Prurit vulvaire, irritation, brûlure ou picotements au niveau du vagin, certaines femmes connaissent de nombreux troubles dermatologiques et infectieux à l’origine de ces désagréments.
Malheureusement, ces maladies vulvaires sont encore trop peu diagnostiquées et sous traitées.
Causes, symptômes et traitements : Mia s’intéresse à ces démangeaisons intimes qui peuvent intervenir à différentes périodes ; après un rapport sexuel, lors de la grossesse ou après l’accouchement, lors de la ménopause…
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De forme ovoïde, la vulve est située entre le pubis et l’anus (en bas de l’abdomen) et correspond à l’ensemble des organes génitaux externes de la femme. Elle a notamment une fonction protectrice de l’entrée du vagin.
En son milieu, la fente vulvaire divise la vulve en deux grandes lèvres, qui recouvrent les petites lèvres, qui se rejoignent en bas et en haut, afin de former le capuchon du clitoris. Le pubis au-dessus de la vulve est recouvert d’une pilosité (les poils pubiens).
Comment se manifeste le prurit vulvaire ?
Le prurit vulvaire (ou parfois prurit vaginal) est un symptôme fréquent dans de nombreuses maladies dermatologiques.
On peut alors parler de « dermatoses vulvaires inflammatoires et prurigineuses » dans le monde médical. Cela se manifeste par des démangeaisons intimes localisées sur l’ensemble de la vulve ou des zones précises comme les lèvres, et les organes génitaux externes.
Parfois, les démangeaisons de la vulve sont simplement causées par une utilisation de produits irritants et mal adaptés à la fragilité de cette zone intime. Certaines maladies ou affections de la peau et des muqueuses peuvent aussi être responsables d’un prurit vulvaire. Ces démangeaisons s’accompagnent parfois de pertes vaginales anormales de couleur jaunâtre ou verdâtre.
C’est le cas d’une infection à trichomonase, l’IST la plus répandue dans le monde.
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“Pourquoi mes parties intimes me démangent ?” ?
En présence de ces symptômes, le médecin prend en considération plusieurs caractéristiques :
- Les caractéristiques épithéliales : les cellules qui recouvrent la surface du corps ou l’intérieur de certains organes creux ;
- Les changements hormonaux temporaires qui peuvent perturber la composition de base de la peau ;
- La présence d’œstrogènes sur les récepteurs des kératinocytes : les kératinocytes sont des cellules qui recouvrent la peau. Elles constituent 85% de la couche superficielle de l’épiderme, des ongles, des poils ou des cheveux (plumes et écailles pour les animaux).
Par exemple, des changements au niveau du taux d’œstrogènes peuvent entraîner des changements dans l’hydratation de la vulve ou du vagin, la teneur en collagène (des protéines présentes dans la matrice extracellulaire) ou la concentration de glycosaminoglycanes, des macromolécules de glucide.
Avec pour effet notamment de modifier le pH vulvo-vaginal et la composition de sa microflore.
Qu’est-ce que le pH vulvo-vaginal ?
Le pH vulvo-vaginal est élevé dans l’enfance, mais à la puberté, il commence à diminuer d’une moyenne de 7 à une moyenne de 4 chez les femmes adultes.
Les lactobacilles (des bactéries qui protègent le vagin) commencent à coloniser la région vulvo-vaginale.
Dans la première moitié du cycle hormonal, les taux d’œstrogènes augmentent et les cellules épithéliales vulvo-vaginales prolifèrent. Dans la seconde moitié du cycle, sous l’effet de la progestérone (une autre hormone), les kératinocytes débarrassent l’épiderme, la peau, des cellules mortes.
Il y a aussi des changements de la flore bactérienne au cours du cycle hormonal. Donc, les niveaux de pH vont fluctuer et éventuellement provoquer un prurit ; une augmentation du pH peut également activer le récepteur-2 (activé par la protéinase), qui est un médiateur bien connu des démangeaisons.
Enfin, en raison de la diminution des œstrogènes, le pH vaginal peut aussi augmenter pendant la ménopause, en période de sécheresse vaginale.
Donc un certain nombre de paramètres naturels, de dérèglement, peuvent causer des démangeaisons intimes, sans que cela soit le signe d’une infection ou d’une maladie dermatologique.
Ces démangeaisons peuvent par exemple être simplement dues à l’utilisation de produits inadaptés pour la toilette intime, un manque ou un surplus d’hygiène, déréglant la flore vaginale. Toutes les muqueuses du vagin et de la vulve sont très sensibles, c’est pourquoi il est important d’en prendre soin !
Par exemple, ne faites pas de douches vaginales, portez plutôt des sous-vêtements en coton, évitez les matières synthétiques, n’utilisez pas de produits agressifs pour la peau et les muqueuses, etc.
Quelles sont les causes du prurit vulvaire ?
Plusieurs maladies ou affections peuvent avoir comme symptômes des démangeaisons de la vulve :
- Une irritation de la vulve, causée par des savons au pH acide ou des produits agressifs (comme des détergents) ;
- Des affections dermatologiques : l’eczéma de la vulve, le psoriasis ou encore le lichen scléreux ou la mycose vaginale ;
- Certaines infections bactériennes ou certaines IST comme la trichomonase ;
- Des allergies ;
- Une infection causée par des morpions (le « pou du pubis ») ;
- Le champignon Candida albicans, responsable des mycoses ;
- Une inflammation de la vulve (vulvite ou) : elle est causée par un champignon, des bactéries ou un virus ; on parle de vulvo-vaginite lorsque les démangeaisons s’étendent au vagin ;
- L’herpès ;
- Prurit pendant la grossesse ;
- Atrophie vulvo-vaginale de la ménopause : une conséquence du vieillissement, qui endommage les tissus vulvo-vaginaux ;
- Ou certains cancers, comme le cancer de la vulve.
