Itch

Itchy Vulva? Here’s what you need to know.

An itchy vulva can be intense and incapacitating. It can also be embarrassing to discuss. But, it’s really common and you shouldn’t be embarrassed. In this post, we’ll talk about what may be causing the itch and the steps you can take to stop the itch.

Why the vulva?

The vulva is the area of skin around the urethra and vagina. The vulvar skin barrier is weaker and more fragile compared to other parts of the body. It’s also a location where friction and moisture can happen leading to skin breakdown. Additionally, vulvar skin is more sensitive to irritation. Therefore, an itchy vulva can occur without itching in any other part of the body.

What is the cause of an itchy vulva?

There are many possible causes of an itchy vulva.  Itching may be due to infection, skin diseases or skin irritation from hygiene products.

Infections:

Multiple types of infections can cause vulvar itching. Overgrowth of the normal yeast of the vagina can cause vulvovaginal candidiasis, commonly known as a yeast infection. Similarly, overgrowth of certain types of bacteria can cause a bacterial infection and lead to itch and vaginal discharge. While many sexually transmitted infections (STIs) do not cause any symptoms, some STIs such as pubic lice can cause itching around the vagina.  

Skin diseases:

The most common itchy skin condition of the vulva is vulvar dermatitis, or vulvar eczema. There are two types of vulvar dermatitis:

  • Endogenous vulvar dermatitis, or atopic dermatitis of the vulva. This condition is due to problems with the skin barrier in general.
  • Exogenous vulvar dermatitis, or contact dermatitis of the vulva. There are two types of contact dermatitis – allergic and irritant contact dermatitis.
    • Allergic contact dermatitis. In this condition, an allergen triggers an immune system response. It is the immune system that causes inflammation and itching.
    • Irritant contact dermatitis. In this condition, an irritant causes direct damage to the skin.

Allergens and irritants can be hiding in many everyday products. Skip ahead to see what products can be irritating in the area.

Other skin conditions that affect the vulva can cause itching. However, many of these conditions are uncommon in the vulvar area. Some of these conditions include:

  • Seborrheic dermatitis
  • Psoriasis
  • Lichen planus

Lichen sclerosis is a skin disease that occurs more commonly around the genitals and less commonly on other areas of the body. Severe itching is the most common symptom. Skin changes can also occur. Typically the skin appears thin, but thickening of the skin is also possible. If you’re concerned about lichen sclerosis, ask your doctor if this is a possible cause. Lichen planus is another skin condition where you may see raised, purple spots that are very itchy. Again, if you’re worried you may have lichen planus, ask your doctor.

How do I treat an itchy vulva problem?

A visit to a doctor or nurse should be one of your first steps for treatment of an itchy vulva. He or she will identify any infection or underlying skin condition that needs treatment. You can also immediately enact steps to prevent and treat vulvar itching with the information below.

Avoiding Irritants and Allergens

Irritants and allergens are found in many everyday items. Review your daily routine for items that be causing a contact dermatitis. In general, avoid products with perfumes and dyes. Also remember that “all natural” does not mean irritant or allergen free. Even products such as tea tree oil can cause dermatitis.

Remember to consider all products as potential sources for irritants and allergens:

  • Laundry detergents
  • Shower products: soaps, bubble baths, shampoo
  • Sanitary products: toilet paper, pads, tampons
  • Contraceptive products

Hygiene

It is important to remember that vulvar hygiene includes both cleaning the vulva and steps to ensure the correct environment during the day. In regards to cleansing, many soaps are too strong for the vulva. Over cleansing with soaps, antiseptic wipes and powders can irritate the vulva. We have a list of the gentlest products out there that don’t have potentially irritating fragrances, preservatives or other chemicals.

Good practices for cleaning include:

UseAvoid
Warm water, fingertips Washcloths
Unscented CleanserrScented cleansers,
Unscented toilet paperBaby wipes, scented toilet paper
Sprays, powders

Heat and excess moisture can worsen itching. Clothing and underwear should promote sufficient ventilation. In older women, incontinence can be a cause of excess moisture and skin breakdown. Using pads to ensure appropriate dryness and seeking treatment from a healthcare professional for incontinence can help address this cause of excess moisture.

Here are some ways to avoid excess heat and moisture.

UseAvoid
Cotton underwearSynthetic underwear
Loose pants, skirts, dressesTight pants
Tampons, cotton padsPantyliners

Sitz baths – A good way to relieve itching

A strong, healthy skin barrier requires moist, soft skin. Your doctor may suggest “sitz baths” to hydrate the skin and relieve itching. Sitz baths are commonly performed twice a day – once in the morning and once at night. If you have access to a bathtub, they are an easy method to quickly relieve itch.

  • Sitz bath instructions:
    • Fill bathtub with 2-3 inches warm water (do not add soap to water)
    • Soak vulva for 5 minutes
    • Pat vulva dry with soft towel
    • Apply thin layer of petroleum jelly to seal in the moisture. If you find petroleum jelly too thick, there are other great moisturizers that work for sensitive skin. Check our list here.

Topical Steroids

If you have severe itching you can try an over the counter topical steroid (Hydrocortisone 1%) once or twice a day. This is a low potency steroid that may be effective in the short term to stop the itch. But if you find yourself needing this product for more than 2 weeks at a time, then definitely check with your doctor.

Your doctor may prescribe a prescription strength topical steroid for very severe itch. You should follow her instructions regarding how to use the topical steroid. If used for longer periods of time than indicated, topical steroids can cause skin thinning.

Antihistamines

Antihistamines are oral medications that decrease itching. Many of them are available over the counter (e.g. Benadryl, Zyrtec, and Allegra). Some of these medications can make you drowsy so check with your doctor on which ones may work best for you. 

Other treatments

In rare cases of severe itching that doesn’t respond to the treatments above, your doctor may consider other topical medications.

Bottom Line

Make an appointment with your doctor to see if there is an underlying infection or skin condition that needs treatment. Frequently vulvar itching is due to allergens and irritants in the environment. Reducing itching can be accomplished with appropriate hygiene, gentle skin care, and avoiding irritating hygiene products.

  • Stop products with possible allergens and irritants to see if your symptoms improve
  • Wash the vulva with warm water and unscented cleanser only
  • Wear loose clothing and cotton underwear
  • Try sitz baths to relieve itching and care for the vulvar skin
  • Use steroid creams as needed. An over the counter steroid cream can be helpful. But, if the itch is persisting you may need something stronger so don’t be afraid talk to your doctor!

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