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Genital Itching

by David H. Barad, MD, MS

Genital itching may involve the vagina or the genital area (vulva), which contains the external genital organs. Itching is an unpleasant sensation that seems to require scratching for relief.

Many women occasionally have short episodes of vaginal itching that resolve without treatment. Itching is considered a problem only when it persists, is severe, recurs, or is accompanied by a discharge (see Vaginal Discharge).

Causes

The most common causes of genital itching include the following:

  • Infections: Bacterial vaginosis, candidiasis (a yeast infection), and trichomoniasis (a protozoan infection—see Overview of Vaginal Infections)

  • Irritation or allergic reactions: Chemicals that come in contact with the vagina or genital area, such as those in laundry detergents, bleaches, fabric softeners, synthetic fibers, bubble baths, soaps, feminine hygiene sprays, perfumes, menstrual pads, fabric dyes, toilet tissue, vaginal creams, douches, condoms, and contraceptive foams

  • After menopause, atrophic vaginitis: Thinning and drying of the lining of the vagina due to decreased estrogen levels

Less common causes include skin disorders such as psoriasis (see Psoriasis) and lichen sclerosus. Lichen sclerosus is characterized by thin white areas on the vulva around the opening of the vagina. If untreated, lichen sclerosus can cause scarring and may increase the risk of cancer of the vulva.

Evaluation

Doctors can usually determine the cause by asking about symptoms and by examining the genital area and vagina.

Warning signs

There are no warning signs for genital itching unless it is accompanied by pain and/or discharge. Then, the warning signs are the same as those for pelvic pain (see Warning signs) and/or vaginal discharge (see Warning signs).


When to see a doctor

Women should see a doctor if itching lasts more than a few days or if other symptoms suggesting an infection (such as pain or discharge) develop.


What the doctor does

Doctors first ask the woman questions about her symptoms, particularly whether she has any symptoms of infection, and about her medical history. She is also asked whether she uses any products that may irritate the area. Doctors then do a physical examination, which focuses on the pelvic examination.

If women have a discharge, a sample of the discharge is taken, examined, and analyzed.


Treatment

The underlying condition is corrected or treated when possible. General measures can help relieve symptoms.

General measures

Changing underwear and bathing or showering once a day help keep the vagina and genital area clean and less likely to become irritated. More frequent washing may cause excessive dryness, which can increase itching. Using a cornstarch-based unscented body powder can help keep the genital area dry. Women should not use talc-based powders. Washing the area with plain warm water is recommended. But if soap must be used, a nonallergenic soap should be used. If itching persists, a sitz bath may help. Other products (such as creams, feminine hygiene sprays, or douches) should not be applied to the vaginal area. These general measures may minimize exposure to irritants that cause itching.

If a medical product (such as a prescription cream) or a brand of condom appears to cause irritation and itching, it should not be used. Women should talk to their doctor before they stop using prescription products.


Drugs

Applying a mild (low-strength) corticosteroid cream such as hydrocortisone to the genital area may provide temporary relief. The cream should not be put into the vagina and should be used for only a short period of time. For severe itching, an antihistamine taken by mouth may help temporarily. Antihistamines also cause drowsiness and may be useful if symptoms interfere with sleep.

Severe itching should be evaluated by a doctor.

Lichen sclerosus is treated with a cream or an ointment containing a high-strength corticosteroid (such as clobetasol), available by prescription.


Key Points

  • Itching is a problem only when it persists, is severe, recurs, or is accompanied by pain or by a discharge that looks or smells abnormal, suggesting an infection.

  • Keeping the genital area clean and dry and not using products that can irritate it can help.

  • Sometimes a mild corticosteroid cream relieves itching temporarily.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • CORTEF, SOLU-CORTEF
  • CLOBEX, TEMOVATE