This is a guest post about the condition Pruritis Vulvae (itchy vulva) by Dr Natalie Atere-Roberts General Practitioner and adviser to Dr Morton’s – the medical helpline.
Catherine came to see me with a three month history of vaginal itching (itchy vulva). Initially she had not been too concerned about it because she had had thrush in the past and so assumed that was the problem. She went to her pharmacist and bought an antifungal cream.
However, after a few weeks of using it her symptoms were no better and if anything slightly worse. The itching was keeping her up at night and she dreaded the day as she often got an uncontrollable urge to scratch which she couldn’t resist, making her job as a Pilates teacher increasingly difficult. Too embarrassed initially to make a GP appointment, she started washing more frequently, showering morning and night and douching every time she went to the loo or using wet wipes. The skin on her vulva had become so inflamed and cracked that she was in considerable discomfort only relieved for a short time by the various skin creams she tried on the area. Her symptoms started to affect her mood. Her marriage was already under strain and having to repeatedly refuse to have sex with her husband was making things worse. By the time she came to see me she was quite desperate for a solution.
Having examined Catherine and spoken to her in a bit more detail, we were quickly able to work out what may be going on. She had actually been having peri-menopausal symptoms for some time and she described having vaginal dryness before the vaginal itching started. She wasn’t depressed although it had certainly had a huge impact on her personal and professional life.
The first thing we did was stop the frequent washing, shower gels and perfumed creams and she started using an emollient which she applied liberally until her skin was in better condition. We had a long discussion about HRT and she decided she wanted to try a vaginal oestrogen cream as her hot flushes were not bothering her too much. It took a few months, but her symptoms are now much better controlled.
Pruritus Vulvae (Itchy Vulva) – what is it?
This is the medical name for an itchy vulva, which refers to the labia, clitoris and the area around the vaginal opening. It is very common, with 1-in-10 of us seeing our GP with it at some point in our lives. In most cases there will be an underlying cause for it which can be treated.
Causes of Pruritus Vulvae (Itchy Vulva)
• Contact dermatitis, which is inflammation of the skin, can be caused by a number of allergens found in perfumes, soaps, fabric conditioners, fabrics and dyes. This is the most common cause of pruritus vulvae
• Skin conditions such as eczema and psoriasis, which may be more likely if you have those conditions elsewhere on your body
• Other skin conditions that may affect the vulva such as lichen planus and lichen sclerosis
• Infections such as thrush, trichomonas and threadworms
• Hormonal changes at times such as perimenopause, menopause and during breastfeeding where the vaginal tissues may become thin and dry due to a lack of oestrogen, and conversely, it can also happen in pregnancy when the hormone levels are very high
• General medical conditions such as diabetes, thyroid disorders and anaemia, which can all cause a generalised itch
• It is very rare for vulval cancer to present only with itching, more commonly there tends to be a lump
How will my GP be able to diagnose it?
Most of the time, your GP will be able to get a good idea of what is going on by just taking a history from you and examining you. If they suspect an infection they may want to do some swabs and in some cases they may perform blood tests to rule out a general medical cause. If there are skin changes on examination that suggest certain conditions such as lichen sclerosis and lichen planus, or if your symptoms are resistant to initial management, your GP may refer you on to a dermatologist or gynaecologist that specialises in vulval disorders for a biopsy or skin patch testing.
What if no underlying cause can be found? Will I just have to live with it?
In most cases of pruritus vulvae, a cause will be found. However, even if your GP can’t find a specific cause, there are lots of things that can be done to try to help the situation.
What you can do:
Avoid potential allergens…
You may be surprised to find out just how many products contain ingredients that the vulval skin can become sensitive to:
• Perfumes in tampons, panty liners and sanitary towels
• Body creams
• Scented soaps
• Fabric conditioners
• Biological washing powders
• Dark dyes in underwear
• Coloured toilet paper
• Condoms with spermicide
If you can, have a good think about whether any of these things could be contributing to your symptoms and try to avoid them completely.
It isn’t a case of the cleaner the better…
Like Catherine in the case at the beginning of the article, many women will begin to over cleanse in an attempt to control their symptoms. It is best not to do this as it can lead to the skin becoming even drier, which may worsen the irritation and discomfort. Showers are better than baths and you only need to do this once a day. There is no need to douche, wash the area or use wet wipes after using the loo. You should avoid using antiseptics on the area which may act as an allergen in some people.
Let your skin breathe…
Although they may not be the most attractive option, simple cotton underwear is the best for people that suffer with pruritus vulvae. Other synthetic fabrics may further irritate the area and increase sweating. It is also best for this reason if underwear and clothes are loose fitting.
Try not to give in to the itch….
This may be easier said than done, but it is important to understand that although scratching may give you temporary relief, scratching the itch only makes it worse in the long run. You are also more likely to damage the skin, which will be sore and may get infected.
What your GP can do:
These are moisturisers that are non-perfumed and can work well to maintain skin hydration and to calm the itch. They can also be used instead of soap and shower gel.
Medicines like Piriton do not really do much to stop the itch in itself, but they do have sedating effects which can be very helpful if like Catherine, you are troubled with symptoms at night and it is affecting your sleep.
In some circumstances, a short course of a steroid cream can help to quell any inflammation and in doing so help break the itch-scratch cycle. In some situations though, it may make your symptoms worse, so do not be tempted to try over-the-counter creams, seek medical advice first.
Treat the underlying cause
This really will depend on what is found on examination and any investigations that are performed, but could mean hormone replacement for a hormonal cause or antibiotics for an infection.
It may be a long road to completely getting rid of your itchy vulva symptoms but there are many things that can be done, so do not give up hope.
More posts by Dr Morton’s – the Medical Helpline
Dr Morton’s – the medical helpline is a service for people wanting quick access to an experienced doctor for confidential reassurance of advice by phone or email.
All doctors are UK based and GMC registered. Dr Morton’s Limited is regulated by the Care Quality Commission.
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