible, because the pathology is considered precancerous: in 5-15% of cases it degenerates into cancerous tumor. But some types of disease ( simple form) Dont Have atypical cells, therefore considered relatively safe. The disease is usually diagnosed at the age of 40 years and older, and its causes are not always clear. Among all cervical pathologies, leukoplakia accounts for up to 3-7%.

Types of leukoplakia

The classification includes the division of pathology into 3 forms:

simple leukoplakia;
scaly leukoplakia;
erosive leukoplakia.

Simple leukoplakia of the cervix is not visible during a gynecological examination, being detected only after colposcopy with staining. It is a thin film of grayish color, dry to the touch, somewhat rough, but not protruding above the surface of the mucous membrane. Simple leukoplakia is a disease that often affects the vaginal walls and the labia area.

With squamous leukoplakia, the affected epithelium thickens, its structure becomes tuberous. The color of the spots is gray, white, they protrude above the surface of the vaginal mucosa and cervix by 1-3 mm. Often the spots are layered one on top of the other, with large areas of the genital mucosa becoming lumpy. The disease is easy to detect during a routine gynecological examination. Treatment is mandatory: after the occurrence of scaly leukoplakia, cancer most often develops.

The erosive type of pathology causes the appearance of white spots that deepen into upper layer mucosal epithelium in the form of erosions. They may have varying degrees manifestations and unequal sizes, cracks often form on erosions. This type of disease almost always gives a clear clinical picture.

The last two forms of the disease are considered proliferative. After proliferative transformation, the differentiation of the mucous membrane into layers is disrupted, elements of an atypical structure appear, that is, the initial focal stage of the precancerous process occurs. Gradually, proliferative forms of leukoplakia develop into dysplasia, or intraepithelial neoplasia.

According to another classification, leukoplakia is divided into:

primary (actually, one of the above types of disease);
secondary (leukoplakia becomes a symptom of another disease, for example, genital syphilis).

Causes of leukoplakia

Currently, the exact causes of the disease are a controversial issue. Most experts agree that the basis for the pathological process is hormonal imbalances, which lead to a lack of estrogen - female sex hormones. When studying the hormonal status of patients, it is also revealed wrong ratio estradiol and other estrogens in the blood. Oddly enough, progesterone deficiency with hyperestragenia can also become a prerequisite for the development of leukoplakia. Women diagnosed with the disease often have abnormal menstrual cycles (eg, amenorrhea).

The causes of leukoplakia are often associated with injury to the mucous membrane of the vagina, labia or cervix. Thus, in a significant proportion of women, symptoms of cervical leukoplakia arose after cauterization of erosions by electrocoagulation. Sometimes the disease occurs after abortion, curettage and other manipulations affecting the vagina and cervix.

It has been noted that the causes of genital leukoplakia in women are often associated with dystrophic changes mucous membrane in chronic vaginitis, endometritis, adnexitis, with involutional processes in the body, occur with recurrent ectopia.

Risk factors for the development of leukoplakia may include:

work in conditions of occupational hazards;
smoking;
complicated heredity (family history of dyskeratosis);
vitamin deficiencies (especially vitamin A deficiency);
STIs (ureaplasmosis, chlamydia, genital herpes, HPV);
decreased local and general immunity;
poor sexual hygiene.

Sometimes leukoplakia worsens during pregnancy, when serious hormonal changes in organism. Labor with trauma to the cervix can also contribute to the rapid progression of the disease.

Symptoms of leukoplakia

When examining the cervix or vaginal walls, lesions are detected in the form of individual grayish-white spots, or group or extensive damage to the mucous membrane is observed. Often, widespread, advanced pathology is combined with cervical hypertrophy or with scars and adhesions. At the initial stage, leukoplakia lesions are bright red areas of inflammation, and only later do they become covered with a gray coating that cannot be removed with a gynecological spatula.

