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Vulval itching is a very common and distressing symptom. I often get women in my office telling me that they have chronic thrush that is not responsive to usual thrush medication. The first thing I want to say is that thrush is only one of a multitude of reasons why the vulva becomes itchy.

An important part of any successful doctor’s visit particularly the gynaecologist is for the doctor to take a detailed and full history.

In the patient’s own words a full disclosure of symptoms is helpful such as:

  1. When the itch started
  2. How long it’s been going on for
  3. Is it worse at night?
  4. How much scratching is there?
  5. Response to any medication
  6. Family history of:
    a) Psoriasis
    b) Allergic dermatitis
    c) Asthma, hay fever
  7. Infections such as thrush, scabies, worms.

Full and detailed examination
Your doctor should then examine you in detail and take a number of swabs depending on what they find. You may need to have biopsies (tiny pieces of tissue taken for further analysis with a pathologist )

A diagnosis will then be made. This could be any one a number of causes.

Here are a few of the commoner ones and how they should be treated.

Lichen Simplex
This is a chronic itch. It represents the scratching the itch-scratch cycle. Try and find a cause. The treatment is to remove the cause and treat with steroid cream and night sedation

Lichen Sclerosis
Can occur at any age but mainly perimenopausal and postmenopausal.

  • The skin is white, cracked and inflamed.
  • The diagnosis is made usually with a biopsy.
  • Can get loss of tissue around the labia and clitoris.
  • The treatment is topical steroid cream.

Lichen Planus
This is an autoimmune condition. It is less common than Lichen Sclerosis.

  • There is pain and itchiness.
  • The appearance is that of ulceration.
  • Can also occur in the mouth.
  • The diagnosis is made with biopsies.
  • The treatment is also topical steroid creams.

Bacterial Vaginosis
This is extremely common. it is caused by a tiny organism that often lives normally in the vagina.

However, it can cause an itchy, profuse white to green discharge and a fishy unpleasant odour. Treatment is very simple and very effective and required a one-off dose of oral tablets.

Thrush
The is caused by a fungal infection and is extremely common. 30% of women show no symptoms.

The symptoms are itching, swelling, and a white milky to thick (cottage cheese) discharge. The treatment is very effective and can be taken orally or as a vaginal cream or pessary. An important rule is if the thrush does not respond to standard treatment then the diagnosis should be reconsidered.

Trichomonas Vaginitis
This is caused by a tiny organism that lives in the vagina. Interestingly enough, it is one of the only infective organisms affecting the female genital tract that can live outside the body for up to 45 mins.

The symptoms are a frothy vaginal discharge that can be offensive. It is sexually transmitted. The treatment is simple and effective with oral tablets. Both partners need treatment.

Contact Dermatitis
I have left the commonest cause for last. Most women with a vulval itch will have this as the cause.

The vulval skin is very sensitive and any irritant will cause itchiness, swelling and even ulceration. The commonest causes of itchiness due to a contact are soaps, deodorants, sanitary products, condoms, lubricating gel (especially flavoured ones), toilet paper, washing detergents, and waxing.

The important thing is to identify a cause and remove it. Topical steroids will alleviate the acute itch.

 

I have tried to cover a large subject very briefly. Remember you don’t have to put up with embarrassing itches.

See your health professional and get the problem resolved.

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