Okay – tell me, at some point in your life as a person-with-vulva you haven’t googled anything related to an itch down there?? I guarantee that most of us have, and if Google isn’t the tool we’ve at least thought about it or somewhat awkwardly asked our doctor/provider. Because itching down there is definitely common, but what causes it? Well, a myriad of things to be honest and that’s why I’m writing this blog post – to provide some clarification. Keep in mind – you should always bring it up with your doctor if you have concerns. This is not medical advice.
I see a lot of “jumps” to assuming an itch in the vulvar region is always caused by yeast infections, leading to a lot of people self-diagnosing and self-medicating for this presumed issue. As common as yeast infections can be, this is certainly not the only cause (though they are common).
Note: honestly, each of these could be their own post so I’m only providing an overview. They will be expanded on in future I am sure!
As always a reminder that this post and this blog do not contain medical advice. This is not medical advice. It is for informational purposes only. Any of your own health concerns should be addressed with your healthcare provider.
What are a few of the possible causes of vulvar itching?
Sometimes also known as vulvitis, pruritus vulvae, or vulvovaginitis if it involves the vulva and the vagina, like any type of bodily itching it can sometimes be challenging to pinpoint a cause because frankly there are just a lot of options to choose from. The symptom of itching is also commonly grouped together with other vulvar symptoms like burning or pain too, so that opens the door to a lot of other conditions. There will be too many possible causes for me to cover in one blog post, so I’m going to cover common causes (some which are lesser known or recognized as potential causes of itching).
#1 – Contact Dermatitis
Meaning, your skin is reacting to something it has come in contact with. I bring this up first because this is pretty much always a possibility – if you’ve recently changed laundry detergents for example, this can cause irritation of the vulvar region and itching as a result. Other common irritants: bubble bath is a big one; swimming pools with chlorine; putting things into your vagina to “clean” them (which is unnecessary because they are self-cleaning!); irritation by pads or tampons; or anything that causes friction to the area
This one is usually easy to pinpoint (because if you stop using this new product, it will stop) and relatively easy to treat (it will often resolve when the cause is removed). If pain is bad, symptom management can be done through cold compresses to the area and resisting itching because this will just make it worse. If it’s quite severe, seeking assistance from your MD or healthcare provider may be warranted.
#2 – The Lichens (Sclerosus, Planus, and Simplex Chronicus)
This one seems to be a bit better lesser known unless people have direct experience with it or are a healthcare professional.
All three types are associated with skin changes – plaques, or areas of raised skin, are commonly seen. They are generally appear white with these conditions. Itching is associated with all 3 conditions, as well as burning and sometimes pain.
Lichen sclerosus and lichen simplex chronicus are usually treated with steroidal creams long-term, while lichen planus treatment may require additional treatments if it falls into the ‘erosive’ classification.
If you’re looking for some more information on all 3, this article is a helpful overview but you should see your healthcare provider as always as well to discuss and address your concerns.
#3 – Infections (Yes Yeast, But Not Just Yeast!)
Yeast infections tend to be what we most associate with vulvar itching because they are certainly a more common cause. They also may entail “curd-like” (I hate the worse of that description but it’s probably reflective of the appearance) discharge (but it can also be normal) and a burning sensation with sexual intercourse or urination (but again, this can be absent).
The fungus Candida (or what we call yeast) lives in us – mostly in our gastrointestinal system but also in our vagina (just normally – it is in small amounts and doesn’t cause us any grief). The CDC says that 20% of women may have a larger amount of yeast in their vagina and still not have symptoms.
Generally speaking it is Candida albicans but sometimes yeast infections can be caused by other subtypes of Candida. Yeast infections may arise after a round of antibiotics or in relation to stress/after an illness, because this throws off our natural balance of bacteria that normally keeps the Candida population under control.
You may also be more at risk for a yeast infection when you’re pregnant, on certain medications (anything with estrogen!), or when you have certain health conditions. According to UptoDate, IUDs may also increase the risk of yeast infections.
A major problem with yeast infections is that we often assume this is the cause of any itching we have, and we treat it with OTC medications. Unfortunately, we are often incorrect in our diagnosis. So, if you have vaginal itching and any other symptoms of yeast infection – see your doctor or care provider for diagnosis and treatment. You may still end up taking those OTC medications, but at least you’ll know it isn’t for nothing.
If they don’t diagnose a yeast infection at your appointment, it may be because you have another infection like bacterial vaginosis (BV) which is also very common. BV is caused by bacterial overgrowth (as opposed to the fungal overgrowth of a yeast infection). It can present in similar ways to a yeast infection though – abnormal discharge (it may have a fishy odour or grey/green discolouration) and pain/burning and itching. Or, similar again to a yeast infection, it can be asymptomatic.
Sexually transmitted infections could be another possibility in some cases. There are many that could potentially cause itching in the vulvovaginal region. Trichomoniasis is a common one, which is a parasitic infection. In women, the symptoms (beyond itching) may include: pain and burning in the vulvovaginal area or while urinating; and surprise, surprise – abnormal discharge, which can be very similar to the BV description above. Oh, and yes – it may also be asymptomatic.
Verdict re: infections. Don’t self diagnose. See your doctor – because as you can see, many things can present very similarly down there… and it’s best you receive the correct treatment so you can get back to your life!
#4 – Hormones
When itching and burning occur at the same time every cycle it may be a result of cyclic vulvovaginitis which may be related to recurrent yeast infections. This is sometimes due to a sensitivity to increased estrogen. The itching and burning is often worse just before or during your period, and also after intercourse. The natural hormone shifts that occur around and during your period may also cause itching (or those that occur during pregnancy, breastfeeding, etc). Unfortunately, there isn’t much we can do about our naturally fluctuating hormones but you can try to minimize other irritants to the area and use a water-based lubricant during intercourse.
Dryness can also cause itching. It can be related to menopause, breastfeeding (so it is common in the postpartum woman until they are breastfeeding less or wean), and the use of some medications. So, often hormone related in many cases. If dryness is the cause, lubricants and moisturizers specifically for the vagina are common treatment options. Estrogen may also be used in low dose formats, reducing risks.
So – if you have vulvar itching that just won’t quit, it seems like the best idea to see your healthcare provider to make sure it isn’t anything that requires treatment.
Keep in mind: this list is certainly not exhaustive nor is it presented in any particular order. You may very well have a yeast infection as you presume, but sometimes it’s worth it to check especially if it seems to be recurring despite OTC treatment. Or if you notice the itch is recurring at a certain time of the month only.
Sometimes speaking to other allied health professionals for support (if your doctor finds you don’t have anything infection-wise) can be helpful. For example, sometimes are diet can impact our vaginal pH and discharge. Here is an interesting study from 2007 on the impact of diet on BV in women. So that’s another avenue to explore once you get the all-clear from your doc or NP.
I want to note that it was actually quite difficult to find information on the hormonal aspect of itching – at least from a reliable source. The one I linked was probably the best I could find. Studies are also more limited, sadly. As we all know, women’s health needs more research and more accessible information sources for common issues like this!