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Rosenbaum reports two cases of pruritis vulvoe. In the first, the symptom recurred each year in the same month, an anniversary which was found to be determined by several historical and emotional factors. A striking result was obtained in the second case. A sixty-six-year-old woman, who for ten years had suffered from pruritis and 'burning of the bladder', became symptom free for the observation period of six months. During hospitalization she was given insight into the causal relationship between the disturbance and some of her emotional conflicts. However, she also underwent cystometry which apparently gratified her masochism.
The author considers pruritis vulvoe as a classical hysterical conversion symptom because 'it combines elements of both pleasure and pain'. It expresses unconscious hostility, guilt, and forbidden immature sexual impulses.
Why the skin is sometimes preferred for the physical expression of conflict seems answered by the development of goose-flesh and scratching in the second case which occurred coincidently with the discussion of a traumatic erotic incident in early life, one in which exhibitionistic excitation was most obvious.
Chicago dermatologists contributed to the discussion, Becker pointing out the rôle of exhaustion in functional skin diseases, and Rothman revealing that chronic scratching causes epithelial changes which in turn increase the susceptibility to itching stimuli for which reason local treatment may be justified.