Itching of the vagina

What Is Vaginal Itching?

Itching of the vagina or surrounding area can be a sign of infection.

Vaginal itching, sometimes called vaginitis, occurs when the vagina becomes inflamed, often also causing discharge and pain.

Changes in the normal balance of vaginal bacteria, as well as infections, are both common causes of vaginal itching.

Causes of Vaginal Itching

Itching on the skin of the vagina or vulva (area surrounding the vagina) can be a sign of:

  • Yeast infection
  • Sexually transmitted diseases, such as chlamydia, gonorrhea, or trichomoniasis
  • Overgrowth of normal bacteria in the vagina, called bacterial vaginosis

Other causes of vaginal itching may include:

  • Menopause or low estrogen levels
  • Foreign objects left in the vagina, such as a tampon
  • An intrauterine device (IUD) for birth control
  • Medications, such as antibiotics and steroids
  • Damp or tight-fitting clothing
  • Chemicals found in detergents, fabric softeners, feminine sprays, ointments, creams, douches, and contraceptive foams, jellies, or creams
  • Skin conditions, such as desquamative vaginitis or lichen planus
  • Poorly controlled diabetes
  • Cancer of the cervix or vagina

Signs of a Vaginal Infection

The following symptoms may indicate a vaginal infection:

  • Itching
  • Swelling
  • Pelvic pain
  • Foul-smelling discharge
  • Green, yellow, or gray discharge
  • Foamy or clumpy (like cottage cheese) discharge

Seek medical attention if you experience any of the above.

Treatment for Vaginal Itching

Medical treatment will depend on the cause of your symptoms, and may include prescribed medications or creams.

The following home remedies may also help relieve your symptoms:

  • Keeping your genital area clean and dry
  • Wearing loose-fitting clothing, cotton underwear during the day, and no underwear while sleeping to help your vagina “breathe”
  • Refraining from using soap, and rinsing the area with water instead
  • Soaking in a warm (not hot) bath
  • Avoiding douches, as they eliminate healthy bacteria that help fight infections
  • Not applying hygiene sprays, fragrances, or powders near the vagina
  • Using pads instead of tampons if you have an infection
  • Wiping from front to back when using the toilet
  • Keeping your blood glucose under control if you have diabetes

What causes vaginal itching, burning, and irritation?

There are several common causes of vaginal itching, burning, and irritation, including:

  • Bacterial vaginosis . It’s normal to have a healthy mix of bacteria in the vagina. But the wrong bacteria growing there can lead to an infection. Besides itching, other symptoms that come with bacterial vaginosis are inflammation, burning, discharge, and a fishy-smelling odor.
  • Sexually transmitted disease (STDs). Chlamydia, genital herpes, genital warts, trichomoniasis, gonorrhea and other organisms can cause vaginal/vulvar itching and irritation and other symptoms.
  • Yeast infection (vaginal candidiasis). About three out of every four women will develop a yeast infection at some point in their lives. Yeast infections occur when the yeast, candida, grow excessively in the vagina and vulva. Pregnancy, intercourse, antibiotics, and a weakened immune system can all make women more likely to get a yeast infection. In addition to itching and irritation, a yeast infection will produce a thick, white, cheesy discharge.
  • Menopause. The drop in estrogen production that occurs at the end of a woman’s reproductive years can cause the vaginal walls to thin and dry out. This can lead to itching and irritation. Thinning of the vaginal walls is also a problem in some women who breastfeed.
  • Chemical irritants. A number of chemical substances, including creams, douches, condoms, contraceptive foams, laundry detergents, soaps, scented toilet paper, and fabric softeners can irritate the vagina and vulva.
  • Lichen sclerosis . This is a rare condition that causes thin white patches to form on the skin, especially around the vulva. The patches can permanently scar the vaginal area. Postmenopausal women are most likely to develop this condition.

A “slight” vaginal itch without a change in your normal vaginal fluid/discharge is usually caused from a reaction to something your vagina has come in contact with (contact dermatitis), for example: scented soap, body wash, vaginal lubricants and spermicides, latex condoms, scented tampons and pads. Underwear that has been washed in scented detergent and/or fabric softener, tight underwear/thongs or staying in a wet bathing suit can also be irritating to the vagina and cause itching. Other possible reasons for a vaginal itch (without a discharge) can be an uncommon skin condition called “lichen sclerosus” or the result of an infestation with pubic lice. While yeast infections usually are associated with a change in the vaginal discharge, you should be checked for a yeast infection if your symptoms don’t clear up with simple measures.

Avoid using any scented soaps or shampoos near your vagina and wash your clothes with a unscented detergent then double rinse. Never use feminine hygiene deodorant sprays or douches. These products change the normal balance (ph) in your vagina which can cause irritation and vaginal yeast infections.

Vaginal itching can be annoying but try not to scratch this area because it will make the skin even more itchy. If the vaginal itch doesn’t go away after you have removed possible irritants, make an appointment with your health care provider. Treatment is available.​

Vaginal Itching and Irritation

Symptoms

Vaginal itching and irritation can occur even if you don’t have a vaginal infection.

Vaginal itching and irritation are usually characterized by a tingling, stinging or burning sensation of the external skin surrounding the vaginal area. The itching can range from mild to severe and can come and go at any time.

