Itchiness anywhere is unpleasant, but when the feeling is “down there,” it can be especially awkward to navigate — not to mention difficult to interpret. “A lot of people say ‘vaginal itchiness,’ when they really mean ‘vulvar itchiness,’” Dr. Andrea Braden, an ob-gyn in Atlanta, tells Yahoo Life, referring to the internal passage connecting to a woman’s uterus rather than her external genitals. “The first thing you want to figure out is if it is internal or external, or if it’s both.”
There are many known causes of vaginal or vulvar itching, and they can range from the most mundane causes (like a new shower gel) to something much more serious. While itching of the vulva and vagina may not always indicate that something is wrong, it’s important to confer with a medical professional in order to find the source of the issue.
Here are some causes of vulvar and vaginal itchiness, according to experts — and what to know about them.
- Yeast infection
One of the more common causes of vulvar and vaginal itching is a yeast infection, which can be caused by an overgrowth of fungus called candida. According to the Cleveland Clinic, there are several reasons why one might develop a yeast infection. Antibiotics, birth control, pregnancy, a weakened immune system and diabetes are all potential risk factors, but lifestyle choices like sitting in a wet bathing suit, not changing out of sweaty clothes or using scented vaginal products like tampons or deodorant can also contribute.
“A yeast infection often has vaginal discharge, and it tends to be neutral smelling and white-ish in color with clumps in it, almost like cottage cheese,” says Braden. “It’s almost a slam-dunk diagnosis if you’re having itching and that discharge, and you can treat it at home.”
Treatment: According to VeryWell Health, “Mild vaginal yeast infections can be treated with over-the-counter anti-fungal creams, inserts, and tablets.” However, a more severe or recurring yeast infection may require prescription treatments. “Your healthcare provider may prescribe a one-time dose or a multi-day dose depending on the nature of your yeast infection,” VeryWell Health says.
A common cause of irritation, which can lead to itchiness, is using products that shouldn’t be anywhere near one’s vulva. “Women are told they should use all these vulvar washes and other products, and it’s really poison to the vulva,” says Dr. Lauren Streicher, professor of obstetrics and gynaecology at Northwestern University. “It’s not meant for vulvar use, even if the product says it is. All these perfumes and chemicals can cause a lot of problems in terms of itching and burning and irritation.”
Treatment: Ceasing the use of these products will clear up the issue, says Streicher. “I ran a vulvar clinic, and one of the first things we would tell women when they came to the vulvar clinic is to stop using all this junk on their vulva. Nothing. Not even soap,” she says. “There are certain soaps that are better than others, but for someone who is having problems, we tell them, ‘Just rinse with water. You will not smell. I promise.’”
Some people may mistake a burning sensation for itching, but Streicher says that feeling is more likely from bacterial vaginosis (BV), which “leads to an alteration in the microbiome, or your bacterial content.” Your pH can be thrown off by things like sex and douching (which comes with the risk of eliminating good bacteria along with the bad). “With BV, we tend to see more of a foul-smelling, fishy discharge. The colour tends to be more greenish, or green-grey,” says Braden.
According to the Centers for Disease Control and Prevention (CDC), BV is associated with a higher risk of getting or passing on HIV as well as giving birth prematurely, if you are pregnant.
Treatment: “A lot of people have BV, and it doesn’t cause them problems,” says Braden. “I treat that when it is bothersome because some people report itchiness.” People who do want treatment will need antibiotics.
- Lichen sclerosus
Lichen sclerosus is a skin condition that can cause itching and pain, and while any body part can be affected, it typically involves the genitals, which can lead to vaginal and vulvar itching. “Lichen sclerosus is very, very important to diagnose because in addition to the fact that it can be really uncomfortable and miserable, there are long-term problems, if it’s untreated, of increased risk of vulvar cancer down the road,” says Streicher.
Treatment: According to VeryWell Health, “The first-line treatment involves the use of a very potent steroid ointment. Lifelong follow-up and care are needed since flares can occur even after you control symptoms. When scarring occurs, surgery may be advised.”
- Vulvar cancer
Itching that doesn’t go away can be a sign of vulvar cancer, while vaginal cancer is typically accompanied by painful and frequent urination. Streicher stresses the importance of seeing a gynaecologist rather than just a general practitioner, who is more experienced in dealing with vulvar and vaginal issues. “Vulvar cancer is typically seen in older people, but one of the risk factors is lichen sclerosus, the dermatologic condition that affects the vulva,” she says.
Other risk factors for vulvar cancer, according to the Mayo Clinic, include HPV, smoking, a weakened immune system and a history of precancerous conditions on the vulva. Streicher stresses the importance of looking at your vulva so you can see any potential abnormalities and to “know when there’s a sore or discolouration or something different on your skin,” she explains. “If you don’t know what you look like when all is normal, you won’t know what you look like when something is abnormal.”
Treatment: Your doctor can come up with a plan to treat vulvar cancer, and treatments include surgery, radiation therapy, chemotherapy and immunotherapy.