I have a burning sensation when I urinate recently.

A woman has recently experienced a burning sensation when urinating. Since there are no other symptoms to refer to, the only possible cause can be determined, which is vulvar leukoplakia. Vulvar leukoplakia not only causes a burning sensation when urinating, but also gradually forms white spots on the vulva, which are very obvious. If you feel a little burning sensation when you urinate, it may be that white spots have not yet formed. However, if the burning sensation occurs frequently, it is enough to cause attention and actively analyze the cause.

Vulvar white lesions include vulvar white lesions, vulvar leukoplakia or vulvar dystrophy, which were previously considered to be vascular malnutrition. However, with further understanding of the disease, the above changes were not found, but rather lesions in which pigmentation and degeneration of the vulvar skin and mucosal tissues occurred. Because the vulvar skin and mucosa of patients with lichen sclerosus and squamous cell hyperplasia are mostly white, it is called vulvar white lesions, which belong to non-neoplastic changes in the vulvar epithelium. Lichen sclerosus and squamous cell hyperplasia have changed their names several times in different eras due to different clinical and pathological understandings. They were originally called vulvar leukoplakia, leukoplakia vulvitis, vulvar xeroderma, hyperplastic or atrophic vulvitis, neurodermatitis, lichen sclerosus and atrophic, etc.

Causes

The exact cause of white lesions of the vulva is unknown. It may be related to the following factors: genes, autoimmunity, sex hormone deficiency or decreased sex hormone receptors, etc. Vulvar squamous epithelial hyperplasia may be related to vulvar moisture and long-term stimulation by secretions, leading to vulvar itching and repeated scratching.

Clinical manifestations

The main symptom is severe itching of the vulva. The itching may last from 2 to 3 months from onset to treatment, or even up to 20 years. The severity of the itching is not affected by season or day or night. Patients with vulvar squamous hyperplasia may experience more severe itching. If accompanied by trichomoniasis or candidal vaginitis, the secretions will be more, and the local burning, stinging and itching are related to the damage or infection of the skin and mucous membranes. There is varying degrees of local hypopigmentation of the skin and mucous membranes, often with edema, chapped skin and scattered superficial ulcers.

examine

Biopsy should be performed on areas with fissures, ulcers, bumps, nodules, or roughness. Multiple biopsies are sent for pathological examination to determine the nature of the lesion and rule out early cancer. In order to ensure appropriate sampling when vulvar squamous epithelial hyperplasia is suspected, the affected area can be first painted with 1% toluidine blue, and then scrubbed with 1% acetic acid to decolorize it after it dries. Any area that does not discolor indicates the presence of naked nuclei. If a biopsy is performed at this location, there is a high possibility of finding atypical hyperplasia or even cancer.

diagnosis

A preliminary diagnosis can be made based on clinical manifestations; pathological examination is required for definitive diagnosis. When sampling, it is necessary to sample from multiple points such as the affected area: ulcers, chapped fissures, nodules, protrusions or rough areas, and the sampling should be appropriate. When vulvar squamous epithelial hyperplasia is suspected, 1% toluidine blue can be applied to the affected area first. After drying, it can be decolorized with 1% acetic acid solution. In the non-decolorized area, biopsy forceps can be used perpendicular to the skin and deep into the dermis to obtain a biopsy. Any area that does not discolor indicates the presence of naked nuclei. Biopsy in this area can improve the accuracy of diagnosis.

Differential Diagnosis

Pay attention to differentiate it from vitiligo, albinism, physiological atrophy of the vulva in the elderly and specific vulvitis.

treat

1. General treatment

Pay attention to keeping the vulva clean and dry. Do not use irritating drugs or soaps to clean the vulva. Avoid wearing non-breathable synthetic underwear and do not eat spicy or allergenic foods. For those with severe itching symptoms leading to insomnia, sedatives, sleeping pills and anti-allergic drugs can be added.

2. Medication

Commonly used drugs for vulvar lichen sclerosus include pyruvic acid ointment, compound vitamin A ointment and progesterone ointment. Alternatively, glucocorticoid ointments or immunotherapy may be used. Drugs can improve symptoms but cannot cure the disease, and long-term use is required. Lichen sclerosus in young girls may heal on its own by puberty, and pyruvate ointment is generally not used for treatment to avoid virilization. 1% hydrocortisone ointment or 0.3% progesterone ointment can be applied, which can relieve most symptoms, but long-term follow-up is required.

Vulvar squamous epithelial hyperplasia can be treated with topical corticosteroids to control pruritus. Treatment is effective for most patients, but long-term medication is required.

3. Physical therapy

Suitable for patients who are ineffective with drug treatment or whose condition is serious. Microwave therapy, carbon dioxide laser and helium-neon laser, Bohm light, high-frequency electric knife, local electrocautery therapy and liquid nitrogen local cryotherapy, etc.

4. Surgery

Surgical treatment is only suitable for patients with severe conditions and those who have failed to respond to repeated medication or physical therapy. Surgery is required when vulvar squamous hyperplasia is suspected to be malignant.