Causes

Feminine itch can be caused by a number of factors.2 Some of the most common are associated with:

  • Irritants from chemicals, including fragrance, found in soaps, detergents, fabric softeners, feminine sprays, douches, topical contraceptives, body washes
  • Vaginal infections
  • Fluctuations in estrogen levels due to menopause
  • Irritation caused by urinary incontinence
  • Allergic reactions or medicinal side effects
  • Skin conditions such as eczema, psoriasis, or atopic dermatitis

Treatment

Vaginal itching occurs occasionally for all women and relieving the symptoms temporarily by applying a topical cream like Instant Itch Relief Cream from MONISTAT® CARE™ can be very effective. Unlike many vaginal itch creams that contain benzocaine, Instant Itch Relief Cream from MONISTAT® CARE™ contains the #1 doctor recommended OTC ingredient for external itching. It instantly stops the itch. In fact, 95% of women agree that it helped stop the external itch instantly and provided long-lasting relief.1 If the itch persists, make sure to see your healthcare professional.

For external use only.
Do not use if you have vaginal discharge. Consult a healthcare professional.
Note: Itch relief creams CANNOT cure a vaginal infection.

Prevention

Bad Habits to avoid:

  • Wearing nylon or synthetic underwear material
  • Wearing tight-fitting clothing
  • Using scented products that might irritate the skin around the vaginal area like soaps, perfumes, bubble baths, body washes, deodorants, scented creams, fabric softeners or toilet paper, etc.

Good Habits to Practice:

  • Rinse well in the shower to avoid lingering soap residue on skin
  • Allow skin to dry fully before dressing

When to See Your Healthcare Professional

It’s important to see your healthcare professional if you have persistent vaginal itching. Or, if the itching is combined with another symptom such as suspicious or abnormal discharge, consult a healthcare professional. If you’d like help getting the conversation started, download our Doctor Discussion Guide.

Footnotes:

1. Company study on file

2. http://women.webmd.com/vaginal-itching-burning-irritation

Vulvitis

What is vulvitis?

Vulvitis is not a disease, but refers to the inflammation of the soft folds of skin on the outside of the female genitalia, the vulva. The irritation can be caused by infection, allergic reaction, or injury. The skin of the vulva is especially susceptible to irritation due to its moistness and warmth.

Who is affected by vulvitis?

Any woman of any age can be affected by vulvitis. Girls who have not yet reached puberty or post-menopausal women may be at higher risk of vulvitis. Their lower estrogen levels may make them more susceptible to the condition due to thinner, dryer vulvar tissues.

What causes vulvitis?

Vulvitis can be caused by many factors or irritants, including:

  • The use of colored or perfumed toilet paper
  • An allergic reaction to bubble bath or soap used to clean the genital area
  • Use of vaginal sprays or douches
  • Irritation by a chlorinated swimming pool or hot tub water
  • Allergic reaction to spermicide
  • Allergic reaction to sanitary napkins
  • Wearing synthetic underwear or nylon pantyhose without a breathable cotton crotch
  • Wearing a wet bathing suit for extended periods of time
  • Bike or horseback riding
  • Fungal or bacterial infections including scabies or pubic lice
  • Herpes
  • Skin conditions such as eczema or dermatitis

What are the symptoms of vulvitis?

The symptoms of vulvitis can include:

  • Extreme and constant itching
  • A burning sensation in the vulvar area
  • Vaginal discharge
  • Small cracks on the skin of the vulva
  • Redness and swelling on the vulva and labia (lips of the vagina)
  • Blisters on the vulva
  • Scaly, thick, whitish patches on the vulva

The symptoms of vulvitis can also suggest other disorders or diseases of the genitals. If you are experiencing any of these symptoms, you should consult your healthcare provider.

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Of all the places that can get itchy, red, and irritated on your body, your vagina might rank as the absolute worst—I mean, it’s not exactly easy to scratch down there.

But what’s even more frustrating than doing the crotch-itch dance in public, is not knowing why your vagina’s itchy in the first place (is it a yeast infection? Or…crabs?).

Truthfully, there are tons of reasons why it feels like a wool sweater is permanently attached to your vagina. Here are a few things that might be causing the itch—and how to take care of it for good.

1. Bacterial vaginosis

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Bacterial vaginosis (BV) is a pretty common condition caused by bacterial overgrowth and a pH imbalance in the vagina.

But itching actually isn’t the primary symptom—the hallmarks are actually a loose discharge, strong odor, and general irritation (though it definitely can make you itchy too), says Mary Jane Minkin, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University.

To treat it, you can try an OTC medication like RepHresh to make your vagina more acidic, according to Minkin—acid in the vagina is actually a good thing, as it kills off bad bacteria, she says. If that doesn’t work, your doc might prescribe antibiotics.

3. Eczema or psoriasis

“Skin conditions like eczema and psoriasis can occur due to an allergy or autoimmune issue,” says Natasha Chinn, M.D., FACOG, and ob-gyn with Brescia & Migliaccio Women’s Health in New Jersey. “Eczema often appears in the crevices of arms, in folds, the groin area, and on the labia, and psoriasis can also present on the vagina.”

Most people with eczema and psoriasis are well-versed in the appearance (and treatment) of these red, patchy rashes, but if you’ve never had the symptoms before, make an appointment with your doctor. Both conditions can be managed if they’re flaring up, and Chinn says that psoriasis can sometimes warrant a prescription for an oral pill or a topical cream.

4. Contact dermatitis

Ever try a new moisturizing cream and wind up with dried out, flaky, or rashy skin a few days later? Well, guess what: The same thing can happen to your vagina. “Soaps, detergents, and bubble baths, a new kind of underwear—really any new products at all that come in contact with your vagina ,” explains Minkin.

If your vagina feels itchy and irritated, but you don’t have any other symptoms, it’s worth thinking about whether you’ve recently started using any new products. Pads and tampons, condoms and lubricants, shaving products, and even toilet paper can all be to blame (basically anything with added perfumes or chemicals, so stick with hypoallergenic stuff if you’re sensitive).

In the meantime, stop using whatever you think is bugging you, treat the itch with an epsom salt bath or an OTC hydrocortisone cream applied externally, and wait a few days to see if the itch resolves. If not, go see your doctor.

