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Funny you should ask. Cases like yours are tough for gynecologists, but I have some thoughts. I’ve seen several patients in the past few months with complaints just like yours. One young woman (we’ll call her Ellie) had seen every specialist at every university in the area. They even biopsied her vulva to try to figure out what was going on. But alas, nobody could figure it out. I ordered food allergy testing and we discovered that she was allergic to gluten, dairy, eggs, and several fruits. When we took her off the offending foods, her 7 year itch magically disappeared. But I was concerned about why she had so many food allergies, so we investigated further.
Turns out that a controversial gastrointestinal condition -- “leaky gut syndrome”-- may be at the root of her chronic vulvar itching. Although clinical data on “leaky gut syndrome” and its link to gynecological conditions is limited, this very issue has been coming up a lot in my holistic gynecology practice lately.
When friendly bacteria (like Lactobacillus) are eliminated, often through the use of antibiotics, yeasts (such as Candida albicans) can start to grow out of control, not just in the vagina, but in the gut. The yeast burrows into the gut wall, causing “leaks” in the protective barrier. Toxins and allergens, including microscopic undigested food particles, are allowed to enter the bloodstream. These “leaks” can cause antigens to travel anywhere in the body, spurring an inflammatory response that may result in a whole host of symptoms, such as gas, bloating, mood disorders, chronic fatigue, eczema, food allergies -- and yes, rarely -- chronic vulvar itching.
To begin healing, see your OB/GYN or primary health care provider to rule out any other causes of vaginitis, such as infection, irritants/allergies, other dermatological conditions (like eczema, psoriasis) or autoimmune problems (like lichen sclerosis).
To find out if you have “leaky gut syndrome,” you may need to see an integrative medicine doctor or naturopathic doctor. Although many conventional physicians do not acknowledge the existence of this controversial condition, evidence is mounting to support that it does exist and can be treated. “Leaky gut syndrome” is diagnosed with an inexpensive lactulose-mannitol intestinal permeability test, which is based on an oral challenge with lactulose and mannitol, two non-metabolized sugar molecules. Normally, tiny water-soluble molecules such as mannitol are easily absorbed through cell membranes, whereas larger molecules like the lactulose are normally excluded by cell membranes but can be slightly absorbed between cells. The amount of lactulose and mannitol found in a urine test 6 hours after the oral challenge can determine whether large molecules like mannitol are seeping through the normally barely permeable membrane.
This is where things get tricky. Every alternative medicine doctor has their own recipe of elimination diets, supplements, yeast-fighting treatments, gut healing potions, and the like. Because there is no standardization about treatment, there is little proof that any one regimen works better than others, so the diagnosis can lead to treatments that risk falling into the category of snake oil.
Things you can do at home include avoiding alcohol and NSAIDs such as Motrin, taking high doses of quality probiotic supplements, cutting out frequent food offenders such as dairy and gluten, and eating raw garlic, which may be helpful for curbing intestinal yeast because the herb’s organosulfur compounds suppress intestinal secretion of inflammatory cytokines that perpetuate leakage. More treatment may be necessary to repair the intestinal permeability itself. Personally, I use a leaky gut protocol created by the pharmaceutical grade company Integrative Therapeutics, in addition to a host of lifestyle modifications.
If itching is unbearable, I usually prescribe a high potency prescription steroid cream such as clobetasol for symptomatic relife, until the underlying condition begins to repair.
Bottom line? You're not alone! Talk to your doctor and see what "leaky gut syndrome" solutions can work best for you.
Yours in health,
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