Vulvar itching is a very common discomfort that significantly affects women’s well-being.
These itches can be very intense and debilitating, especially when they persist over time.
Those who suffer from vulvar itching tend to have more psychological problems, including depression. They also report lower sexual satisfaction.
In addition, an itching-scratching cycle often develops, which is difficult to break and can lead to complications that perpetuate the problem.
More than a condition in itself, vulvar itching is a symptom of vulvovaginitis. Therefore, the important thing is to know how to identify the cause of this inflammation and/or infection in the genital area.
However, diagnosis is not always simple due to the particularities of the vulva.
For starters, it’s located in an area where the urinary, genital, and gastrointestinal tracts meet. It also includes areas of hairy (pilous), glabrous (hairless), and mucous skin.
Added to all this is the fact that it’s a region subject to heat, humidity, and friction. These factors create an occlusive effect, which accentuates the action of irritants and can complicate some skin conditions.
Another aspect that can sometimes complicate the diagnosis is the specific presentation of certain dermatological conditions in the vulva.
Specifically, there is less presence of scales due to the heat and humidity of the area.
For all these reasons, a correct diagnosis must be made when experiencing vulvar itching.
Self-medication should also be avoided, as it is not always a fungal infection.
Causes of vulvar itching
In the case of vulvar itching, the causes can be very varied and even have a multifactorial origin.
At a practical level, vulvar itching can be classified as acute and chronic.
Acute vulvar itching begins suddenly. Chronic vulvar itching, on the other hand, tends to begin gradually.
Depending on the cause of the vulvar itching, it may be accompanied by other symptoms.
Among the most common are burning, inflammation, redness, discomfort when urinating, pain during sexual intercourse, bad odor and changes in vaginal discharge.
- Acute vulvar itching
In acute vulvar itching, the causes may be an infection or contact dermatitis.
Infections can be caused by fungi, bacteria, parasites, or viruses. Contact dermatitis, on the other hand, can be irritating or allergic.
- Fungal infections
Vulvovaginal candidiasis is the most common fungal infection of the vulva.
This can appear at any stage of life, but there is a greater risk in adolescence and during pregnancy.
Therefore, if itching occurs on the vulva during pregnancy, an infection should be ruled out.
It can also be due to jock itch or ringworm, especially in female athletes.
- Bacterial infections
Different bacteria can cause vaginal and vulvar itching.
Among the most common bacterial vaginosis are group A beta-hemolytic streptococcus and Staphylococcus aureus.
- Parasitic infections
Itching of the vulva can also be caused by the presence of parasites in the genital area. These are usually sexually transmitted infections.
Among them, trichomoniasis, pediculosis pubis (popularly known as pubic lice or crabs ), or scabies stand out.
In girls, vulvar itching may be caused by pinworms, intestinal parasites that live in the colon and rectum.
Pinworms should be suspected when there is vulvar itching in girls at night.
- Viral infections
Viral infections that cause vulvar itching are also often transmitted through sexual contact.
These include genital herpes, molluscum contagiosum, and condylomata acuminata.
- Contact dermatitis
Contact dermatitis can be irritant or allergic, with the former being more common.
Irritant contact dermatitis is caused by direct damage from the irritating substance. Allergic contact dermatitis, on the other hand, is a hypersensitivity reaction.
Irritation can be caused by urine or feces, which is one of the causes of diaper rash in babies and toddlers.
Sweat, wearing tight clothing, prolonged sitting, excessive hygiene, and intimate hair removal are other factors that can lead to irritation and itching of the vulva.
Also, personal hygiene and grooming products. These include pads, tampons, condoms, and soaps or gels.
Detergents, fabric softeners, and clothing dyes can also irritate the genital area.
Allergic contact dermatitis is less common and is usually caused by fragrances, topical antibiotics, nickel, preservatives, and topical anesthetics.
Infections, contact dermatitis, and skin conditions are the main causes of vulvar itching.
- Chronic vulvar itching
Chronic vulvar itching is usually caused by skin conditions or atrophic vaginitis.
However, some intestinal diseases can also cause this symptom, as can certain systemic diseases.
In much less frequent cases, itching of the vulva may be caused by pre-malignant or malignant diseases (neoplasias).