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Vaginal yeast infections, i.e. overgrowths of the fungus Candida, are probably the first thing people think of when they feel that telltale itching. “A cottage cheese-like discharge, redness around the labia and vulva, and itching are all classic signs of a yeast infection,” Minkin says.

But she also notes that only about one-third of women who experience itching and irritation truly do have a yeast infection. The easiest way to tell which category you fall into is to use an OTC treatment like Monistat; Minkin says that if you really do have a yeast infection, it should do the trick; if it doesn’t, check in with your provider.

5. Sexually transmitted diseases (STDs)

Okay, let me preface this by saying itching isn’t really a classic symptom of most STDs, though it can sometimes be a first sign that something is up, says Minkin. From there, symptoms may progress to burning, painful urination, smelly discharge, sores on your genitals, or painful intercourse, at which point you should definitely head to your ob-gyn for a vaginal culture.
One kind of STD, though, is often associated with itching: genital warts. “Genital warts are lesions on the skin and are generally caused by the low risk types of HPV,” says Chinn. “This type of STD can shift the pH in the vagina, which then causes dryness and itching.”

You can’t completely cure genital warts, per the Centers for Disease Control and Prevention (CDC), but you can treat the symptoms and work with a doctor to lessen outbreaks. As for other STDs, antibiotics usually work to get rid of them. But whatever you think you might have, it’s important to get it checked out by a doctor and not self-treat.

6. Pubic lice

No one wants to think about bugs crawling around on any part of their body, but especially not down there. Unfortunately, that’s exactly what pubic lice (a.k.a., crabs) is: an easily transmittable infestation of little bugs in your genitals that makes you itch like crazy. There’s two reasons for the itching, says Chinn: bites from the crabs and the eggs (nits) they lay on your skin, both of which cause irritation.

Fun fact: You can get pubic lice from hotel room sheets.

Now for the really bad news: having sex isn’t even the only way to get pubic lice. “They’re passed from skin to skin,” says Chinn. “, you go to a dirty hotel and there are nits or lice in the sheets you slept on, and then you go home to your partner and have sex. Or maybe you loan your sister your pants and had them, then you wear the pants and the crabs crawl into the vaginal area.”

Though treatable with an OTC medication like permethrin cream (just like head lice), the morals of the story here are as follows: practice safe sex, read hotel ratings carefully, and maybe don’t let anyone borrow your pants.

7. Lichen sclerosus

Another dermatology issue, like eczema or psoriasis, lichen sclerosus is a patchy white rash that causes intense itching and often pops up in your genital area (though it can appear on other parts of the body, too). It can be treated with a prescription-strength topical steroid, but Minkin says a lichen sclerosus rash can often mimic vulvar cancer, so its appearance may complicate things a little.

“In young women, it’s more likely to be lichen sclerosus than cancer, but I’ll often bring patients back in a few weeks to see how it’s looking, especially if they are older,” says Minkin. “We want to make sure we’re not missing cancer, so if it hasn’t cleared up with steroids, I may do a biopsy to scan it.”

8. Hormonal changes and perimenopause

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When your hormones fluctuate during your menstrual cycle, you might end up with drier vaginal tissue than normal, which can cause itching. But Minkin points out that perimenopause (a.k.a., that time period before you actually start menopause) is a more common reason for vaginal dryness and itching, thanks to the drop in estrogen.

An OTC moisturizer like Replens can provide relief from internal itching for three days, Minkin says, and your provider can give you a prescription estrogen cream for any external itching.

9. Urinary tract infections

A urinary tract infection (UTI) is a bacterial infection that crops up anywhere in your urinary tract (read: kidneys, urethra, ureters, and bladder), and will commonly cause pelvic pain, a strong urge to pee, a burning sensation when you pee, and cloudy or foul-smelling urine.

But Minkin confirms that it can also cause itching in the form of a tingling, irritated sensation, especially if the infection is located near your urethra. You need to snag an appointment with your doctor and get a urinalysis to check for the presence of bacteria (which an antibiotic can clear up).

10. Beauty treatments

In the past few decades, women have grown more preoccupied with the appearance of their vulvas, says Minkin—something she attributes to the trend of having less hair down there. Which means many women have also tried out some pretty unconventional beauty treatments, like activated charcoal vulva masks (basically a facial for your vagina) and vaginal steaming.

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Minkin says these are a no-no, not only because they’re totally unnecessary, but because they can cause reactions in the form of itching and irritation.“The vulva tissue is the most sensitive, delicate tissue in the body,” she says. “Treat it with respect and a gentle hand. The less stuff you do to it, the better.”

11. Tanning bed burns

Okay, first of all why are you going to tanning beds in the first place?! Not only can they give you skin cancer, but tanning in the nude can give you a vagina burn. Yes, a vagina burn. “Redness and peeling of the skin causes itching—that’s what tends to happen when women go to a tanning bed,” says Chinn.

So yeah, just don’t do this in the first place, please. But if you do somehow end up with a burn downstairs, Chinn says you can mix a little aloe vera with coconut oil or tea tree oil and apply it topically (it’s perfectly safe for the vaginal area).

12. Waxing or shaving irritation

Your bikini area is just as sensitive—if not more so—to razor burns and irritation from shaving or waxing your hair. “When we wax or shave anywhere on the body we disrupt the skin’s integrity,” says Chinn. “Redness, itching, and burning can occur if you’re sensitive to it.”

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Chinn recommends applying hypoallergenic cream or lotions to protect the skin, as well as keeping it dry and clean. If it’s becoming an ongoing problem for you, you may have to stop waxing, wax less frequently, or change up your shaving products to something gentler on your skin, she adds.

