Leukoplakia vulvae is a chronic inflammatory gynecological condition with white lesions as the main sign, accompanied by an itching, burning painful sensation in the area of the vulva. Common symptoms include painful urination, painful intercourse, or painful bowel movements. Common signs are thickened skin and white patches on the vulva, or thin patches on the vulva, or wrinkled and hypopigmented vulva; the vulva and contiguous anatomy can be distorted in severe cases. There is also often a general skin disease manifesting a genital mucosa with white, thick patches, or an atrophic condition. This condition relates to nutritional disorders, nerve degeneration, along with blood vessel and pigment changes on the vulva itself.
Traditional Chinese Medicine treatment (TCM) can improve the condition of leukoplakia vulvae in clinical practice. From clinical observation and experience, the usual treatment of leukoplakia vulvae with Traditional Chinese Medicine includes the use of acupuncture and Chinese herbal formulas, some to be taken orally, with others to be applied topically in the local area of the vulva. This combination of treatment modalities has proven to be very effective.
Based on Traditional Chinese Medicine, the condition of leukoplakia vulvae is due, primarily, to a deficiency of the liver and kidney organs and functional systems. This deficiency occurs in combination with an accumulation of dampness, disharmonies in the qi and blood, and heat stagnation. For treatment of this condition, the most common and effective acupuncture points (where electro-acupuncture can also be applied) includes RN2, RN3, RN4, Zigougxue, BL28, 34, SP10, SP9, SP6, ST36, HT7 and DU2, 3, 4, 20; add LV2, LV3 and SP10 for damp heat of liver; and add KI3 and BL57 for yin deficiency in liver and kidney. Auricular (ear) acupuncture therapy may also be considered.
The common use of oral Chinese herbal formulas include Liu Wei Di Huang Wan and Zhi Bai Di Huang Wan to nourish the liver and kidney, treating their deficiencies; and Shen Ling Bai Zhu San and Zhi Dai Tang to clear damp-heat, dredge collaterals and stop itching; finally, modified forms of Si Wu Tang and Xue Fu Zhu Yu Tang can aid in the regulation of qi and blood, etc.
For cases with itching, burning sensation and burning pain with dryness of the genitals, a special Chinese herbal formula mixed with water is used to wash or soak the area. These herbs include Ku Shen, Huang Bai, Dang Gui, Zhi Mu, Bai Xian Pi, Bing Pain, and Bu Gu Zhi, among others. It is best to mix these herbs with sesame oil to apply topically to the vulva.
As a result of treatment, itching, burning pain and dryness will usually improve after one or two weeks of treatment. Regular reports suggest that softening of skin tissues of the vulva and in the genital area, including the mucosa, occurs after two or three months of treatment. The white color of the vulva exhibits change after three to four months of treatment.
Before you make a decision to try the acupuncture and Chinese herbal formulas to help leukoplakia vulvae, it is necessary to rule out local cancerous growth. It is worth noting that Chinese herbal formulas can be combined and made into creams that can be applied topically in many external genital problems, with symptoms such as itching, burning sensations, burning pain, pain due to sexual intercourse, dryness, discharge with possible odor, among others. Symptoms such as these can be related to allergies, inflammation, leukoplakia vulvae, etc.
My friend Dr. Paul Reynolds, AP (who now practices in Clearwater, FL) phoned for a consultation for one of his patients in 2008. The patient was a 60 year old female who had been diagnosed with leukoplakia vulvae the previous month. The main symptoms the patient reported were itching in her vulva and genital area, burning pain with dryness in her vulva without vaginal discharge and pain during sexual intercourse. She had hot flashes that got worse in the afternoons and evening, and reddish color her face at night sometimes, night sweating and fatigue, weakness of body; she had poor sleep and wake up 3 to 4 times per night due to itching and painful sensations in the vulva and her genital area; she also had stress and anxiety from her diagnosis at leukoplakia vulvae. She was overly worried, and often nervous. Her appetite was normal without acid reflux or constipation. She had bowel movements once a day and normal urine; her menstruation ended 10 years ago, and her libido was decreased. There was no more information about the condition of her tongue and pulse by phone, and no examination of local genital and vulva.
