An evidence-based review of pruritus vulvae (Hikkatul Farj): From etiology to emerging therapies

Abstract

Pruritus vulvae, or vulvar pruritus, is a chronic and debilitating symptom affecting 5-23% of women globally, often underreported due to social stigma and embarrassment. It manifests as an unpleasant sensation provoking the urge to scratch, arising from a multifaceted interplay of inflammatory, infectious, neoplastic, hormonal, neural, and microbial factors. This condition significantly impairs quality of life, including sexual function, relationships, sleep, and psychosocial well-being. This evidence-based review synthesizes data from clinical reviews, case reports, and traditional medicine studies on etiology, pathophysiology, diagnostic approaches, and therapeutic management. Key etiologies include atopic and contact dermatitis, lichen sclerosus (LS), lichen simplex chronicus (LSC), vulvovaginal candidiasis, and neoplastic lesions like vulvar intraepithelial neoplasia (VIN). Management emphasizes barrier restoration, anti-inflammatory agents, antimycotics, and emerging integrative therapies such as Unani polyherbal formulations for abnormal vaginal discharge (Sayalan al-Rahim) and Ayurvedic medicinal leech therapy (Jalaukavacharanam) for refractory pruritic dermatitis. Further randomized controlled trials (RCTs) are needed to standardize protocols and validate integrative approaches for optimal patient outcomes.