Itchy vulva

The vulva, or external genitalia of the female, includes the mons pubis, labia majora (outer lips), labia minora (inner lips), clitoris, perineum (the tissue between vagina and anus) and the external openings of the urethra and vagina.

Itching often affects the vulva. The sensation of itch in this site in the absence of a known skin condition is referred to as pruritus vulvae. Pruritus vulvae should be distinguished from vulval pain and from vulvodynia, which refers to chronic burning symptoms in the absence of clinical signs. Vulval itch, pain and burning can co-exist.

Who gets an itchy vulva?

Girls and women of any age and race can experience mild, moderate or severe vulval itch, which can be intermittent or continuous. They may or may not have an associated skin condition.

What causes an itchy vulva?

One or more specific conditions may be the cause of a vulval itch.

Itch due to infections

Candida albicans infection (vulvovaginal thrush) is the most important microorganism to consider in a postpubertal woman with vulval itch. Candida can be a cause of napkin dermatitis in babies. Postmenopausal women are unlikely to have Candida albicans infection unless they have diabetes, they are treated with oestrogen or antibiotics, or the overgrowth of candida is secondary to an underlying skin disease.

Several less common infections may cause vulval itch.

  • Bacterial vaginosis causes a frothy, malodorous discharge, and uncommonly causes vulval itch, possibly as a result of contact dermatitis.
  • Genital viral warts are often itchy.
  • Pinworms can reside in the vagina or anus and cause itch when they exit at night.
  • Infections that rarely cause vulval itch include cytolytic vaginosis (associated with vaginal lactobacilli) and trichomoniasis.

Itch due to an inflammatory skin condition

Irritant contact dermatitis is the most common cause of an itchy vulva at all ages. It can be acute, relapsing or chronic. It may be due to various reasons, including:

  • Age-related prepubertal or postmenopausal lack of oestrogen
  • Underlying tendency to atopic dermatitis
  • Scratching and rubbing
  • Friction from skin folds, clothing, activity, or sexual intercourse
  • Moisture due to occlusive underwear
  • Urine and faeces
  • Soap or harsh cleanser
  • Frequent washing
  • Inappropriate or unnecessary chemical applications, including lubricants, over-the-counter or prescribed medications
  • Normal, excessive or infected vaginal secretions.

A severe vulval itch may be due to:

  • Lichen simplex
  • Lichen sclerosus
  • Lichen planus.

Other common skin disorders that may cause vulval itch include:

  • Psoriasis
  • Seborrhoeic dermatitis
  • Allergic contact dermatitis*
  • Irritant or allergic contact urticaria
  • Dermographism
  • Folliculitis.

*Potential vulval allergens include:

  • Methylisothiazolinone, a preservative in moist wipes
  • Various textile dyes in underwear
  • Fragrance in a douche or antiperspirant
  • Rubber accelerants in condom, menstrual cup or underwear
  • Adhesives in pads, pantyliners and tampons.

Latex rubber and semen are potential causes of contact urticaria.

Itch due to neoplasia

Benign and malignant neoplastic disorders of the vulva are often asymptomatic in their early stages, but they can cause itch. The most common cancerous lesions are:

  • Squamous intraepithelial lesions (SIL, also known as vulval intraepithelial neoplasia or VIN)
  • Extramammary Paget disease
  • Invasive vulval cancer (squamous cell carcinoma)

Itch due to neuropathy

Neuropathy should be considered as a cause of vulval itch if there are no signs of infection or skin disease apart from lichen simplex — which can be secondary to a pruritic neuropathy — especially if vulvodynia is present. The neuropathy may be caused by injury, surgery or disease locally (pudendal entrapment), within the pelvis or in the spine.

What are the clinical features of an itchy vulva?

The clinical features depend on the underlying cause of the vulval itch. There may be an obvious or subtle rash or no signs of disease at all.

When assessing the cause, it’s essential to determine the precise location of the symptoms. Itch often only affects one anatomic part of the vulva:

  • Convex areas and thighs: irritant contact dermatitis due to urinary incontinence (usually symmetrical incontinence-associated dermatitis) or rarely, allergic contact dermatitis (asymmetrical)
  • Flexures: seborrhoeic dermatitis, nonspecific or candida intertrigo
  • Mons pubis: seborrhoeic dermatitis, folliculitis
  • Labia majora: genital psoriasis, atopic dermatitis, lichen simplex (unilateral or bilateral)
  • Labia minora: lichen sclerosus, lichen planus
  • Vaginal introitus: erosive lichen planus, atrophic vulvovaginitis, vaginal discharge or infection
  • Perineum: dermatitis, lichen sclerosus
  • Any site: neoplasia

The itch can also involve other adjacent skin of the abdomen, thighs and perianal area.

An examination may reveal healthy skin, scratch marks (excoriations) and the specific features associated with the underlying cause of the itch.

Morphology may be modified according to the site, with minimal scale evident.

  • Candida albicans vaginitis causes thick white vaginal discharge, erythema, and oedema; candida vulvitis causes satellite red superficial papules, pustules, desquamation and erosions.
  • Candida can also cause subtle fissuring and subclinical dermatitis.
  • Viral warts are clustered as soft condylomata.
  • Acute irritant contact dermatitis may be shiny or waxy or scald-like.
  • Genital or flexural psoriasis has symmetrical circumscribed erythematous plaques, but they are rarely scaly.
  • Seborrhoeic dermatitis presents with salmon pink, poorly defined patches, sometimes with mild exfoliation.
  • Allergic contact dermatitis can have varied morphology but tends to be asymmetrical, intermittent.
  • Lichen simplex presents as confluent thickened papules with broken off hairs.
  • Lichen sclerosus typically has white plaques, ecchymoses and erosions.
  • Lichen planus may present as violaceous or hyperpigmented papules with a white reticulated network (thighs), appear similar to lichen sclerosus; erosive lichen planus causes tender well-defined red patches and erosions in the introitus/vagina and is not usually itchy.
  • An intraepithelial or invasive squamous lesion should be considered if there is a solitary plaque with irregular shape, structure, surface and colour. Firm or hard consistency and ulceration and bleeding are particularly concerning.

