Vulvar Itching

Vulvar itching is a symptom of various conditions affecting the genital area and may negatively impact quality of life if not properly treated.

Symptoms and Causes

Vulvar itching, also known as vulvar pruritus, is a very common symptom that can affect women of all ages, from childhood to postmenopause.

Vulvar pruritus is not a disease in itself, but rather a sign of an underlying condition affecting the genital area. The causes can be highly varied, making early diagnosis essential in order to determine the most appropriate treatment.

Although it may be mild and transient, vulvar itching negatively affects quality of life when it is intense or persistent, as the discomfort causes irritability and distress. In addition, nocturnal vulvar pruritus may disrupt sleep and lead to insomnia.

Symptoms

The characteristic symptom is itching, usually accompanied by stinging, which creates the urge to scratch the external genital area. Other associated signs include:

Burning and irritation: a burning sensation that may worsen upon contact with urine or during sexual intercourse.
Redness and inflammation of the vulvar skin and outer labia.
Skin changes: these may include:
- Small bumps and pruritus.
- Dryness.
- Scaling.
- Fissures.
- Thickening, usually caused by chronic scratching.
Abnormal vaginal discharge: changes in odour, consistency, or colour.
Pain during urination or sexual intercourse (dyspareunia).
Itching extending to the anus.

Causes

The most common causes of vulvar pruritus are:

Infections:
- Vaginal or vulvovaginal candidiasis: this is the most common cause. It is caused by the fungus Candida albicans. It is usually associated with a thick, white discharge.
- Bacterial vaginosis: an imbalance in the vaginal bacterial flora. The itching is accompanied by a greyish discharge with a characteristic fish-like odour.
- Sexually transmitted infections (STIs):
  - Genital herpes: caused by the herpes simplex virus. It produces painful blisters or sores.
  - Trichomoniasis: caused by the parasite Trichomonas vaginalis. It presents with itching, pain, burning, and foul-smelling yellow or green vaginal discharge.
  - Genital warts: caused by the human papillomavirus (HPV). They are cauliflower-shaped and pinkish or whitish in colour.
Contact dermatitis: caused by irritants and allergens such as:
- Hygiene products: scented soaps, shower gels, intimate deodorants, and wet wipes.
- Laundry products: harsh detergents and fabric softeners.
- Feminine hygiene products: panty liners, sanitary pads, or tampons.
- Underwear made from synthetic fabrics.
- Spermicides.
- Latex condoms.
Other dermatological conditions:
- Lichen sclerosus: white patches on the skin accompanied by intense itching. It is more common during menopause.
- Lichen planus: an inflammatory disease that causes purplish papules.
- Atopic dermatitis (eczema): a chronic condition causing dryness, inflammation, and itching.
- Psoriasis: a chronic inflammatory disease that accelerates the skin cell growth cycle.
Hormonal changes:
- Menopause: reduced oestrogen levels cause vulvovaginal atrophy, which manifests as vulvar dryness, pruritus, and discomfort.
- Pregnancy: increased vascularisation may heighten the sensation of vulvar itching.
- Breastfeeding: decreased oestrogen levels may lead to dryness and pruritus.
Enterobiasis (pinworm infection): the most common cause of nocturnal vulvar itching in girls, as the parasites migrate to the perianal and vulvar area to lay their eggs.
Precancerous or cancerous conditions: although uncommon, persistent itching that does not respond to treatment may be a symptom of vulvar intraepithelial neoplasia (VIN) or vulvar cancer.

Risk Factors

Conditions that increase the risk of vulvar pruritus include:

Poorly controlled diabetes mellitus.
Recent antibiotic use, as it may alter the vaginal flora.
Weakened immune system.
Use of tight-fitting clothing or synthetic fabrics that do not allow adequate ventilation.
Excessive intimate hygiene or use of inappropriate products.
Skin allergies.
Reduced oestrogen levels.

Complications

If vulvar itching is not properly treated, it may lead to:

Skin lesions due to scratching: fissures, wounds, lichenification (skin thickening).
Secondary infections: wounds may become infected with bacteria.
Insomnia and other sleep disturbances.
Anxiety.
Reduced libido.

Which doctor treats vulvar itching?

Assessment and diagnosis of the cause of vulvar itching are carried out within the specialty of Gynecology and Obstetrics. In cases where the primary cause is a skin disorder, intervention by a specialist in Medical-surgical dermatology and Venereology is required.

Diagnosis

The diagnosis of conditions causing vulvar itching includes the following procedures:

Medical history: the specialist collects information regarding the patient's medical history, hygiene habits, and lifestyle. They also assess the characteristics and duration of symptoms.
Visual examination of the vulva.
Collection of vaginal discharge samples for laboratory analysis to determine whether an infection is present.
Vulvar biopsy: a tissue sample is collected for analysis. This procedure confirms or rules out the presence of cancerous cells or certain dermatological conditions.
Allergy testing: when contact dermatitis is suspected, the skin is exposed to a series of carefully selected allergens under controlled conditions to assess whether an allergic reaction occurs.

Treatment

Treatment for vulvar itching depends on the underlying diagnosed cause. The most effective options include:

Fungal or bacterial infections: topical antifungal or antibiotic treatments are used, either as vaginal suppositories or locally applied creams. In recurrent cases, oral medication may be prescribed.
Dermatological conditions: the main treatment consists of corticosteroid creams of varying potency to reduce inflammation and pruritus.
Effects of menopause: vulvar moisturisers and local oestrogens in the form of suppositories or creams are recommended.
Irritation or allergy: in addition to avoiding the causative agent, soothing creams or mild corticosteroids can accelerate recovery.
Skin damage caused by scratching: lesions may be treated with creams containing Centella asiatica (Blastoestimulina), due to their healing and regenerative properties.

Some home remedies to relieve itching while treatment takes effect include: