What Could an Itchy Vulva Mean?

The vulva is the external part of the female genitalia, which includes the skin between the anus and the vagina, and the lips of the vagina. An itchy vulva is medically called pruritus vulvae. It is normal for women to experience a slight vulvar itch, but if you have an uncomfortable and persistent itch in the vulva, it may indicate that something is not right down there. 

Vulval itching can affect women at any age. Around 1 out of 10 women complain of having an itchy vulva at some point in time, particularly at night. The itching often leads to irritation, soreness, broken skin, and skin infections. 

Causes

An itchy vulva is not a medical condition in itself, but a symptom of a number of health conditions. For a proper diagnosis, It is recommended to consult a doctor if you continuously experience an itchy vulva for proper diagnosis and treatment. The following are some of the causes of an itchy vulva:

1. Infection

In women, sexually transmitted infections (STIs), such as genital warts and trichomoniasis may cause vulval itching. Other infections that can cause an itchy vulva are:

• Yeast infection
• Scabies
• Enterobiasis (a parasitic infection caused by threadworms or Enterobius vermicularis)

2. Allergic Reaction

Persistent vulval itching can also be caused by an allergic reaction. An allergic reaction usually happens when the vulval skin is exposed to the following irritants:

• Scented soap
• Perfume
• Excessive sweat
• Condom
• Vaginal cream
• Wet wipes
• Detergent and fabric conditioners
• Pantyliners
• Tampons
• Sanitary pads
• Fabric dyes in colored underwear

3. Skin Conditions

The following skin conditions can also cause vulval itching:

• Genital psoriasis
• Atopic dermatitis or eczema
• Lichen simplex (a skin response when the skin is repeatedly rubbed or scratched for a long time) 
• Lichen planus (an inflammatory skin condition that also affects mucous membranes, hair, and nails)
• Lichen sclerosus (a chronic skin disorder that usually affects the perianal and genital areas)

4. Menopause

During and after menopause in women, the levels of estrogen tend to be lower, which makes the vulval skin drier and thinner. When the skin is thinner and drier, it becomes more fragile and prone to itch. Another effect of a low estrogen level is vaginal dryness. 

5. Fecal or Urinary Incontinence

Being unable to control urination and bowel movements can make the vulval skin irritated and moist, especially in young girls. Females may develop an itchy vulva if their genital area is carelessly or inadequately washed or dried, and when they incorrectly wipe (from back to front) after using the toilet. Another potential cause of vulval itching is wiping too roughly using a harsh toilet paper. 

6. Breastfeeding

Breastfeeding often transforms a woman's body in numerous ways. A change in the levels of estrogen while breastfeeding may also lead to itching of the vulva. 

7. Pregnancy

Pregnant women normally experience an increase in vaginal discharge, which can irritate the vulva. An increase in vaginal discharge also makes pregnant women more prone to developing yeast infections, which can also irritate the vulva. 

8. Diabetes

A persistent itchy vulva may also indicate uncontrolled diabetes or high blood sugar levels. 

9. Vulvar Cancer

Cancer of the vulva is a rare cause of vulval itching. The symptoms of vulvar cancer may include vulval itching and the presence of a small lump on the skin or a warty skin. 

10. Stress

Although uncommon, vaginal discomfort, such as an itchy vulva, can be a result of stress or chronic anxiety. Stress tends to weaken your immune system and makes you more susceptible to developing infections that cause vulval itching. 

Diagnosis

After your healthcare provider takes your medical history and physically examines you, he or she will be able to find out what's causing your itchy vulva. 

A sample swab from the vaginal area, including the vulva, may be taken to help identify any infection. In some cases, blood tests may be required to diagnose certain medical conditions such as diabetes, kidney problems, liver disease, and thyroid issues, among others. 

Patch testing may also be suggested if your doctor suspects that something is causing the irritation of your vulval skin. In rare cases, healthcare providers may need to examine the vulva using a vulvoscope. A sample biopsy may also be suggested. 

Treatment

Treatment for an itchy vulva usually involves treating its underlying cause. Depending on its cause, treatment may include:

• Antibiotic medications for infections
• Antifungal creams for fungal or yeast infections
• Steroid creams for a number of skin conditions
• Hormone replacement therapy (HRT) or hormone creams if vulval itching is related to menopause
• Stopping the use of anything that is causing an allergic reaction 
• Proper washing and drying of the genital area 
• Gently wiping from front to back after using the toilet

Whatever the cause, other treatment options for an itchy vulva usually include the following:

1. Moisturizers

Make use of a bland moisturizer, such as emollients, to help relieve dry skin and vulval itching. Applying moisturizers can be used as an addition to other treatment methods. 

Emollients can also be used as a substitute for soap. There are certain creamier versions of emollients, which can be placed in the refrigerator to keep them cool. Apply cool emollient to the itchy area to help soothe your irritated skin. Vaginal moisturizers, as well as lubricants, are also said to help provide relief from itching and irritation. 

2. Avoid the cycle of itching and scratching

The cycle of itching and scratching usually happens when scratching leads to more itching, which then leads to more scratching, which causes more itching, and so on. Thus, if you scratch an itchy vulva, itching may become worse. Moreover, when you excessively scratch the affected area, it may cause skin thickening, which makes the vulva become itchier. For this reason, control yourself and try not to scratch the area if possible. 

Also, keep your nails short and avoid wearing nail polish. You can also wear cotton gloves at bedtime to avoid scratching the affected area in your sleep. The vulval skin can get damaged or broken if you persistently scratch it as well as increases your susceptibility to developing bacterial infections. 

Prevention and Skin Care Tips

The following skin care tips may help relieve an itchy vulva:

• Do not use synthetic underwear or those made of nylon since they tend to block airflow in the genital area and cause more sweating. Wear cotton underwear instead. 
• Change your underwear every day. 
• Wear loose clothes instead of tight-fitting clothes to allow airflow in the genital area. 
• Try not to wear any underwear at bedtime or when you are at home. 
• Gently wash the vulva using warm water and an unscented, hypoallergenic moisturizer instead of soap. 
• Take a shower instead of a bath to properly wash the vulva. 
• Consider changing your detergent and avoid the use of fabric softeners in your laundry. 

Outlook

An itchy vulva can be relieved if its underlying cause is also treated. Although there may be a number of causes, treatment may sometimes be repeated or prolonged. Consult your healthcare provider to know the best approach to treating your condition.