What are the complications of an itchy vulva?

An itchy vulva can result in a lot of psychological distress and sleeplessness. Scratching injures the skin, which can lead to pain and secondary bacterial infection.

How is the cause of an itchy vulva diagnosed?

The cause or causes of an itchy vulva may be diagnosed through careful history (include genitourinary and musculoskeletal systems) and examination of the vulva.

A full skin examination may reveal a skin condition or disease in another site that gives a clue to why the vulva is itchy.

  • Bacterial and viral swabs of the affected area and the vagina may be taken for microbiological examination.
  • Skin biopsy of the area affected by itch or visible skin condition may be necessary to determine its exact nature. Sometimes several biopsies may be taken.
  • Patch tests are sometimes performed to see whether any contact allergy is present.

What is the treatment for an itchy vulva?

The conditions causing an itchy vulva often require specific treatment. For example:

  • Topical and oral antifungal or antibiotic for an infection
  • Topical steroids or calcineurin inhibitors for inflammatory disease
  • Oral antihistamines for contact urticaria
  • Surgery for neoplasia
  • Tricyclic antidepressants, serotonin reuptake agents, and anticonvulsants for neuropathic symptoms.

Nonspecific treatment

  • Minimise scratching or rubbing the affected area.
  • Wear loose-fitting absorbent underwear and outer clothing.
  • Avoid occlusive nylon such as pantihose.
  • Select modern absorbent underwear.
  • Keep cool, especially at night-time.
  • Apply emollients (eg, sorbolene) and barrier preparations (eg, petroleum jelly).
  • Hydrocortisone cream can be used safely and purchased without a prescription.

Contact dermatitis occurs quite readily when inflamed skin affects the genital area.

  • Wash once or twice daily with lukewarm water alone or use a soap-free cleanser.
  • Do not use leave-on moist wipes, antiperspirants or other cosmetics in the vulva.
  • Insert tampons with care or use reusable silicone menstrual cups.
  • Change sanitary pads, pantiliners and incontinence products frequently.
  • Avoid riding bicycles or horses.

Tricyclic antidepressants may be prescribed to control intractable itch, even in the absence of a defined neuropathy.

How can vulval itch be prevented?

A vulval itch cannot always be prevented, depending on its cause. However, vulval health is optimised by the nonspecific measures described above.

What is the outlook for vulval itch?

Vulval itch is usually a minor, short-lived nuisance. However, some women may suffer from a vulval itch for years, and may only receive temporary relief from treatment if not correctly diagnosed.

Managing common vulvar skin conditions

Proper diagnosis, treatment vital to get relief from vulvar itching and other irritating conditions

Updated: December 12, 2019Published: November, 2008

The vulva is subject to a range of skin problems, many of them inadvertently self-inflicted.

You may routinely pamper your face and work hard to keep it moisturized and irritation-free, but what have you done lately for the more sensitive skin of your vulva, the external genital area surrounding your vagina?

Many women have been primed to think no further than “itch equals yeast infection.” But with age and the decline in estrogen after menopause, women become more prone to a variety of conditions that irritate vulvar skin. These conditions aren’t getting the medical attention they need — and women aren’t getting the relief they deserve.

Anatomy of the vulva

The vulva (Latin for womb or covering) consists of several layers that cover and protect the sexual organs and urinary opening. The fleshy outer lips of the vulva — the labia majora — are covered with pubic hair and contain fat that helps cushion the area. Inside the labia majora are the thinner, more pigmented and delicate flaps of skin called the labia minora. The labia minora join at the top to enclose the clitoris. The labia majora, labia minora, and clitoris are made up of erectile tissue, that is, tissue that can become engorged with blood. The area between the labia minora, the vestibule, contains the openings to the urethra and the vagina, as well as the Bartholin’s glands, which are located on either side of the vaginal opening and produce lubricant for the vestibule. The flesh between the vaginal opening and the anus (not part of the vulva but often involved in vulvar skin problems) is the perineum. This is where the incision called an episiotomy is sometimes made during childbirth.

Getting a diagnosis for vulva skin conditions

Getting a diagnosis for vulva skin conditions

Vulvar skin conditions are highly treatable, but the treatment depends on the specific cause. And identifying the underlying diagnosis can be very challenging.

Tell your clinician about any other past or present medical conditions (including bladder and bowel issues) and any skin problems elsewhere on your body. For example, psoriasis anywhere on the body raises the risk of a vulvar condition known as lichen sclerosus. (This condition and others are described, below, in “Vulvar conditions and their treatment.”) Crohn’s disease, a chronic inflammatory intestinal disease, may cause abscesses or draining fistulas in the vulvar area, and vulvar skin problems are often one of its early symptoms. A mouth condition called lichen planus is another cause of vulvovaginal problems. (The term “lichen,” as applied to skin disorders, refers fancifully to skin lesions that resemble lichen on rocks.) Long-term treatment with oral steroids, immune suppressants, or antibiotics can affect vulvar skin and raise the risk infection.

Your clinician will want to know how you care for your vulvar skin, which can help identify possible sources of irritation. Even if you can’t pinpoint a change, that doesn’t mean your standard routine isn’t the culprit. Sometimes vulvar problems are the cumulative effect of long-term practices.

