Itchiness anywhere in body can cause significant distress, more so when it is over the genital region. The vagina is actually a complex maze of various 'good bacteria' in an acidic environment to prevent external sources of infection. However, sometimes this balance of bacteria can get upset with the act of douching, which is basically washing the inside of the vagina, leading to the manifestation of vaginal complaints.
Where exactly is the itch arising from?
This can be a difficult question to answer at times because the itch can be difficult to localize. When it arises, think about where you feel the maximum discomfort - is it the region outside the vagina where the skin area is, or is it actually arising from within the vagina? This is important to differentiate as the causes for each are slightly different and the treatment as well. Sometimes they overlap and the itch happens both inside and outside the vagina, which also helps to narrow down the cause for the itchiness.
The itch is mainly over the outside, what could it be?
Consider some common causes which could be related to lifestyle reasons first before we talk about some medical conditions that might be causing it.
Shaving irritation and stubs
This is not an uncommon reason for external vaginal itching because for women who regularly shave, the short hair stubs can cause local itching. To avoid this, either choose to stop shaving altogether or shave at regular intervals to prevent these short stubs from forming. It is however, if you notice small bumps over the shaving sites, it might be from folliculitis or infection around the hair folliculitis and this will need topical antibiotic treatment.
Irritant contact dermatitis
This is yet another common cause for external vaginal itching, often from lifestyle choices. It is from direct tissue damage following a single exposure or multiple exposures to a known irritant. In this case, it could be a variety of triggers, ranging from direct application like soaps, feminine washes, shaving cream, perfume sprays to secondary uses like panty materials, toilet paper, local wipes. So think back to any recent changes or additions to your feminine hygiene routine, and one of these causes could actually be triggering it!
Now we are moving onto possible medical causes, eczema or atopic dermatitis can sometimes be difficult to different from irritant contact dermatitis. Often, if the trigger for the contact dermatitis is isolated and removed, the vaginal itchiness does tend to resolve with or without topical medication. However, for eczema, it tends to have a more prolonged course and can be recurrent, even despite initial resolution. Often if there is history of eczema elsewhere in the body, the likelihood of vaginal eczema is also higher. This should best be monitored with a physician as scratching from eczema can often lead to local skin infections.
Local skin infections
Infections are often suspected if there is concurrent itch both externally and inside the vagina, which will be covered subsequently below. They may include fungal infections like yeast or bacterial infections like bacterial vaginosis. Also apart from the vaginal itchiness, they can often present with vaginal discharge, which tends to spread over the external vaginal region, causing itch externally as well. So if your vaginal itch is coupled together with vaginal discharge, it is best to seek medical attention to get treatment for both inside and outside the vagina. As mentioned previously as well, look out for small bumps over external vaginal region which can arise from hair follicle infection or folliculitis.
Other skin disorders
There are many other reasons for local vaginal itch and irritation and only some of the most common ones are covered above. More rare conditions would include other kinds of skin conditions like psoriasis and lichen planus, which has slightly different appearance and may be suspected if there are other skin issues elsewhere. Very rarely, vulvar cancer is another cause, which is considered if the local skin irritation does not resolve after treatment of the most common causes and persists.
The itch is mainly over the inside, what could it be?
This is a common fungal infection that arises sometimes from vaginal douching, as mentioned previously, or the act of washing the inside of the vagina, often with soap or feminine washes. Douching affects the good bacteria in the vagina and can lead to an overgrowth of bad bacteria and eventual infection. Yeast often presents prominently with vaginal itch and sticky cheesy vaginal discharge. Treatment involves anti-fungal tablets or pessaries. Read more about 'Is my vaginal discharge normal?' here.
Unlike yeast which is caused by a fungus, bacterial vaginosis is caused by bacteria and produces a greyish watery vaginal discharge consistency with a characteristic ‘fishy smell’. Vaginal itch is not as prominent as in yeast infection but sometimes it could be a mix of both. The treatment for BV involves an oral course of antibiotics. Even though yeast and BV are both not sexually transmitted diseases, sometimes sexual partners are also treated to prevent recurrence in women.
Sexually transmitted diseases
STDs can similarly present with vaginal itch or sometimes local vaginal pain. This can be difficult to differentiate at times because vaginal itch can often cause scratching and open wounds, resulting in vaginal pain. There is also often associated with yellowish green vaginal discharge that appears almost pus-like and can be malodorous. The causes can range from trichomoniasis, to gonorrhoea or chlamydia. This needs prompt treatment as the infection can ascend up into the uterus and pelvis and can lead to pelvic inflammatory disease.
Vaginal atrophy from menopause
If you are in the appropriate age group to consider this, dryness in vagina after menopause can also often lead to vaginal itch and sometimes a burning discomfort. A speculum examination with a doctor can reveal atrophic vaginitis and it can sometimes turn up in a pap smear result as well.
Urinary tract infection
UTI can sometimes present with vaginal itch though less commonly, it is often associated with a burning sensation with passing urine, sometimes frequent urination or pinkish urine. It can be difficult at times to differentiate where the vaginal discomfort is arising from but UTI symptoms are usually associated with the act of urination.
When to seek help?
Some basic home remedies to help initially when it first starts would probably to help rule out the causes likely shaving irritation or irritant contact dermatitis - localize any possible likely trigger and remove it. Avoid scratching and also avoid feminine washes, spraying with warm water or frequent washing (more than 3 times a day) as all these can cause the skin to become drier and itchier. If it persists, best to consult a doctor to make sure it is not any of the other causes.
If you experience any of these or are in any doubt at all, do look for help:
Persistent itch for more than 1-2 weeks
Unbearable itch resulting in a lot scratching
Vaginal itch arising both on the outside and the inside
Association with vaginal discharge
Suspected sexually transmitted diseases
Urinary symptoms come together with itch
If you have any specific questions related to Women’s Health, do drop by Paddington Medical Clinic to visit our lady doctor, Dr Zhang Huipei for a consultation. Also remember to protect yourself with regular pap smear screening and relevant cervical cancer vaccinations where appropriate.
Dr Zhang Huipei (Mdm)
MBBS (Singapore), GDFM (Singapore)