Itchy vulva (pruritus vulvae)

Itching often affects the genital area of women, and is sometimes referred to as pruritus vulvae. It should be distinguished from vulvodynia, which refers to chronic burning symptoms.

An itchy vulva can result in a lot of distress. Women may suffer for years, and may only receive temporary relief from treatment.

There are a number of causes of itching in the vulva. These include:

• A skin condition such as dermatitis, lichen simplex, psoriasis or lichen sclerosus.
• Microorganisms such as candida (thrush), lactobacilli (cytolytic vaginosis), and less often, gardnerella, trichomoniasis or pinworms.
• Irritant contact dermatitis due to scratching, friction, occlusive underwear, soap or inappropriate applications.
• Small tears, often due to recurrent fissuring of the posterior fourchette
• A skin cancer such as vulvar intraepithelial neoplasia, extramammary Paget disease or rarely, invasive vulvar cancer.
• Neuropathic causes such as a stretched or overactive nerve supply (vulvodynia or pudendal entrapment); these tend to cause a burning sensation as well as itch.

Often several of these factors are present, and it can be difficult to determine the exact cause of the itch and/or rash. The doctor will need to examine the affected area and to take swabs for microbiological examination. Other areas of the skin will be examined to determine the likelihood of a more widespread skin disorder being the cause.

Skin biopsy may be necessary to determine the exact nature of the skin condition.

Patch tests are sometimes performed to see whether any contact allergy is present such as to a fragrance, medicament or other material.

Treatment

There are some general principles for all cases:

• Keep cool, especially at night time
• Wear loose fitting underwear and outer clothing
• Avoid nylon pantihose
• Wash once or twice daily with lukewarm water alone or use a soap-free cleanser instead of conventional soap
• Avoid scratching or rubbing the affected area – a single scratch keeps the itching going for a week
• Avoid riding bicycles or horses
• Insert tampons with care, and change sanitary pads frequently
• Do not apply strong steroid creams for more than a few days.

Unfortunately, allergic reactions occur quite readily when inflamed skin affects the genital area. So, avoid the temptation to try every cream in the chemist's shop.

If your specific prescribed medications do not seem helpful, sorbolene cream, petrolatum, or another simple emollient can be used. Hydrocortisone cream is generally safe, but if it seems to irritate, discontinue its use and seek advice from your doctor.

Some patients with severe itching are helped by oral antihistamines or sedative tricyclic antipressant medications, such as amitriptyline or serotonin reuptake agents such as paroxetine, taken at night. Rarely, oral gabapentin or pregabalin may be prescribed for severe itching that has failed to respond to local therapy.