It’s often what you’ve done day after day, year after year, that causes the problem. If you wear abrasive clothing and engage in abrasive activities like bicycling or spinning class and wear tight workout clothes that expose your vulva to sweat or to detergent or soap residue, eventually it might catch up with you.

Report all the symptoms that concern you, including itching, burning, soreness, discharge, bumps, and any rashes the vulva. It will also help if you can provide a history of your symptoms and recall what seems to make them better or worse. Your clinician will examine the vulva, perhaps using a magnifying glass, and insert a speculum to inspect the vagina. She or he may test the pH (acid-base balance) of the vagina and take samples of secretions to examine under the microscope or culture for yeast. Remember, even if you’re seeing an experienced clinician, several visits may be needed to diagnose and improve certain vulvovaginal conditions.

The problem with self-treatment

When vaginal or vulvar itching occurs, women usually assume it’s a yeast infection and treat it with an over-the-counter antifungal cream. Often this does the trick, but not always. Instead, the cause of the symptoms might be dry skin, a sexually transmitted disease or bacterial infection, a less common strain of yeast that required special medication, or irritation by and allergic reactions to common products such as soaps, creams, and lotions.

If yeast isn’t the problem, an antifungal cream isn’t the solution. And if your skin is already irritated, you may exacerbate the problem by introducing preservatives (such as alcohol or propylene glycol) and other ingredients contained in many antifungal remedies. That’s why it’s important to see your gynecologist or dermatologist if a problem persists after you’ve tried a standard antifungal cream.

Another common response of women faced with a vaginal discharge or itch is to wash the vulvar skin vigorously, on the assumption that this will disinfect the area or remove irritants. But aggressive cleansing can add to the irritation. Until the problem is diagnosed, it’s best to follow a gentle skin care routine (see “Gentle vulvar care”). In fact, gentle cleansing applies whether you have a vulvar skin condition or not: Wash the area gently with your fingertips or a soft cloth and pat dry with a soft towel. Don’t use a rough washcloth, and don’t rub.

Vulvar skin conditions and their treatment

Several vulvar skin conditions are familiar from other areas of the body but may be difficult to recognize when they appear on the vulva. These include the following:

Eczema. This inflammatory skin condition disrupts the skin’s surface, causing red patches and thin cracks, weeping, and crust formation. On the vulva, crusts are less likely, but eczema may initiate a cycle of vulvar itching and scratching that leads to lichen simplex chronicus — thickened and intensely itchy skin. If eczema affects an area of the vulva called the vestibule, it may cause stinging and burning. Sometimes eczema appears in early childhood and its cause is unknown. More often, it begins with exposure to an irritant or allergen (see “How irritating”).

Many things can cause an allergic reaction or irritate vulvar skin. Here are some of the leading suspects:

Irritants (on exposure, can cause immediate stinging or burning)

  • Soap, bubble baths and salts, detergent, shampoo, conditioner
  • Adult or baby wipes
  • Panty liners and their adhesives
  • Nylon underwear, chemically treated clothing
  • Vaginal secretions, sweat, and urine
  • Douches, yogurt
  • Spermicides, lubricants
  • Perfume, talcum powder, deodorants
  • Alcohol and astringents

Allergens (symptoms may not appear until several days after exposure)

  • Benzocaine
  • Neomycin
  • Chlorhexidine (in K-Y Jelly)
  • Imidazole antifungal
  • Propylene glycol (a preservative used in many products)
  • Fragrances
  • Tea tree oil
  • Latex (in condoms and diaphragms)

Adapted from The V Book, by Elizabeth G. Stewart, M.D., and Paula Spencer (Bantam Books, 2002).

To diagnose vulvar eczema, the clinician will ask about your symptoms; your history of eczema, allergy, and related conditions; your vulvar cleansing habits; and any products the vulva has been exposed to. During the exam, she or he will look for redness, scaling, cracking, and thickening.

All eczema requires gentle skin care. In simple cases, patients use topical corticosteroid ointments twice a day for two to four weeks and then gradually reduce the frequency until the symptoms are gone. Severe cases may require a short course of a potent corticosteroid ointment.

During treatment, you must stop scratching, so your clinician may prescribe an antihistamine (usually taken at night to prevent daytime drowsiness). A cold pack can also help relieve itching.

Psoriasis. This is a common condition in which new skin cells are produced too rapidly, leading to thickened, scaly patches of inflamed and red skin on various parts of the body. On the vulva, skin surfaces are usually too moist for dry scaling, so psoriasis is more likely to appear in the form of pink patches with defined edges. It most commonly affects the labia majora. If the skin cracks open, infection may result.

You may have treated psoriasis outbreaks elsewhere on your body with remedies that may be too harsh to be used on the vulva. Your clinician may prescribe a topical steroid cream or ointment.

Gentle vulvar care

Whether you have a vulvar skin problem or are just prone to irritation, gentle care of the area is a must. Wear loose clothing. Choose cotton underwear (and go without when at home). To cleanse the area, use your fingers instead of a washcloth and an unscented, non-alkaline cleanser such as Cetaphil or Basis (plain water is also fine). Soak for five minutes in lukewarm water to remove any residue of sweat or lotions or other products. Pat dry, and apply any prescribed medication or a soothing and protective substance such as Vaseline or olive oil.

Avoid products with multiple ingredients. Even those that sound designed for vulvar care — like A&D Original Ointment, baby lotion, or Vagisil — contain chemicals that could irritate or cause contact dermatitis. In the bathroom, forgo moistened wipes. If you want moisture, use a spray bottle with plain water, and then pat dry.

