Genital allergy is a set of pathological conditions of allergic genesis characterized by lesions of the skin and mucous membranes in the genital area. Symptoms vary depending on the form of the disease, possibly redness, swelling, itching, burning and dryness of the skin in the affected area. Diagnosis is made by examining the genitals, studying the patient’s anamnesis, identifying specific antibodies in the blood and conducting allergological tests. Treatment includes elimination of contact with the allergen, symptomatic and desensitizing therapy.
ICD 10
L23.2 L23.8
General information
Genital allergy is a fairly common condition, but it is often confused with venereal or gynecological diseases. Pathology affects males and females with approximately the same frequency. The disease may have an isolated character (manifest only on the genitals) or be part of a broader symptom complex – for example, Lyell’s syndrome, dermatitis, urticaria. The difference between this allergy is the probability of damage to the urinary and reproductive systems (urethritis, balanoposthitis and vulvovaginitis).
Causes
Like other allergic pathologies, this disorder occurs in response to the ingestion of special substances-allergens – compounds that provoke unusual immune reactions. The pathways of antigen penetration vary, they can be local and systemic. In the first case, symptoms are observed with direct contact of the mucous membranes and skin with provoking compounds. In systemic forms, the allergen penetrates parenterally, through the digestive tract or respiratory tract and potentiates local changes through a cascade of pathogenetic reactions. There are the following main sources of substances dangerous in terms of genital allergy:
- Means of contraception. Mechanical means of protection against unwanted pregnancy and STDs often provoke allergic reactions due to close contact with the genitals. The use of condoms, spermicidal agents in the form of ointments, gels and vaginal suppositories can cause manifestations of pathology in women and men. Latex or auxiliary components of contraceptives can act as an allergen.
- Male sperm. In some women, itching and redness of the vulva, labia, pubic skin occur when seminal fluid gets on them during sexual contact. It has been established that hypersensitivity to sperm glycoproteins is the cause of such reactions.
- Medications. Various remedies can provoke genital allergies, both with local and systemic use. Intolerance reactions are often noted in the case of local application of antiseptics in the form of solutions or ointments. With oral or parenteral administration of sulfonamide and iodine-containing drugs, damage to the integuments of the genitals is also sometimes detected.
- Cosmetic and hygiene products. A variety of shampoos, shower gels, cosmetics for intimate hygiene have a complex chemical composition and may contain allergens. Pathological symptoms develop after using these funds.
- Lingerie. Poor quality of materials, the presence of synthetics or latex in the fabric can provoke allergies. As a rule, it has the character of contact dermatitis, proceeding by the mechanism of a delayed type reaction. A large amount of synthetic materials also complicates ventilation and evaporation of fluid, impairing the breathing of the skin.
Pathogenesis
Basically, the pathogenesis of genital allergy corresponds to the first and fourth types of immune reactions (according to the classification by Jell and Coombs). Most often, a reagin variant (the first type) is registered, sometimes the disease occurs due to delayed cellular reactions (contact dermatitis). In both cases, initial contact with the allergen is necessary, during which it is recognized by the immune system and the formation of “allergic readiness”. The patient develops immunological memory cells, which, upon repeated contact with the provoking substance, can trigger an allergic process.
With intolerance of the first type, repeated contact with the antigen causes accelerated formation of special antibodies of class M and E. The latter have the ability to stimulate tissue basophils located in the skin and mucous membranes, causing their degranulation. During its course, histamine, serotonin and other compounds responsible for the development of redness, swelling and itching in allergy are released into the tissue. Delayed reactions of the cellular type are formed rather slowly with prolonged and repeated contact with the allergen. In addition to nonspecific symptoms, allergies in the genital area can manifest as balanoposthitis and urethritis in men or as vulvovaginitis in women.
Classification
There are several main clinical variants of genital allergy that differ in etiology and symptoms. Determining the type of disease plays an important role in identifying its causes and in developing treatment tactics by an allergist or dermatologist. The generally accepted classification contains the following types of pathology:
- Acute allergic dermatitis. The most common type, which includes a wide list of conditions, is balanoposthitis in men, redness and itching of the labia majora and perineum in women. It may be caused by local or systemic exposure to an allergen. This group also includes some forms of drug allergies – for example, genital lesions in Lyell’s syndrome.
- Acute allergic urethritis. It is characterized by inflammation of the urethra, its symptoms practically do not differ from infectious acute urethritis. It most often occurs with intolerance to antiseptic drugs injected into the urethra for the treatment and emergency prevention of STDs.
- Acute allergic vulvovaginitis. The female version of allergy, in which swelling and itching of the vulva, labia majora and labia minora, the frenulum of the clitoris develops. Common causes are the local use of spermicidal or medicinal ointments and suppositories, as well as intolerance to the components of seminal fluid.