Clinical symptoms of simple leukoplakia are rare. But when covering pathological processes significant areas may be observed:

itching in the perineal area (usually at night);
pain, discomfort during sexual intercourse;
feeling of dryness in the vagina;
feeling of tightness, irritation in the area of the vulva, perineum;
the appearance of microcracks on the labia;
the formation on the external genital organs of areas similar to warts, erosion, flaking and cracking, with clear contours.

If the disease is not treated, gradually, against the background of simple leukoplakia, scaly or erosive leukoplakia with a tendency to proliferation may develop. The growth of lesions occurs not only in width, but also upward, resulting in the formation of a plaque of 2-3 mm. height. The plaques become lumpy, cracks and microerosions appear on them.

The disease exists for decades, but sometimes it can suddenly begin its malignant degeneration. The period of malignancy in women varies and takes from a year to several years. Typically, malignant lesions are externally unevenly compacted, and tuberosity and erosion occupy only a certain part of them. But even an apparently benign form of leukoplakia can be prone to transformation into cancer, so when it is detected, a histological analysis is always carried out.

Diagnosis of leukoplakia

The disease diagnostic program includes the usual gynecological examination, colposcopy and collection of material for cytological examination. If necessary, the doctor may recommend a smear test, a smear or blood test for antibodies to STI pathogens (if an infection is suspected) and other examinations.

Pathological changes in the epithelium of the mucous membrane of the genital organs are best visible when examined with a colposcope. It magnifies the image many times, allowing you to evaluate the structure and type of tissue. Additionally, a Schiller test is performed (staining cells with Lugol's solution). In this case, areas with atypical degeneration are not stained Brown color, but remain the same in shade.

To perform cytology, a smear is taken from the cervix and vagina, as well as cervical canal. If leukoplakia occurs, smears reveal a large number of diskeracites, keratin. According to indications, a biopsy is taken, after which a histological examination of the biopsy tissue is performed. If the analysis clearly shows epithelial dysplasia, the process is precancerous.

Another method for diagnosing the disease is microcolpohysteroscopy. During such a study, a specialist examines the condition of the epithelium of the genital organs and can also take a biopsy from abnormal areas. Leukoplakia should be differentiated from cervical dysplasia, erosions, and cervical cancer.

Medical and surgical treatment of leukoplakia

The treatment tactics for leukoplakia are determined by whether its simple or proliferative form has been detected. For full recovery it is necessary to remove all pathological foci. Cervical leukoplakia is not treated with medications, but treatment of concomitant pathologies is mandatory. It may include antivirals, antibiotics, anti-inflammatory, immunomodulatory agents, hormonal drugs. You cannot prescribe drugs to accelerate tissue regeneration, which can stimulate the development of dysplasia.

If intraepithelial neoplasia is present, conization of the uterus or excision of the cervix is often performed. Without the presence of precancerous changes, minimally invasive removal of leukoplakia foci is performed using modern techniques. After the procedure, which is performed under local (less commonly, general) anesthesia, the recovery period lasts 2-8 weeks. During this time, you cannot be sexually active or use any methods of contraception.

Chemical coagulation

This method is most often used to treat vulvar leukoplakia. Chemical coagulation, or cauterization of leukoplakia lesions using special preparations, is performed by Solkovagin. Treatment involves treating the affected areas with this substance, excluding healthy areas of the mucous membrane. This method of therapy is practically painless and very effective: recovery after it is observed in 75-96% of women.

Electrocoagulation

Treatment with electrocoagulation is the cauterization of leukoplakia using electric current. Despite complete removal plaques and erosions after this technique often develop serious side effects. Among them are implantation endometriosis, heavy bleeding, exacerbation of ovarian diseases, disorders menstrual cycle, tissue infection. Therefore, electrocoagulation of leukoplakia is not often used.

Cryodestruction

Cold treatment, or treating areas of leukoplakia with liquid nitrogen, promotes tissue death and rejection. The procedure takes no more than 5 minutes, is painless, and is performed once. The effectiveness of the technique reaches 96%. The remaining 4% are relapses, and in most cases they occur in women with hormonal imbalances in the body.