Lichen planus. This skin condition, believed to result from an overactive immune system, can affect the vulva, the vagina, the inside of the mouth, and other skin surfaces. In most areas of the body, lichen planus causes itchy purple bumps sometimes streaked with white. On vulvar skin, the most common symptoms are soreness, burning, and rawness. The vulva may appear pale or pink, sometimes with a white lacy pattern. If the vulvar skin breaks down, the eroded areas appear moist and red. Lichen planus often affects the vagina as well, causing a sticky yellow discharge and erosions that can make intercourse painful. Eventually, lichen planus can affect underlying as well as surface tissues and produce scarring that alters the vulva’s shape, sometimes leading to the virtual disappearance of the labia minora.

Lichen planus is diagnosed by its appearance (although it can be difficult to distinguish from atrophy caused by a lack of estrogen or the excessive use of steroids), and the diagnosis is confirmed with a biopsy. The condition may start as a reaction to certain medications, so be sure to tell your clinician about any drugs you take.

The most common initial treatment is high-potency topical steroid medication. Unfortunately, lichen planus is persistent and likely to require long-term maintenance treatment.

Lichen sclerosus. Although it can occur elsewhere on the body, this inflammatory skin disorder usually affects the vulvar or anal area in postmenopausal women. By some estimates, one in 30 older women has lichen sclerosus; it’s especially common in women with psoriasis. Itching is usually the first symptom, and it may become severe enough to disrupt sleep and other activities. During an examination, the clinician may notice white (sometimes crinkly or shiny) patches. Some may contain tears or red areas from bleeding (often the result of scratching) and these areas may be painful and sting. As the disease progresses, there’s a danger that vulvar tissues will scar and shrink.

Lichen sclerosus is diagnosed by its appearance and sometimes by biopsies. No matter how mild the symptoms, it should be treated to prevent progression. The usual treatment is application of a high potency corticosteroid ointment for several weeks, then slowly tapering the dose.

Women also need regular examinations after treatment for lichen sclerosus because the condition can make affected skin more likely to develop skin cancer. Early treatment and prompt attention to new lesions or nonhealing sores in the area will reduce the risk further.

Some women with vulvar skin problems may benefit from estrogen therapy (delivered vaginally via ring, tablet, or cream, or applied directly to the vulva), which can help counter atrophy and inflammation and make the vulvar skin less vulnerable to irritation.

Image: michaeljung/Getty Images

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Vaginal itching and discharge – adult and adolescent

Glands in the cervix and the walls of the vagina normally produce clear mucus. This is very common among women of childbearing age.

  • These secretions may turn white or yellow when exposed to the air.
  • The amount of mucus produced varies during the menstrual cycle. This happens due to the change in hormone levels in the body.

The following factors can increase the amount of normal vaginal discharge:

  • Ovulation (the release of an egg from your ovary in the middle of menstrual cycle)
  • Pregnancy
  • Sexual excitement

Different types of infections may cause itching or an abnormal discharge in the vagina. Abnormal discharge means abnormal color (brown, green), and odor. It is associated with itching or irritation.

These include:

  • Infections spread during sexual contact. These include chlamydia, gonorrhea (GC), and trichomoniasis.
  • Vaginal yeast infection, caused by a fungus.
  • Normal bacteria that live in the vagina overgrow and cause a gray discharge and fishy odor. This is called bacterial vaginosis (BV). BV is not spread through sexual contact.

Other causes of vaginal discharge and itching may be:

  • Menopause and low estrogen levels. This may lead to vaginal dryness and other symptoms (atrophic vaginitis).
  • Forgotten tampon or foreign body. This may cause a foul odor.
  • Chemicals found in detergents, fabric softeners, feminine sprays, ointments, creams, douches, and contraceptive foams or jellies or creams. This may irritate the vagina or the skin around the vagina.

Less common causes include:

  • Cancer of the vulva, cervix, vagina, uterus, or fallopian tubes
  • Skin conditions, such as desquamative vaginitis and lichen planus

(Picture: Ella Byworth/Metro.co.uk)

Why is my vagina itchy?

If you’re reading this, it’s probably not out of general curiosity. Right now your pants on fire and all you want to do is scratch. You need to figure out what’s going on, ASAP, so you can go about your day without awkwardly shuffling in your seat or sticking your hands down your jeans.

So, why is your vagina – or your vulva, if we’re talking about the external bits – itchy?

Let’s explore some potential explanations.

But for ease of information, it’s best to work out whether your vagina itches (the internal parts) or your vulva (the labia, the pubic area, all the external stuff you can see). We’ll cover itchy vaginas first.

Why is my vagina itchy?

There are quite a few reasons why your vagina may be itchy internally.

Bacterial vaginosis

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If your vagina is itching, bacterial vaginosis (BV) is the most likely explanation. This is a mild infection of the vagina, caused by an imbalance in healthy bacteria and a change in the pH.

This can be caused by getting your period, washing your vagina, semen, or taking antibiotics.

You’ll know your itch is down to BV if you notice your discharge has a strong fishy smell, especially after sex, or is thin and watery.

BV is usually treated with an antibacterial gel or pills, which can be bought over the counter or given by a GP or sexual health clinic.

Yeast infection/Thrush

Yeast infections (also known as thrush) are also really common.

You can tell you have a yeast infection if your discharge is thick and white, like cottage cheese, you feel itching and irritation in around the vagina, and you experience soreness or stinging during or after sex or when you pee.

Treatment can be picked up from a pharmacist, and is usually in the form of a pessary (a tablet you put inside your vagina) and a cream to relieve irritation. After treatment yeast infections should clear up within a week. If they don’t, it’s time to go to your GP.

To prevent yeast infection in the future, it’s crucial to avoid soaps and scented products to clean your genitals, dry the area properly after washing (not internally, only externally), and avoid wearing tight synthetic fabrics.

Yeast infections are also more common on those with diabetes, those taking antibiotics, and those with a weakened immune system.

