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Seriously, it hurts so bad I can't even touch it. No redness, no discharge, no odor, no itching, no pain urinating, just dryness and burning. Similar to a rash or rugburn. I've treated it for yeast infections, but it still keeps burning off and on. Maybe it's sensitive skin? I use natural and PH-balanced soaps because I can't stand using only water down there. Please help! It REALLY makes it difficult to enjoy my sex life.

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Hello tfk1221

I will list some common factors below -

Pruritus vulvae is a symptom, not a condition in itself. Pruritus vulvae can be caused by many different conditions. Therefore, if you have a persistent vulval itch, you should see your doctor to find out the cause.

Causes of pruritus vulvae tend to differ slightly between adults and children. However, they can include the following.

  • Infections. For example: thrush, threadworms, scabies, and some sexually transmitted infections.
  • Skin conditions may affect vulval skin. For example: eczema, psoriasis, lichen simplex, and variants
  • Sensitisation of the vulval skin to soaps, perfumes, deodorants, excessive sweat, condoms, wet wipes, textile dyes, detergents, fabric conditioners, sanitary wear, etc.
  • Urinary or faecal incontinence. This can make the skin of the vulva moist and irritated. In little girls a particularly common cause is careless or inadequate washing or drying of the area, and wiping the bottom in the 'wrong' direction (towards the front). Scrubbing too vigorously with toilet tissue can also contribute.
  • Menopause. Because of lower oestrogen levels, the vulval skin tends to become thinner and drier after the menopause, and this can make it prone to itch.
  • Pregnancy can cause itch due to vulval engorgement. There is also an increased risk of vaginal discharge and thrush during pregnancy, which may also cause itch.
  • Breast-feeding can cause itch due to low oestrogen levels.
  • Any cause of a generalised body itch may also cause itching of the vulva. For example, a generalised body itch may be a side-effect of some medicines or due to some blood disorders, thyroid problems or kidney or liver disease.
  • Diabetes can cause itch in the vulval area, particularly if the diabetes is not well controlled and sugar levels are tending to run high.
  • Lichen sclerosus is a condition of the vulva which causes itching and soreness and is more often seen in women with immune conditions such as thyroid disorders or diabetes.
  • A cancer of the vulval skin is an uncommon cause. Usually in these cases a small lump or nodule is present.
  • Unknown causes. In some cases, including some severe cases, no cause can be found.

Often, your doctor will be able to find the cause of pruritus vulvae after talking to you and examining you. Examination may involve your doctor looking at the skin of your vulva and may also involve an internal (vaginal) examination. They may suggest that swabs should be taken from your vulva and/or vagina to look for causes of infection..

Sometimes, other tests may be suggested, including blood tests - for example, to look for diabetes, thyroid, kidney or liver problems, etc. Skin patch testing may be suggested in some cases to determine if there is something that may be sensitising and causing irritation of the vulval skin. Rarely, a biopsy of the vulval skin may be suggested. A small sample of the skin is taken and examined underneath a microscope.

Treatments for pruritus vulvae?

Treating the cause

Most of the time, when a cause can be found, the cause can be treated and pruritus vulvae improves. However, depending on the underlying cause, sometimes prolonged or repeated treatment may be needed. Your doctor will advise on the best approach depending on the particular cause.

The treatment varies, depending on the cause. For example, identifying and stopping the use of anything that may be sensitising the vulval skin, using antifungal cream for thrush, using antibiotic medicines for certain infections, using steroid cream for various skin conditions, using hormone cream or hormone replacement therapy (HRT) if the itch is related to the menopause.

In young girls, learning to wipe gently from front to back, and to wash and rinse well and dry even when showering (when the vulva can be missed or left soapy) will help.

General treatments

These are treatments which are likely to help with vulval itch whatever the cause:

Moisturisers

Bland moisturisers (emollients) such as aqueous cream or emulsifying ointment can help to ease the itch, whatever the cause. You can use these in addition to most other treatments. Use them liberally. They can also be used as a soap substitute. Emollients such as aqueous cream can be stored in the refrigerator to keep them cool. If you are feeling particular irritation, using some cool emollient from the refrigerator on the skin may be soothing.

You can buy moisturisers at pharmacies, or obtain them on prescription. However, there is a slight word of caution. Occasionally, some people become sensitised to various ingredients that are in some moisturisers. This can make itch worse. This is unusual, however, and bland moisturisers without added perfumes do help symptoms in most cases.

Try to avoid the itch-scratch cycle

The itch-scratch cycle occurs when scratching causes more itching - which causes more scratching - which causes more itching - etc. So, if you scratch, it may make the itch worse. Excessive scratching can also cause thickening of the skin - which then becomes even itchier. Therefore, apart from any other treatment, try not to scratch if at all possible. Keep your nails cut short and don't wear nail varnish. Consider wearing cotton gloves at night to stop scratching in your sleep. Scratching may also damage the vulval skin and increase the risk of the skin becoming infected with germs (bacteria).

General vulval skin care and other advice

The following may also help ease vulval itching, whatever the cause.

Clothes

  • Wear loose 100% cotton underwear. Avoid nylon or synthetic underwear material which tends to block fresh air, and causes you to sweat more.
  • Change your underwear daily.
  • Avoid wearing tight-fitting clothes such as cycling shorts or leggings. Skirts and dresses are probably better than trousers. Stockings are probably better than tights. The aim is to allow some air to get to the vulva, and not to allow it to become too sweaty.
  • Consider wearing no underwear - for example, when you are at home, or at night.

Washing

  • Wash your vulva gently, once a day. Do not scrub or wash vigorously and avoid using a sponge or flannel to wash with. Over-cleaning may make symptoms worse. Use a bland, unscented moisturiser as a soap substitute. (Using water alone may dry out the skin and make symptoms worse.)
  • Taking a shower is generally better than having a bath, as it is easier to wash the vulva - but take care to wash off any soap..
  • Do not put on your underwear until your vulva is fully dry. Dry the skin gently with a soft towel. A hairdryer may be useful to dry properly. Make sure it is on cool and held well away from the skin.
  • Try to avoid getting shampoo (which runs down your body in a shower) on to the vulva, where it may irritate.

Other general advice

  • Sometimes soaps, perfumes, bubble baths, deodorants, scented creams, the dye in toilet tissue, etc, can irritate (sensitise) the delicate vulval skin. Don't use any of these on your vulva or in your bath water or shower. Use plain, non-coloured toilet tissue. Use non-perfumed sanitary towels and panty liners and try to avoid using them on a regular basis. Consider avoiding plasticised 'one-way' top sheets which can cause sweating and reduce air circulation. Avoid antiseptics or special vaginal washes.
  • Some people develop a skin sensitivity to a washing powder or fabric conditioner. This is uncommon, but it may be worth considering changing to a different brand of washing powder, and not using any fabric conditioner or biological washing powder for underwear.
  • Avoid condoms that are lubricated with spermicide, as they can be sensitising. Similarly, avoid perfumed lubricants.
  • Do not shave pubic hair.

My recommendation, follow healthcareprovider's advice and continue treatment. If you need second opinion, do so ASAP. Good luck

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