Vulval itching

Vulval itching

Itchiness of the vulva is almost never caused by a sexually transmitted infection, but is usually a result of thrush or a skin condition. The ‘lips’ of the vulva (the labia) are covered by ordinary skin, so the area can be affected by conditions such as eczema and psoriasis. And sometimes only the vulval skin is affected, so the diagnosis may come as a surprise.

The usual mistake with vulval itching is to assume that you have thrush, and keep on applying anti-thrush creams that you have bought from a pharmacy. This may actually worsen the condition, because you can become allergic to some of the ingredients. If an anti-thrush cream does not deal with the problem within a few days, or if the itching comes back, see your doctor. If you have a skin condition, and not thrush, you need the appropriate treatment.

This section explains the most common causes of vulval itching and what you can do about them. And you can find more information about thrush and trichomoniasis in the section on genital infections.

Thrush is a fungal infection caused by Candida albicans. About 1 woman in 5 has Candida in her vagina without it causing any symptoms. Hormones in the vaginal secretions and the ‘friendly’ vaginal bacteria keep it at bay. But problems can arise when this natural balance becomes upset, and the Candida multiplies.

Thrush does not always cause a discharge – the main symptom is itching or soreness, and this gets worse in the week before a period. If there is a discharge, it is usually only slight, does not smell and looks like cottage cheese.

Trichomoniasis. Infection with Trichomonas vaginalis can be itchy.

Psoriasis is a skin condition that can be extremely itchy when the genitals are involved. The skin usually becomes bright red, often with painful cracks. The affected area may extend to the groin and to around the back passage (the anus) and between the buttocks. Psoriasis on other parts of the body is scaly (check your scalp, knees and elbows), but in the vulval area it tends to be smooth. You can have psoriasis on the vulva without having it anywhere else on your body.

Lichen sclerosus is another extremely itchy skin condition affecting the vulva. The itching is often so bad that it can affect a sufferer’s sleep. It is most common around the menopause and in girls just before puberty, though it can occur at any age. Its cause is a mystery. The skin looks thin and pale, and the area around the anus may also be affected. If it is not treated, the lips of the vulva eventually shrink, the vaginal opening narrows and sex becomes painful.

Treatment of this condition is simple, and your doctor can prescribe a special steroid cream.

Allergies and sensitivities can cause redness and itching. The vulval area seems to be very sensitive to chemicals, probably because the vulva is moist and warm – conditions that favour the absorption of chemicals by the skin. It is possible to develop an allergy to almost any chemical substance that comes into contact with the vulva, such as may be present in:

skin creams
perfumes in soaps, bubble baths, shower gels and shampoos
disinfectants
washing powders and fabric softeners
deodorants (including ‘intimate’ ones).

Excessive washing can irritate the vulval area. Older women who may find it difficult to get into a bath may worry about personal hygiene, with the result that they wash the area too much. There is no need to wash several times a day – once is sufficient.

Stress or anxiety can cause itching. When you are stressed or anxious, your nervous system is on alert, and small sensations can become amplified into unpleasant itching or even pain. So it is not imaginary, it is real.

What you can do

Start by trying to eliminate anything that could be causing an allergy or sensitivity – look at the Common-sense dos and don’ts for vulval problems. Avoid swimming while you have the irritation – the chlorine may make it worse.
If you have been applying cream from the pharmacy for more than 1 week, and you still have the problem, stop using it. You may have developed a sensitivity to one of the ingredients.
If the itch is really bad, you may be scratching in your sleep, causing more damage. Keep your fingernails short and wear cotton gloves when you go to bed (you can buy them from a pharmacy).
If you think thrush is a possibility, look at the information on thrush in the genital infections section.

If itching is disturbing your sleep, antihistamine medication at bedtime may help. Ask your pharmacist for a ‘sedating’ antihistamine.