Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Updated in January 2016.
The vulva, or external genitalia of the female, includes the mons pubis, labia majora (outer lips), labia minora (inner lips), clitoris, perineum (tissue between vagina and anus) and the external openings of the urethra and vagina.
Itching often affects the vulva. The sensation of itch in this site is also referred to as pruritus vulvae. Pruritus vulvae should be distinguished from vulval pain and from vulvodynia, which refers to chronic burning symptoms in the absence of clinical signs. Vulval itch, pain and/or burning can co-exist.
Girls and women of any age and race can experience mild, moderate or severe vulval itch, which can be intermittent or continuous. They may or may not have an associated skin condition.
One or more specific conditions may be the cause of vulval itch.
Candida albicans infection (vulvovaginal thrush) is the most important microorganism to consider in a postpubertal woman with vulval itch. Candida can be a cause of napkin dermatitis in babies. Postmenopausal women are unlikely to have Candida albicans infection, unless they are diabetic, they are treated with oestrogen or antibiotics, or candida is secondary to an underlying skin disease.
There are several less common infections that may cause vulval itch.
Irritant contact dermatitis is the most common cause of an itchy vulva at all ages. It can be acute, relapsing or chronic. It may be due to diverse causes, including:
Severe vulval itch may be due to:
Other common skin disorders that may cause vulval itch include:
*Potential vulval allergens include:
Benign and malignant neoplastic disorders of the vulva are often asymptomatic in their early stages, but they can cause itch. The most common cancerous lesions are:
Neuropathy should be considered as a cause of vulval itch if there are no signs of infection or skin disease apart from lichen simplex — which can be secondary to a pruritic neuropathy — especially if vulvodynia is present. The neuropathy may be caused by injury, surgery or disease locally (pudendal entrapment), within the pelvis or in the spine.
The clinical features depend on the underlying cause of the vulval itch. There may be an obvious or subtle rash, or no signs of disease at all.
When assessing the cause, it’s important to determine the precise location of the symptoms. Itch often only affects one anatomic part of the vulva:
The itch can also involve other adjacent skin of the abdomen, thighs and perianal area.
Examination may reveal apparently normal skin, scratch marks (excoriations) and the specific features associated with the underlying cause of the itch.
Morphology may be modified according to the site, with minimal scale evident.
Erosive lichen planus in particular can also cause significant pain/soreness as well as itch.
The cause or causes of an itchy vulva may be diagnosed through careful history (include genitourinary and musculoskeletal systems) and examination of the vulva.
A full skin examination may reveal a skin condition or disease in another site that gives a clue to why the vulva is itchy.
The conditions causing an itchy vulva often require specific treatment. For example:
Contact dermatitis occurs quite readily when inflamed skin affects the genital area.
Tricyclic antidepressants may be prescribed to control intractable itch, even in the absence of a defined neuropathy.
Vulval itch cannot always be prevented, depending on its cause. However, vulval health is optimised by the nonspecific measures described above.
Vulval itch is usually a minor, short-lived nuisance. However, some women may suffer from vulval itch for years, and may only receive temporary relief from treatment.
Vulvovaginal Disorders: an algorithm for basic adult diagnosis and treatment — ISSVD
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