Laser cauterization

Laser removal of leukoplakia is a modern and, along with cryodestruction, the most preferred treatment for the disease. The technique eliminates direct contact with tissues, is completely aseptic, and does not cause pain. There is also no bleeding after the procedure, because the laser beam seals the damaged tissue, preventing microbes from penetrating into them. If the disease covers large areas of the genital organs, treatment is carried out in several stages. Complete tissue healing occurs in 4-5 weeks.

Radio wave cauterization

Radio wave treatment of leukoplakia is no less effective than laser treatment, but is somewhat more expensive. He is advised nulliparous women who are planning a pregnancy in the near future. The procedure is performed using a radio knife, which evaporates the affected areas using high temperature. This treatment method does not require anesthesia and does not cause bleeding or septic complications.

Folk remedies for leukoplakia

Doctors do not recommend practicing the treatment of leukoplakia folk remedies, if it is associated with the use of tampons, douching, because the procedure itself can intensify the growth of plaques and keratinization, cause bleeding from erosions and cracks. Also, using exclusively traditional methods, you may miss time and not detect cancer in time. But after diagnosis and treatment, the following recipes can be used in parallel:

Shallow washing of the external genitalia with infusions of chamomile, calendula, eucalyptus, St. John's wort twice a day for 14 days. Infusions are prepared based on the norm: 4 tablespoons of raw materials per liter of boiling water, leave for 1 hour.
For leukoplakia of the vulva, you can gently rub it into painful areas such an ointment. Melt 100 gr. palm oil in a water bath, add 3 grams. calendula tincture, 10 ml. glycerin, 1 ml. vitamin A, 2 ml. propolis tinctures and eucalyptus tinctures. After cooling the ointment in the refrigerator, it is applied twice a day, without rinsing, for 10 days.
You can take an infusion of boron uterus internally, which improves the functioning of the reproductive system in women. It is prepared by brewing 2 tablespoons of herbs with a glass of boiling water. Take 50 ml. four times a day in a course of 21 days, excluding menstruation.

Leukoplakia during pregnancy

The combination of leukoplakia and pregnancy, as a rule, greatly frightens a woman when a pathology is detected during a standard examination. The disease itself does not have a harmful effect on the baby or the pregnancy. But there is a risk for expectant mother, since hormonal and immune changes, stretching of the uterus often provoke the progression of leukoplakia. IN severe cases the disease during pregnancy can develop into cancer. If leukoplakia is identified at the planning stage, it is removed using low-traumatic methods. Often large foci of pathology have to be cauterized during gestation, especially if atypical cells are detected after cytological analysis.

Prevention of leukoplakia

To prevent the occurrence of leukoplakia, you must follow these rules:

treat erosions, STIs, inflammations in the genital area in a timely manner;
prevent any gynecological diseases from becoming chronic;
exclude abortions;
choose only reliable clinics for gynecological procedures;
maintain intimate hygiene;
have a permanent, trusted partner;
treat menstrual irregularities as they arise;
be regularly observed by a gynecologist;
quit smoking.

If no relapse occurs within 2 years after treatment of leukoplakia, the woman is considered recovered, after which she is removed from the register.

The periods of menopause and menopause are always associated with hormonal changes in the woman’s body and are often complicated by the appearance of various unpleasant symptoms and diseases. One of these gynecological ailments related to precancerous conditions, is leukoplakia of the vulva. Initially, this disease can be completely asymptomatic, and in the absence of timely treatment may lead to the development of cancer.