Ces démangeaisons peuvent s’accompagner d’autres symptômes tels que des brûlures vulvaires, des rougeurs, des douleurs localisées ou encore des pertes vaginales anormales.
Démangeaisons après un rapport sexuel
Lorsque les démangeaisons surviennent après un rapport sexuel, cela est peut-être dû à une IST, comme une infection à Candida albicans (mycose), à trichomonase, à l’herpès ou encore à des morpions.
Toutefois, une sécheresse vulvaire ou vaginale peut aussi être responsable de démangeaisons. N’hésitez pas à vous servir d’un lubrifiant à base d’eau adapté afin d’écarter cette piste. Si les symptômes persistent, consultez rapidement un médecin.
L’eczéma : responsable de 50% des cas de prurit vulvo-vaginal chez la femme adulte
La dermatose vulvaire (une affection dermatologique de la vulve) la plus courante chez les adultes et les enfants est la dermatite ou l’eczéma.
L’examen clinique montre des grandes lèvres (et parfois aussi des petites lèvres) enflammées et squameuses (qui perdent des peaux mortes, ou écailleuses) avec fréquemment une rugosité due à un lichen (un champignon).
La démangeaison est constante et peut être due à de mauvaises habitudes d’hygiène, à une utilisation excessive de savon, ou au port prolongé de maillots de bain humides. La dermatite allergique de contact est très rare chez les enfants car l’exposition à des allergènes potentiels est faible.
Chez la femme adulte, la dermatite représente environ 50% des cas de prurit vulvo-vaginal chronique. Cela peut compliquer le diagnostic d’autres dermatoses.
Théoriquement, il existe un risque accru de sensibilisation : en raison des différences de structure et d’occlusion, d’hydratation et de sensibilité au frottement, la peau vulvaire est plus perméable que la peau exposée.
Le symptôme prédominant est la démangeaison. Mais des brûlures et des douleurs peuvent également être présentes, surtout en cas de fissures. Les irritants courants comprennent :
- Certains savons ;
- Des antiseptiques ;
- Des lubrifiants ;
- Les spermicides ;
- Les tampons, les serviettes hygiéniques, les sous-vêtements synthétiques, trop serrés, etc.
Les anesthésiques topiques et les antibiotiques, les conservateurs, les colorants et les parfums sont également des allergènes potentiels. Beaucoup de femmes utilisent régulièrement des produits intimes disponibles en vente libre.
Or, ces produits sont parfois irritants. Un nettoyage excessif de la peau de la vulve, ainsi qu’une incontinence urinaire et fécale, peuvent également provoquer une dermatite irritante.
Enfin, les femmes en carence d’œstrogènes sont particulièrement sujettes aux dermatites de contact irritantes. La prise en charge consiste à éliminer tous les irritants et allergènes potentiels. Il faudra aussi appliquer des stéroïdes topiques jusqu’à ce que la peau redevienne normale.
Prurit vulvaire : diagnostic et traitements
Le diagnostic repose généralement sur un prélèvement mycobactériologique afin d’identifier si les démangeaisons sont causées par une infection. Le traitement dépendra donc de la cause.
S’il s’agit d’un eczéma, un traitement à base de cortisone (dose minimale) pourra être proposé, avant l’arrêt progressif de ce traitement. La corticothérapie locale peut aussi être indiquée, en cas de lichen. C’est la seule indication possible à la corticothérapie, car la peau et les muqueuses sont fragiles.
En cas d’atrophie vulvo-vaginale, liée à la ménopause, on recommande dans un premier temps une œstrogénothérapie locale, ou un traitement au laser. Mais il existe des traitements alternatifs lorsqu’une patiente ne supporte pas le laser.
Les traitements possibles sont donc :
- L’utilisation de savons adaptés, apaisants, pour zone intime ;
- Des antibactériens ou des antifongiques ;
- Des anti-inflammatoires ;
- En cas de douleur, des antalgiques peuvent soulager le prurit vulvaire ;
Enfin, la prévention repose sur une bonne hygiène intime (sans excès) et l’utilisation de savons doux. Le port de vêtements trop serrés peut aussi favoriser le prurit vulvaire.
Quelle crème choisir lors d’une irritation vulvaire ?
Lorsque les démangeaisons sont dues et accentuées par les grattements, il est recommandé d’utiliser des crèmes cicatrisantes (comme Cicalfate ou LHF Calendula) qui peuvent contenir de la vitamine E.
Pour les femmes qui vont à la piscine, il existe des crèmes protectrices à appliquer sur la vulve, qui forme une barrière contre l’eau chlorée. L’huile de coco peut aussi être utilisée, sauf en cas de lichen vulvaire.
Attention tout de même : chez certaines personnes sensibles, l’huile de coco provoque des mycoses.
Ce qu’il faut retenir
Gênantes au quotidien, n’attendez pas pour consulter un médecin en cas de démangeaisons intimes. Les causes peuvent être variées : IST, allergies, irritation ou mycoses ; il est préférable de se soigner.
Rassurez-vous, la plupart du temps, un traitement efficace suffit à guérir complètement !
Parfois il s’agit seulement d’un excès d’hygiène, se rappeler les bons gestes suffira à résoudre les démangeaisons.
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