Vulval pruritus is the medical term for vulval itch. Many women automatically assume if they itch in that area then it must be down to a thrush infection, but not everything that itches is thrush.
There are many other causes of vulval itch. These are:
• Various medical conditions such as vulval dermatitis (eczema), lichen sclerosus, lichen planus or diabetes.
• Pregnancy and breastfeeding – There is increased blood flow during pregnancy which may result in itching. After the birth, low estrogen levels due to breastfeeding can also cause vulval itching and dry skin.
• Menopause – Reaching this time of life has the same effect as breastfeeding -- low estrogen levels. Advancing age also means that your skin is thinner than it used to be and this can make you more prone to itching and infections.
• Medication side-effects – Certain medicines can make you itch, including thyroid medicines, medicines for liver or kidney diseases and medicines for blood disorders. Topical steroids if used long-term can thin your vulval skin and make you more likely to itch.
• Allergies – You may be allergic to the detergent you wash your clothes in, the soap you wash with, cleansing wipes, sanitary products or condoms.
• Infections – There are many infections in addition to thrush, including STIs, threadworms or pinworms, scabies or bacterial vaginosis.
• Vulval Pain Disorders – There is disagreement within the medical profession over whether vulval pain disorders like vulvodynia cause itching. Some professionals say they can cause itching and others say they can’t. Many women with vulval pain disorders do report that they suffer from itching.
• Pre-cancer or cancer of the vulva – This is a rare cause of vulval itching, but having vulval itch may be a sign of cancer.
Sometimes the cause of vulval itch is never known.
Diagnosis
If you are itching and don’t know why, the first thing you should do is go to the doctor as it may be an infection that requires treatment.The doctor will examine you to look at the condition of your vulval skin and may also take swabs from it and from your vagina to identify whether there is an infection.
He may offer patch testing to see if you are allergic to anything (tiny traces of various household chemicals are put onto your back and covered over with patches. They are later checked to see if there is any redness or reaction that would indicate allergy).
Blood tests may also be done to check for diabetes and other medical illnesses. If cancer is suspected, a vulval biopsy may be taken (this is when a small sample of vulval tissue is taken to be examined under a microscope to see if it contains cancer).
If no cause can be found, you may be offered a short-term topical steroid treatment to get the itching under control. You will be advised on self-care to minimize the chance of itching (such as wearing plain cotton underwear, wearing skirts and dresses rather than jeans, not putting soap directly on the vulva, using unbleached sanitary protection).
Treatment
Treatment varies according to the cause of your itch. If it is infectious, you may be offered antifungal medication or antibiotics, steroid creams for vulval skin conditions, lidocaine anaesthetic gel for vulval pain disorders. This dims the itching as well as the pain.
If your itch is related to low estrogen you may be offered topical hormone replacement cream. Allergies can be treated by getting rid of the trigger (for example, not using commercial washing powder or switching to hypoallergenic condoms).
If you have a pre-cancer or cancer, you will be referred to an oncologist who will be able to discuss treatment options with you, however, don’t panic and think you have cancer before a diagnosis as most cases of vulval itch are not cancer.
Vulval itch is not a normal part of being a woman and you don’t have to put up with it so don’t be afraid to ask for advice. There are treatments to help you.
Sources:
Pruritus Vulvae, Patient UK. Web. 22 February 2012. http://www.patient.co.uk/health/Pruritus-Vulvae.htm
Vaginal Itching, Medline Plus. Web. 22 February 2012.
http://www.nlm.nih.gov/medlineplus/ency/article/003159.htm
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/
She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting.
Reviewed February 22, 2012
by Michele Blacksberg RN
Edited by Jody Smith