Vulval itching is quite common and can be very disturbing. Up to 10% of women experience this symptom and need to see a doctor for a persistent itch. If left untreated, it can lead to soreness, ulceration and infection.
What are the common causes of vulval itch?
-Candidiasis (yeast infection)
-threadworm (often due to poor perineal hygiene)
*Vulval skin diseases
-lichen sclerosus (a chronic inflammatory disease of the anus and genitals)
-vulval dermatitis (can be an allergic reaction to soaps, creams or fabrics)
-lichen planus (a rare cause)
-vulval psoriasis (well-defined reddish or whitish patches with scaling around the pubic area)
*Vulval pre-cancerous growth or vulval cancer
*Urinary incontinence (constant soiling and irritation)
*Systemic conditions (liver failure, kidney failure, diabetes, etc.)
*Medications (eg. Chloroquine)
*Hormonal changes (as in pregnancy and menopause)
*Unknown causes (idiopathic)
Management basically depends on the cause, but there are general measures that can be taken.
1. Avoid scratching. It sounds impossible but that’s just the truth. The more you scratch, the more histamine is released into the skin, and the more you feel like scratching! Cut your nails short, resist the urge and avoid the irritants, if known.
2. Anti-histamines. These are drugs that break the itch-scratch-itch cycle. Opt for sedating ones (such as piriton) at night, so that you can sleep well!
3. Identify the actual cause and treat appropriately. You may need some invasive tests like high vaginal swab (for microbiological analysis), skin biopsy, skin scrapping and blood analysis. For example, yeast infection can be easily treated with antifungal creams and pessaries.
4. Practise general vulval and perineal hygiene. Vulval itching is sometimes due to urinary or fecal contamination.
5. Apply simple, natural, non-perfumed emollients (such as olive oil, shea butter etc.)
6. Use weak steroid creams (sparingly, with physician prescription only) for a short period. This is the best option for chronic itching.
7. Avoid sexual intercourse until your condition has resolved. Encourage your sexual partner to get treated for STI too (if that is the cause).