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There is no worse feeling in the world than when your vagina itches in public. It can start as a twinge in your nether regions while you are in a meeting, at a restaurant, or during the world’s longest wedding. You shift in your seat and take a depth breath assuming it will quickly pass, but it does no such convenient thing. Instead, the twinge progresses to an itch and then the itch intensifies until it is almost burningly painful. Your eyes begin to water, as you search desperately for an exit and begin fantasizing about the sweet, sweet relief that scratching your crotch would bring you if only you weren’t in public.
What makes the vagina itch (and how can you make it go away)?
Life
If you feel a twinge every now and then, most likely it’s nothing major. The vagina can be irritated by a new soap and fabric softener. Your new jeans, leggings, or thong may be rubbing you the wrong way. Condoms, or simply friction from sex, can make you feel itchy after intercourse. The labial skin can also be sensitive to weather changes – just as your elbows don’t like winter, sometimes your vulva don’t either. If the itching is random or minor, check your detergents and make sure nothing has changed. Switch to cotton underwear and loose fitting clothes for few days. If your symptoms get better with an easy fix, then no need to worry.
Infection
A rip-roaring yeast infection is probably the most common and most intense cause of vaginal itching. While yeast infections can cause a thick, cottage cheese-style vaginal discharge, sometimes the only symptom is itching. A yeast infection will often cause the skin of the labia and groin tissue to be blotchy, irritated, and red. Another common vaginal infection that can cause itching is bacterial vaginosis (BV). BV is often associated with a grey discharge and fishy odor. It usually doesn’t have external redness and the itching is often more of an irritation than the intense itch of yeast infection.
BV requires a trip to the doctor for prescription antibiotics. Yeast infections can often be resolved by over-the-counter treatments, but more severe yeast infections don’t always respond. So if your symptoms don’t improve with easy treatments, then follow up with your doctor.
Hemorrhoids
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You probably know that hemorrhoids are not on the vagina, but your vagina and rectum are only about 1-2 inches apart, and sometimes it’s hard to tell exactly where that itching is coming from. I often see women who come in complaining of vaginal itching, but the itching is actually coming from “further south.” Some have hemorrhoids, others have ‘pruritus ani’ (fancy medical term for itchy butt). Regardless, the treatment is increased fiber and hemorrhoids creams. If the itching doesn’t improve, follow up with a gastroenterologist.
Skin conditions
“Lichen sclerosis” is chronic skin condition that causes then skin of the labia to become itchy and burn. The skin affected will turn pale or white and will appear thinner than surrounding skin. Lichen sclerosis is more common after menopause, but can be seen at any age. While it is a chronic condition, the symptoms can be treated with topical steroids or laser treatments. Less common skin conditions that cause chronic itching include psoriasis or lichen planus. A simple office biopsy can determine if a chronic skin condition is present.
Menopause
The vaginal tissue is very sensitive to estrogen, so when the estrogen levels begin to plummet during menopause, the vagina can be affected. As blood flow decreases, the vaginal skin becomes significantly thinner causing vaginal atrophy. In some women, this can lead to pain with intercourse and well as irritation and burning. Also it can make the tissue more prone to infections and chronic skin changes like those mentioned above. Step one in treating vaginal atrophy is using lubrication with intercourse and a vaginal moisturizer for daily itching. These are available over the counter, but also coconut oil works well for both. There are also many prescription treatments available for vaginal atrophy of menopause.
Cancer
Vulvar cancer can sometimes present as a persistent itching. Usually, skin changes also occur like warty, cauliflower shaped bumps or flat, brown discolorations. There are many causes of vulvar itching, and the great majority of the time it’s not cancer, but if you notice an itchy bump or discoloration that doesn’t go away then you definitely need to visit your provider to see if you need a biopsy.
If you are struggling with persistent vaginal itching, then get out your hand mirror and see what going on down there. If all’s clear, then you can try changing your detergent to one with no dyes or fragrance, skipping the dryer sheets on your underwear, and trying some looser clothes for a few days. If you notice any bumps or discolorations, then you need to head in to your doc right away.
by Heather Rupe, DOBoard-certified OB/GYN
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