Leukoplakia of the vulva (or lichen sclerosus) is a dystrophic disease of the vulva with manifestations of squamous hyperplasia of the stratified squamous epithelium lining the vulva. With this disease, the appearance of normally absent horny and granular layers in the tissues of the vulva is observed, which leads to the development of para- and hyperkeratosis. This disease can be combined with kraurosis of the vulva, and such clinical cases in last years are increasingly observed in the practice of gynecologists. With leukoplakia of the vulva, malignancy of cells and the development of vulvar cancer is observed in 13-30% of patients, and when combined with kraurosis, the risk of occurrence increases. Unfortunately, doctors also note the fact that this gynecological disease becomes “younger” and is increasingly detected in young women.

In this article we will introduce you to the causes, symptoms, methods of diagnosis, treatment and prevention of vulvar leukoplakia. This information will allow you to start treatment on time and prevent the development of severe complications.

Causes

While modern medicine cannot give an exact answer about the reason for the development of vulvar leukoplakia in each particular clinical case, but doctors are well aware of the factors that can lead to changes in cellular composition vulvar epithelium. These include:

chronic inflammatory diseases of the genital organs;
erosion and dysplasia of the cervix;
genital injuries;
hormonal imbalance;
infection;
neglect of personal hygiene rules;

All these factors become especially dangerous after the age of 40 or during menopause.

Psychiatrists consider leukoplakia as a psychosomatic disease, which is provoked by a whole complex of psycho-emotional disorders and can be corrected by changing the way of thinking. As a rule, women with this diagnosis experience constant dissatisfaction with themselves and the actions of the people around them, place increased demands on themselves and deep distrust of their loved ones and relatives.

Much less commonly, vulvar leukoplakia develops in childhood. However, all of the above factors can cause changes in the vulvar mucosa in girls. That is why regular preventive examinations at this age become important, and when the first signs of the disease appear, you should immediately consult a doctor.

Symptoms

Sometimes vulvar leukoplakia is asymptomatic for a long time and women learn about its development during a planned or preventive examination at the gynecologist. Pathology can be detected accidentally during examination of the clitoris and labia minora. Small, usually multiple, whitish spots appear on their mucous membrane. Over time, they thicken, become keratinized, slightly rise above the surface of the mucosa and acquire a gray-white color with a pearlescent tint. Foci of changed mucosa can increase in size, merge and spread to a significant surface of the vulva. Patients often experience paresthesia in the form of numbness or tingling in the keratosis area.

When areas of leukoplakia are infected or sclerosed, a woman may notice the sudden appearance of swelling and complain of dryness, tension and tightness of the mucous membrane and skin in the genital area, intense, which intensifies at night or with movement, sexual intercourse and urination. Prolonged itching of the vulva leads to psycho-emotional disorders, exhaustion of the nervous system and loss of ability to work.

Multiple subepithelial hemorrhages may appear in areas of leukoplakia. On late stages diseases hyperkeratosis and sclerosis reach their maximum. The mucous membranes become rigid, folded, and glossy-pearl in color. Telangiectasias and subepithelial hemorrhages appear on their surface. The labia majora become like thickened ridges, the labia minora are almost not defined, and the entrance to the vagina becomes sharply narrowed.

Classification of forms of leukoplakia

According to the severity of hyperkeratosis, leukoplakia can be:

Flat. Flat, whitish spots without signs appear on the vulva inflammatory process. After removal with a tampon, they appear again. The spots may be present in limited areas of the vulva, and with a generalized course they cover a large surface of the mucous membrane.
Hypertrophic. Foci of changes in the mucous membrane look like gray-white spots with clearly defined contours; they rise above the surface and sometimes merge with each other and cannot be removed with a swab.
Warty. The lesions are significant and look like warty growths. May be complicated by ulcerations, inflammation, swelling and the appearance of redness, ulcers, cracks and erosions. This form of leukoplakia is considered a precancerous condition.

Leukoplakia of the vulva and pregnancy

In some cases, vulvar leukoplakia can develop during pregnancy. With the help of timely and competently prescribed drug therapy it is usually possible to achieve a stable state without progression of symptoms during gestation and early postpartum period. In such cases, women are advised to give birth naturally. In the presence of severe dryness, thinning, the presence of long-healing ulcerations, cracks and extensive foci of leukoplakia, a cesarean section is recommended for delivery.