(Picture: Ella Byworth for Metro.co.uk)

A semen allergy

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If you’ve noticed that your vagina itches and burns immediately after penetrative sex, it’s possible you may have a semen allergy.

You can test this by having sex using a condom and seeing if the symptoms disappear. If they do, the pain and itching is likely down to a semen allergy. If they don’t, something else is likely to be going on.

A latex allergy

Again, if you’ve noticed the itching after sex, and you used a condom, you may be sensitive to latex.

This doesn’t mean you should just ditch the condoms (safe sex is important, pals). Thankfully there are plenty of condoms available without latex, designed just for all us latex-sensitive types.

Trichomoniasis

Okay, remain calm.

Trichomoniasis is a sexually transmitted infection caused by a teeny tiny parasite, trichomonas vaginales.

Up to half of those affected have no symptoms, so it’s important to get regular checks even if you feel totally fine, but one common sign of trichomoniasis is itching in the vagina.

Other symptoms include a change in discharge, which may be thick, frothy, yellow-green in colour, or have an unpleasant smell. You’ll also experience discomfort when urinating or having sex, and may notice swelling around the vagina.

Thankfully, this STI can be treated with antibiotics. If you think you may have it, head to your GP and don’t have sex until you have the all-clear. Your sexual partners will need to be informed and checked too.

(Picture: Ella Byworth for Metro.co.uk)

Hormonal changes

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Using a hormonal contraception or going through the menopause can cause itching internally thanks to a drop in oestrogen production, which can also cause dryness.

Chat to your doctor about your options, which will likely include the use of a lubricant or a moisturiser designed specifically for the vagina.

Why is my vulva itchy?

A lot of the causes of vaginal itchiness above will also cause vulva itching, but there are some issues that will likely only cause an external itch.

Contact dermatitis

Are you using scented pantyliners, a new shower gel, or a different laundry detergent? Your itch could be a reaction to that.

If your itching appeared shortly after you tried a new product, you’ve probably found the culprit. Revert to your old product again and see if your itch disappears.

Products that could cause irritation of the vulva include laundry detergents, fabric softeners, bath soaps and shower gels, body lotions, feminine cleaning products, baby wipes, tampons, pads, contraceptive creams, condoms, toilet paper, synthetic tights and underwear, and nail polish.

If your itching is severe, you may be prescribed a steroid ointment – but these should only be used on recommendation of your GP, as they can make the issue worse.

Genital herpes

The big one.

If you’re experiencing itching, burning, or tingling on or around your vulva, you may have genital herpes. You may also notice small blisters around your vulva, anus, thighs, or buttocks, that burst to leave red, open sores. Ouch.

These symptoms can take months or even years to appear, and herpes can lay dormant for ages – so don’t jump to conclusions about who ‘gave’ you herpes.

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Symptoms may clear up on their own, but they can come back, meaning it’s essential to head to your GP or sexual health clinic for treatment and education.

If you’re found to have genital herpes, your previous and current sexual partners will need to be informed.

There’s no cure for herpes, but there are ways to treat the symptoms when they pop up, including antiviral medicine and cream for the pain and itching.

(Picture: Ella Byworth for Metro.co.uk)

Lichen sclerosus

Lichen sclerosus is a long-term skin condition that mainly affects the vulva, although it can appear on the upper arms, back, breasts, and shoulders. It can cause itching, small white patches on the skin, fragile skin, red or purple blood blisters, and pain when having sex or going for a poo.

We don’t know what causes lichen sclerosus, but we do know it’s not an infection and it can’t be spread to other people.

If you think you may have lichen sclerosus it’s important to get treatment quickly, as without treatment, the vulva may scar and shrink, which can make sex painful and more difficult as the entrance of the vagina will narrow. If this happens, surgery might be necessary.

There’s no cure, but treatment may include steroid creams and ointments.

Eczema

Yes, you can get eczema on your vulva.

This’ll cause sore, red, dry skin as well as itching, and can be treated (but not cured) through moisturising treatments and topical corticosteroids.

As with all skin conditions, it’s important not to scratch.

Psoriasis

Psoriasis is another skin condition that causes red, flaky, patches of skin covered with silvery scales, along with itching and soreness.

It’s caused by having an increased production of skin cells, which creates a build up, and is thought to be related to an issue with the immune system.

Most people’s psoriasis is triggered by an event, such as a period stress, an infection, or a reaction to a medicine.

Again, there’s no cure, but there are plenty of treatments available including topical creams and phototherapy.

MORE: Mum has vagina tightening treatment on camera to try to improve her sex life after giving birth

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MORE: Everything you need to know about perineal tears

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I had sex in the school bathroom with the same guy that I’ve had sex with for about 6 months. It was the first time that my vagina had burned during sex. After that, my vagina started to itch constantly and continues to burn during sex. Do I have an STD or is it just a yeast infection?

Itching and burning in the vagina can be caused by a bunch of different things, including yeast infections and some STDs. The only way to find out what’s really going on is to get it checked out by a doctor or nurse. Your nearest Planned Parenthood health center can help.

If you’ve had vaginal or anal sex without a condom or oral sex without a condom or other kind of barrier (like a dental dam) then it’s important to get tested for STDs. Be honest with the doctor or nurse and the two of you can decide what tests are right for you.

You can also talk about birth control while you’re there. Using both a regular birth control method and condoms every time you have sex is the best way to prevent both pregnancy and STDs.

And while it might be tempting sometimes, it’s not a good idea to have sex in the school bathroom, or anywhere else on your school’s property. You could risk getting into a lot of trouble that wouldn’t be worth it.

-Emily at Planned Parenthood

Tags: STD testing, STDs, vagina, vaginitis, vulva, yeast infection

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