Treatment of Gynecological Vaginal Allergy
For localized vaginal allergic reactions, barrier protection with condoms is the first-line prevention strategy, while systemic reactions require specialized immunotherapy with fractionated seminal plasma proteins. 1
Identify the Allergen and Reaction Type
The most critical first step is determining whether you're dealing with:
- Seminal plasma hypersensitivity (most common vaginal allergen, affecting 73% of cases) - presents with localized swelling, burning, and itching after intercourse 2, 3
- Latex allergy - from condoms or gynecological examination gloves, can cause severe anaphylaxis 1, 4, 5
- Indirect allergen exposure - house dust mites (54%) or pollen (44%) causing secondary vaginal sensitization 3
Diagnosis is confirmed through skin prick testing with whole seminal plasma from the male partner or suspected allergen, as this is more sensitive than serum IgE testing. 2
Treatment Algorithm Based on Severity
For Localized Reactions (Vulvar/Vaginal Itching and Swelling Only)
Barrier protection with condoms prevents all symptoms and is the recommended first-line approach. 1, 2
- Precoital antihistamines may provide modest symptom relief but are generally ineffective for preventing severe reactions 1, 6
- Intravaginal cromolyn sodium has been reported but shows limited efficacy 1
- Topical hydrocortisone can temporarily relieve external genital itching (apply to affected area 3-4 times daily for adults) 7
Important caveat: Graded intravaginal challenges with whole seminal plasma have been less effective for localized reactions compared to systemic hypersensitivity 1
For Systemic Anaphylactic Reactions
Immunotherapy with properly fractionated seminal plasma proteins has been universally successful in preventing anaphylaxis, but must only be performed in specialized centers. 1
The protocol involves:
- Fractionation of partner's seminal plasma over Sephadex G-100 column into 4-7 allergenic fraction pools 1
- Subcutaneous rapid immunotherapy starting at 2 log dilutions above threshold concentration 1
- Injections every 15-20 minutes until highest concentration achieved, with emergency equipment immediately available 1
- Critical maintenance requirement: Intercourse must continue 2-3 times per week to maintain desensitization, as abstinence for even 5 days can cause loss of tolerance 1
Alternative approach: Intravaginal graded challenge with increasing 10-fold concentrations (1:10,000 to neat) of whole seminal plasma at 20-minute intervals has been successful in preventing subsequent anaphylaxis, though the duration of protection remains unknown 1
Special Considerations and Pitfalls
Differential Diagnosis - Rule Out First
Before diagnosing vaginal allergy, exclude:
- Sexually transmitted infections 2
- Latex sensitivity from condoms (not the seminal fluid itself) 2, 4
- Transfer of food or drug proteins through semen 2
- Bacterial vaginosis or candida infection 1, 3
Critical point: Only half of women with concomitant allergy and Candida infection actually have hypersensitivity to Candida antigens 3
Latex Allergy Management
If latex allergy is confirmed:
- Use non-latex, non-vinyl gloves for all examinations 1, 5
- Avoid latex condoms, blood pressure cuffs, and IV tubing ports 1
- High-risk groups include those with multiple surgeries (especially spina bifida patients) and healthcare workers 1
- Acute reactions require hydrocortisone treatment 5
Fertility Reassurance
Seminal plasma hypersensitivity does not cause infertility and has no effect on ability to conceive. 1 This counseling point is essential to reduce relationship stress.
When Condoms Are Unacceptable
For couples who refuse barrier methods or desire unprotected intercourse: