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Review
. 2019 May 15:6:96.
doi: 10.3389/fmed.2019.00096. eCollection 2019.

Sensitive Skin in the Genital Area

Miranda A Farage  1
Affiliations
Review

Sensitive Skin in the Genital Area

Miranda A Farage. Front Med (Lausanne). .

Abstract

When evaluating sensitive skin, it is common to focus on the face. However, it is becoming increasingly clear that individuals can have different perceptions about the degree of skin sensitivity at distinct anatomic sites. Structural variations in the skin of different body sites can contribute to differences in barrier function, which may contribute to differences in skin sensitivity. Potential triggering factors for skin sensitivity would be expected to vary by body site. For example, the face is exposed to all ambient environmental conditions in the course of daily life, and to several products (e.g., cosmetics for women) and practices (e.g., shaving for men) that may lead to adverse sensations associated with sensitive skin. In contrast, the skin of the genital area is protected from ambient environmental conditions. However, the genital area can be exposed to conditions of higher temperature, different habits and practices and moisture due to the semi-occlusive environment. For some individuals, additional challenges such as incontinence can provide triggering factors for skin sensitivity that effect only the genital area. This article reviews data on the perception of sensitive skin of the genital area, differences based on gender, age, racial differences, and the effects of incontinence on skin sensitivity. The effects of menopause are also considered with regards to sensitive skin perceptions and to emerging differences in biomolecular and physical measures of the urogenital skin.

Keywords: age differences; gender differences; genital skin; self-perceived sensitive skin; urogenital skin.

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Figures

Figure 1
Figure 1
Illustration of stratum corneum thickness at various anatomic sites. This illustration of the relative thickness of stratum corneum at various anatomic sites was adapted from data in Ya-Xian et al. (28).
Figure 2
Figure 2
Prevalence of perceived sensitive genital skin among ethnic groups. Subjects in the metropolitan area of Cincinnati, Ohio were asked to complete a sensitive skin questionnaire. Participants were asked to describe their skin sensitivity as very, moderately, slightly or not sensitive. Subsequently, participants were asked to describe the skin of specific anatomic sites including the genital area using the same four-point scale. The percentage of participants claiming any degree of skin sensitivity, and the percentage giving each degree of response (i.e., very, moderately, or slightly) are plotted. Results for ethic groups were compared using a Mantel-Haenszel Chi-Square analysis. [Data adapted from Farage (16)].
Figure 3
Figure 3
Prevalence of perceived sensitive skin among women. Subjects in three different geographies (urban Ohio, rural Mississippi, and China) were asked to complete the sensitive skin questionnaire described for Figure 2. Results from the Cincinnati and Mississippi studies were compared using a Chi-square analysis. (A) Sensitive genital skin, (B) sensitive skin in general. [Data adapted from Farage (16) and Farage et al. (19, 24)].
Figure 4
Figure 4
Perceptions of sensitive skin among women and men in different age groups. Responses in the Cincinnati, Ohio study were evaluated based on age group. A Mantel-Haenszel chi-square analysis was conducted to determine if increasing age was associated with an increase in the prevalence of sensitive skin (any degree). (A) Sensitive genital skin, (B) sensitive skin in general. [Data adapted from Farage (16, 35)].
Figure 5
Figure 5
Perceptions of sensitive skin among women with incontinence. The sensitive skin questionnaire was administered to women who suffered from light urinary incontinence age 50 and above. Responses were compared to age matched control subjects who do not have incontinence. The percentage of participants claiming any degree of skin sensitivity, and the percentage giving each degree of response (i.e., very, moderately, or slightly) are plotted. Results were compared for any degree of sensitivity using a Chi-square analysis, and for all three degrees of sensitivity using a Mantel-Haenszel chi-square analysis. (A) Sensitive genital skin, (B) sensitive skin in general. [Data adapted from Farage (17)].
Figure 6
Figure 6
Changing perceptions after menopause. A study was conducted to evaluate potential differences in biomolecular and physical measures of the urogenital skin among women in different stages of life. Participants were asked about perceptions of sensitive genital skin, and about specific subjective symptoms (i.e., external and vaginal dryness, external and vaginal itch, or difficulties with intercourse). The groups (15 each) consisted of women who were: pre-menopausal (Pre-M), post-menopausal on no hormone replacement therapy (Post-M Non-HRT), and post-menopausal receiving hormone replacement therapy (Post-M HRT). The proportion of individuals in each test group claiming any degree of sensitive genital skin or any of the subjective symptoms is plotted. Pairwise comparisons were conducted using Fisher's exact test.
Figure 7
Figure 7
Comparison of skin pH at genital sites among women with sensitive genital skin. In the study to evaluate biomolecular and physical measures of the urogenital skin, evaluations of skin pH were conducted at the following anatomic sites; vaginally, at the introitus, the labia minora, and the labia majora. For each group, the mean pH for those who did not have sensitive genital skin was compared to those declaring sensitive skin. The number declaring sensitive genital within each group was: Pre-M, 5; Post-M Non-HRT, 4; Post-M HRT, 5. A mixed linear model was used to analyze the pH at different anatomic sites. None of the comparisons were significantly different (i.e., p ≤ 0.05).
Figure 8
Figure 8
Content of IL-1α, IL-1ra, and the ratio of IL-1ra/IL-1α at genital sites among women with sensitive genital skin. In the study to evaluate biomolecular and physical measures of the urogenital skin, sequential tape strips were used to collect material for the quantitative analysis of a variety of biomarkers and cytokines. Results of analyses of: (A) IL-1α, (B) IL-1ra, and (C) the ratio of IL-1ra/IL-1α are presented for each group. For each group, the mean value for those who did not have sensitive genital skin was compared to those declaring sensitive skin using a mixed linear model. (A) Mean IL-1α, (B) mean IL-1ra, (C) mean of the ratios of IL-1ra/IL-1α.
Figure 9
Figure 9
Content of histamine, histidine, and the ratio of histidine/histamine at genital sites among women with sensitive genital skin. In the study to evaluate biomolecular and physical measures of the urogenital skin, histamine, histidine, and the ratio of histidine/histamine were evaluated. Results of analyses of the Pre-M and Post-M Non-HRT groups are presented for those who did not have sensitive genital skin compared to those declaring sensitive skin using a mixed linear model. (A) Mean histamine, (B) mean histidine, (C) mean of the ratios of histamine/histidine.
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