- Fixed erythema. A rare form of allergy, accompanied by the appearance of a dark red spot with clear borders. It becomes a consequence of parenteral or oral administration of certain medications – most often antimicrobials from the sulfonamides group.
- Chronic forms of allergies. Long-term types of pathology that often lead to dryness of the skin or their lichenification. They usually occur as a result of intolerance to the components of hygiene and skin care products, underwear.
Symptoms of genital allergy
The main feature of the disease is the localization of skin manifestations in the zone, which includes the external genitalia, perineum and perianal region. Sometimes the changes spread to the inner surfaces of the thighs and lower abdomen. The most common symptoms are erythema, itching of the skin, less often – tissue edema. In men, the skin of the scrotum is often affected, balanoposthitis develops. Women often have swelling of the labia, itching of the vulva, burning sensation in the vagina, especially after sexual intercourse.
Some types of the disease can provoke inflammation of the terminal parts of the urinary tract – urethritis. In this case, the symptoms are joined by unpleasant sensations when urinating (burning, soreness), frequent false urges. Fixed erythema on the background of drug allergy leads only to limited redness of the skin, itching and other subjective manifestations are absent. The duration of the course is very different in different forms of genital allergy, it depends on the duration of contact with the allergen. Usually, skin disorders disappear within 2-3 days after the elimination of the provoking substance.
Complications
Serious complications with genital allergy are extremely rare. The most common consequence of the disease is skin infection caused by the ingress of microorganisms into the tissues. Balanoposthitis in rare cases leads to the development of paraphimosis, requiring urgent medical intervention. As a result of allergic inflammation of the foreskin, scarring may occur, accompanied by the appearance of synechiae and phimosis. In women, the disease is a predisposing factor to the defeat of the urinary system (cystitis, pyelonephritis). An indirect threat of allergy is the fact that it is able to mask the symptoms of some sexually transmitted diseases, causing an erroneous diagnosis.
Diagnostics
In clinical dermatology, the definition of genital allergy is often not difficult due to the severity of symptoms. The main diagnostic measures are aimed not so much at clarifying the type of pathology, as at clarifying its causes, excluding other skin or venereal diseases. Accurate identification of the allergen allows you to give the patient the right recommendations for the prevention of allergy relapses in the future. The following diagnostic procedures are prescribed:
- Survey and inspection. The specialist examines the area of the patient’s genitals, assesses the condition of the skin, the prevalence and severity of violations. If necessary, a gynecologist is consulted. By questioning, they find out the prescription of manifestations, the presence of itching and soreness, clarify the possible connection of symptoms with the use of cosmetics and food intake.
- Laboratory tests.Serological studies are mandatory for the presence of antibodies to the causative agents of the main STDs – gonorrhea, chlamydia, syphilis, which can disguise themselves as allergic manifestations. Perform the determination of specific IgE by enzyme immunoassay.
- Allergological tests. Based on the anamnesis data, the range of possible allergens is narrowed, then an accurate identification is carried out by means of scarification skin allergy tests (prick test). Most often, the body’s reaction to latex antigens, seminal fluid, and some medications is studied.
Differential diagnosis is carried out with venereal pathologies and some systemic skin diseases (eczema, seborrhea). With the development of urethritis, taking into account the data of a general urine analysis and a urethral smear, its non-infectious nature is confirmed. Exclude the presence of candidiasis (the glans of the penis in men and the vagina in women), in which there is often a mixed inflammation of an infectious and allergic nature.
Treatment of genital allergy
The main goals of therapy are to eliminate symptoms, limit further contacts of the patient with the allergen and prevent possible complications. To alleviate the patient’s condition, antihistamines are used – in drops for children or in the form of tablets for adults. Reducing inflammation and itching can be achieved by using soothing ointments based on glucocorticoids. In severe cases, with severe damage to the skin, agents that activate the processes of epithelization are prescribed.
To eliminate contacts with the provoking allergen, its exact definition is necessary. If this could not be done at the diagnostic stage, the patient is not recommended to use latex-based products (condoms, underwear), use any unknown ointments and care products. If a woman has hypersensitivity to the components of the seminal fluid, she is shown the use of barrier contraceptives. Patients with genital allergies of unknown origin for intimate care should choose products with a minimum amount of aromatic and emollient additives or hypoallergenic soap. If there are signs of secondary infection, antibacterial drugs are prescribed.
Prognosis and prevention
In most cases, genital allergy is characterized by a favorable prognosis – after the exclusion of the allergen, the manifestations disappear without a trace. In some cases, scarring changes occur in the genital area, leading to the development of synechiae. Among other consequences, there may be problems with conceiving a child in women with hypersensitivity to seminal fluid, damage to the urinary tract. Allergy prevention is reduced to the exclusion of contacts with provoking products or medicinal substances, the correct selection of contraceptives and underwear.