- Skin disease
Different dermatological conditions can cause vulvar itching.
Among the most common are lichen sclerosus, lichen planus, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus.
- Atrophic vaginitis
Vaginal atrophy often occurs during periods of low estrogen levels. As a result, the vulva is more vulnerable to irritants and trauma, as well as to intercourse.
When estrogen levels are low, secretions also decrease and the pH increases, altering the vaginal flora. This leads to an increased risk of infections such as cystitis.
In this context, vaginal dryness is very common and this can cause itching in the female genitals.
Vaginal dryness during menopause is the most common condition. However, it can occur at other stages.
For example, vaginal dryness often occurs postpartum and during breastfeeding.
- Vulvovaginitis in childhood
Low estrogen levels in girls also make them more prone to vulvovaginitis and vulvar itching.
This is because the skin is very thin and, therefore, more susceptible to trauma, as well as irritation from urine, feces, hygiene products, and topical agents.
In atopic dermatitis, the skin barrier is altered, which favors the effect of irritants.
- Intestinal diseases
Hemorrhoids, anal fissures, and fistulas can cause itching of the anus and vulva.
This is because itching, even if it starts in the anal area, can spread to the genitals.
These injuries can also cause pain in the vulva by putting pressure on the nerves in this area.
- Systemic diseases
Some diseases, such as diabetes mellitus, can cause vulvar itching, as can iron deficiency or anemia.
- Psychosomatic factors
Sometimes, vulvar itching occurs without any recognizable cause, and stress-related itching may be suspected.
- Neoplasms
More rarely, genital itching may indicate the presence of precancerous diseases of the vulva.
Treatment for vulvar itching
Treatment for vulvar itching will depend on the cause.
However, it may also be necessary to prevent or treat secondary infections and break the itch-scratch cycle.
At the same time, it is essential to adopt hygiene and personal care measures that respect this area.
1) Treat the cause of vulvar itching
In the case of fungus on the vulva, creams or ointments with antifungal substances should be used.
If the itching on the vulva is due to a bacterial infection, however, antibiotic treatment will be performed.
For vulvar itching due to a lack of estrogen, a 17β-estradiol or estriol cream can be applied locally to the vaginal mucosa.
For any other disease, a specific treatment will be required to combat it.
If the cause of vulvar itching cannot be identified, topical corticosteroids, such as clobetasol, can be applied.
If corticosteroids cannot be used, calcineurin inhibitors (pimecrolimus and tacrolimus) can be used.
In parallel, 2% lidocaine gel can be applied.
2) Prevent infections
Scratching can lead to the development of wounds and secondary infections, especially candidiasis or bacterial vaginal infections.
If these are present, they should be treated. Sometimes, however, preventive treatment may be indicated.
In case of exudative lesions, it is advisable to use products with drying and astringent action.
These usually contain active ingredients such as zinc, copper, and aluminum-potassium sulfates.
By removing exudate, these products promote skin healing, reduce the risk of infection, relieve vulvar itching, and eliminate unpleasant odor.
3) Avoid scratching
When the vulva is very itchy, scratching is almost inevitable, especially at night.
Therefore, it is recommended to keep your nails short and sleep with gloves on.
Sedative medications may also be prescribed two hours before bedtime. These include hydroxyzine, diphenhydramine, amitriptyline, or doxepin.
During the day, selective serotonin reuptake inhibitors such as citalopram, fluoxetine, or sertraline may be prescribed.
4) Maintain good intimate care habits
To prevent the appearance of vulvar itching, it is important to maintain proper hygiene and intimate care habits.
- Wash the area with water only and without rubbing.
- Do not douche.
- Avoid potential irritants or allergens.
- Always wipe from front to back, not the other way around, after using the bathroom.
- Use moisturizing, regenerating, and lubricating creams or gels for the intimate area. These usually contain hyaluronic acid. If the mucosa is in good condition, it can better perform its protective function against external aggressions.
- Wear cotton underwear and change it frequently.
- Keep the area dry. Avoid wearing wet clothing for extended periods, especially swimsuits or workout clothes.
- Avoid wearing tights, leotards, or pants that are too tight.
- Taking probiotics can help maintain the balance of the vulvovaginal microbiota.
- Change diapers frequently for babies and toddlers.