An itchy vagina is the hallmark of a yeast infection, but what about an itchy vulva? The vulvae are the external genital organs of the female, including the labia majora, labia minora, clitoris, and vestibule of the vagina. The labia minora and the labia majora are usually covered in hair (a protective feature).
Several things can make the vulva itchy, and each of them is treated differently. Let's review.
What are the possibilities?
Yeast. Just as yeast can get inside your vagina, it can also get on your external skin--most commonly in the body's folds, particularly if the creases are damp from sweat. Such an infection is treated with a topical antifungal cream or powder.
Dermatitis. Just like any other part of your skin, the skin of the vulva is susceptible to skin disorders. Common skin disorders that make the vulva itchy include a dermatologic condition called lichen sclerosis, which is treated with topical steroid cream. Others include reactions to contact irritants like soap, detergent, poison ivy, fragrances, etc. These are best treated by removing the irritant and then treating the symptoms by a topical steroid cream until improved.
Lice and scabies. Both of these tiny insects are transmitted through contact with infected surfaces. Due to their vulvar location, they are often sexually contracted. Treatment is with application of pesticide shampoos and then eradication of all insects from any bedding and clothing.
Herpes. Most herpes infections are painful but, particularly when they first appear, the lesions can often be itchy as well. Treatment is with antiviral medications that limit the length of the outbreak.
Human papillomavirus (HPV). Warts caused by HPV can also itch when they appear. They are treated through desiccation techniques or immune modulators.
Precancerous and cancerous conditions.Malignant vulvar lesions may itch. Treatment is done by excising the abnormal tissue.
What can you do?
It's important to see your healthcare provider for proper diagnosis of any of these conditions. If a simple yeast infection is causing the itching, your provider will probably just prescribe an antifungal cream. If you suspect that you are reacting to an environmental irritant, discontinue contact with that irritant. If you have lice or scabies, be sure to treat your living spaces as well as yourself and partner. Herpes and HPV should be addressed with appropriate treatments as well.
If you become concerned about the condition, or it does not resolve with first-line treatments, your provider might perform a vulvar biopsy, a simple procedure that can be performed in the office and involves taking a small sample of the skin for diagnosis. The result of the biopsy can help differentiate between a skin disorder (dermatitis), an infection, and a cancerous change.
So go see your healthcare provider and stop the itch!