Diagnostics

To establish a diagnosis, patients are prescribed the following types of examination:

medical history and gynecological examination;
general blood analysis;
smear on flora from the urethra, vagina and cervix;
analysis PCR method for the presence of human papillomavirus with the establishment of the type of virus;
biopsy and histological examination;
cytological examination of scrapings from the cervix and cervical canal for atypical cells;
vulvoscopy (simple and advanced using dyes);
colposcopy;
aspiration of the contents of the uterine cavity and/or cervical canal followed by histological examination of the material;
immunogram.

On early stages leukoplakia of the vulva is carried out differential diagnosis this disease with diseases such as:

neurodermatitis - itching also appears in other parts of the body, the epithelium is compacted, dry and thickened, the skin is reddened, with inflamed papules of a pink-brown color and has an enhanced pattern;
– with this disease there are no areas of pigmentation, the itching is mild, there are no atrophic changes in the affected areas of the skin;
diabetes mellitus – the tissues of the vulva are inflamed, swollen, pasty in consistency, severe itching;
lichen planus - with this disease, the rashes are papular, multiple and tend to cluster; after opening the papules, areas of atrophy or sclerosis form on the skin with the formation of scar changes.

If a skin disease is suspected, a woman is recommended to consult a dermatologist.

If a woman develops psychoneurological disorders, a consultation with a psychotherapist is prescribed.

Treatment

All patients with vulvar leukoplakia are subject to regular follow-up with a gynecologist or oncologist (if there is a malignant lesion). To monitor the condition of areas of leukoplakia, examination methods such as cytological analysis and colposcopic examination.

Treatment tactics for vulvar leukoplakia depend on the degree and nature of changes in the vulvar mucosa and are aimed at eliminating the symptoms of the disease and preventing the degeneration of plaques into. At the initial stages of the disease, the patient is prescribed long-term complex conservative therapy, which requires constant medical supervision and monitoring of its effectiveness (based on test results).

Conservative therapy

For conservative treatment Vulvar leukoplakia patient is recommended to:

taking medications;
proper implementation of hygiene measures;
diet;
physiotherapeutic procedures.

Drug therapy

To eliminate unpleasant symptoms of the disease, the following are prescribed:

local drugs to eliminate inflammation: Baneocin, Elidel cream, Beloderm ointment, Dermovate ointment, Clobetasol propionate, etc.;
local preparations to eliminate itching: Akriderm, Sinaflan ointment, Beloderm, Triderm, Celestoderm, Progesterone cream, etc.;
: Tavigil, Loratadine, Clarisens, Fenkarol, etc.;
local hormonal preparations: Estriol cream, Progesterone cream, Testosterone propionate ointment, etc.;
antibacterial agents for local application(for secondary infections): Levomikol, oil solution Chlorophyllipt, 5% Sintomycin liniment, Sintomycin suppositories, Chlorhexidine emulsion, etc.

To generally strengthen the body and improve the condition of the mucous membrane, it is recommended to take vitamin and mineral complexes.

If it is impossible to eliminate itching of the vulva medications For external use, novocaine vulvar blockades and radio wave puncture of the skin of the vulva are prescribed.

In case of severe inflammation and secondary infection, anti-inflammatory and antibacterial drugs in the form of tablets or injections. If necessary, drugs for immune correction are prescribed.

Patients with psychoneurological disorders are prescribed psychocorrection classes and the use of antidepressants and tranquilizers.

Hygiene measures

Avoid overheating the body.
Do not wear synthetic or tight-fitting underwear.
Avoid exposure to the sun.
Avoid taking hot baths, visiting saunas and steam baths.
To wash, do not use anything that will dry out the skin. antiseptic solutions and soap, but use boiled water with the addition of soda (to soften) and herbal decoctions (chamomile, calendula, nettle, sage).
Don't douche.
Avoid using synthetic pads and tampons.