Based on TCM principles, the condition of the patient was due to yin deficiency in the liver and kidney with heat; the plan of treatment was to tonify and nourishing yin in kidney and liver, clear heat and reduce itching, and calm shen to help her stress, anxiety and poor sleep. This condition suggests the use of the acupuncture points RN2, 3, 6, Zigongxue, ST36, SP 6, 10, 11, LV3 and LI4; the points of electro-acupuncture stimulation include DU20, Yintang, RN12 and 14. The patient underwent acupuncture treatment once a week. The Chinese herbal formula used in this case was one modified from Zhi Bai Di Haung Wan. The herbs include Huang Bai, Zhi Mu, Sheng Di Huang, Shan Yao, Shan Zhu Yu, Mu Dan Pi, Xuan Shen, Ze Xie, Dang Gui, Han Lian Cao and Xian Mao. The formula was a 50g power of an herb Rx for one week, to be taken orally three times a day, 2g per time, mixed with about 2-3oz warm water. These herbs were given in combination with a Chinese herbal formula to be made into a cream to apply topically in area of vulva two to three times a day.
The patient’s symptoms of itching and burning pain in the vulva showed improvement after treatment; dryness and pain in the vulva improved after a few weeks of treatment; the white color of the vulva was much improved after three months of treatment.
A 52 year old female who had painful sensations in her legs and feet was referred to my clinic by her podiatry physician. The patient’s chief complaint was burning pain in the legs, ankles and feet for seven years; she has been diagnosed with leukoplakia vulvae, with symptoms of burning pain and dryness in the vulva, five years before seeing me. She had a vulvectomy two years prior but her vulva was thick and a white color appeared again. Presently the main symptoms were burning pain with stiffness in her legs, pain with stiffness and numbness in the ankles, heels and feet; and ache in the neck and upper back. She had itching in the vulva and genital area, burning pain with dryness in the vulva without vaginal discharge, and pain during sexual intercourse, but her libido was normal. She had hot flashes that worsen in the afternoon and night, and reddish color exhibited on her face in the night accompanied by night sweating; she slept poorly, and woke easily a few times during the night, due to itching and painful sensations in the vulva and genital area. She experienced stress, excessive worry and nervousness, and a hyperactive mind. Her appetite was normal without acid reflux; she had slightly difficult bowel movements once a day, and normal urination. Her menstruation was still regular, coming once a month for five days with a twenty-five day cycle, red blood and moderate volume of bleeding, with some clots and abdominal cramps during menstruation. Examination showed a reddish color on her face, moderate size of tongue body, with pale red color and red in tip of her tongue, slight teeth marks on both edges of tongue and a thin white tongue coating. Her pulse waswiry in distal position and middle position, and weak in proximal position. She experienced pain in a number of areas along her back and legs, most sensitive to a slight touch. There was a painful sensation in her upper back with slight touch – the pain was localized at C6 to C7, T1, and the level of pain was a 4 to 5/10. There was painful sensation in her lower back with slight touch, the pain was found at L2 to S3, and the level of pain was 3 to 4/10. There was painful sensation in her legs with slight touch, the pain was found throughout her legs, and the level of pain was 6 to 7/10. There was a painful sensation in her ankles with slight touch, with pain throughout her ankles, and the level of pain was 4 to 5/10. There was painful sensation in her feet with slight touch, the pain was throughout her feet, and the level of pain was 4 to 5/10. The Ears Pressure Test showed significant pain in the corresponding parts of her brain, neck, back, leg and Shemen, etc., with the levels of pain from 6 to 7/10. No exam of her genital area was conducted.
Based upon TCM, the patient’s condition was due to yin deficiency in the liver and kidney with heat, qi stagnation and blood stasis with shen disorders. The plan of treatment was to tonify and nourish yin in the kidney and liver, clear heat, regulate qi and invigorate of blood, and calm shen to help stress, anxiety and poor sleep. The acupuncture points include RN 2, 3, 6, Zigongxue, ST36, SP6, 10, 11, LV3, KI3, LI4, UB23, 28 and GB34; E-STM was used on points of DU20, Yintang, RN12, 14. Auricular (ear) points applied were Shenmen, Brian, Zigongxue, etc. The Chinese herbal formulas used in this case were modified from Zhi Bai Di Haung Wan and Xue Fu Zhu Yu Tang. It was 50g power of an herb Rx for one week, to be taken orally three times a day, 2g per time, mixed with about 2-3oz of warm water. Additionally, Chinese herbs were provided to be made into a cream to be applied topically in the area of the vulva two to three times a day. These herbs included Ku Shen, Huang Bai, Dang Gui, Zhi Mu, Bai Xian Pi and Bing Pain.
Subsequently, the treatment during follow up visits was modified with some points of the acupuncture protocol, and herbs in the herbal formula, according to changes in the case as the patient progressed. The reported the result was improvement of the itching and burning pain of the vulva after treatment; dryness with pain in the vulva and pain in the lower limbs was improved after a few weeks of treatment; the white color of vulva appeared to be improved after a few months of treatment.