Vulvar Conditions: The Intractable Itch

Dr Samar Gupte,
Gynaecologic Oncosurgeon
81, Swami Vivekananda Rd,
Near Police Station,
Khar West,
Mumbai – 400052

There is a common myth that only men suffer from itching at their crotch. In fact, a large percentage of women also have this same problem. The area surrounding the opening of the vagina is called the vulva and includes the labia (the inner and outer vaginal lips) and the clitoris.
 
By far, the commonest symptoms are itching and pain. Often there is a change in the skin colour and texture. Most conditions affect only the vulva, but often vulvar diseases are a manifestation of a generalized medical condition like anaemia, diabetes, thyroid diseases, allergens, hay fever or asthma.
 
Skin disease that affect other parts of the body can also appear at the vulva, like eczema and psoriasis. Skin at the scalp, elbows, knees and around the anus are the common sites. Moisture, heat or rubbing can make things worse. Sometimes scented products, deodorants can cause an adverse reaction with the vulvar skin.
 
Women can have an allergic reaction in their vulval skin, so it may be useful to note down any treatments such as creams and ointments that you have been using on your skin in that area. Chemicals in washing powders and bath or sanitary products are known to be sources of irritation.
 
It is important that, one does not ignore persistent symptoms at the vulva. Please do visit your doctor, who will then evaluate you and decide whether further testing is required. Treatment that is most likely to work for your condition will be started initially. If your skin does not get better or if the diagnosis is unclear, a biopsy, a tiny sample of skin is taken for testing.
 
Some common skin conditions that affect the vulva
Lichen Sclerosus: Usually affects older women, at or after menopause, possibly due to problems of the immune system. Contrary to common belief, it is not related to the use of hormonal contraceptives or hormone replacement therapy (HRT).
 
Lichen Planus: Can involve skin over all parts of the body even the mouth and is characterised by pain rather than itching.
Vulvar dermatitis (lichen simplex): This is a complex disorder related to stress as well as chemical irritants. Women with sensitive skin, dermatitis or eczema are more prone to it.
Vulvar atrophy: Causes the skin to be pale with itching or soreness. Usually occurs after menopause due to fall in estrogen levels.
VIN (vulvar intraepithelial neoplasia): Condition peculiar to the vulva and can only be diagnosed by taking a biopsy. VIN includes a series of changes that can progress to cancer over time. The changes are on similar line to what one may find on the cervix and often, the doctor may advise a colposcopy (microscopic camera view).
Candida Infection (thrush): This is essentially a fungal infection that causes irritation and soreness of the vulva rather than the discharge that most women are aware of when it affects the vagina. Moisture and poor hygiene can be causative. Candida can be passed sexually to a partner.
Psoriasis: Causes dryness and thickening of the skin. Psoriasis can affect skin over many parts of the body like scalp, elbows, knees and also the nails.
 
Treatment and remedies depend on the symptoms and the skin condition. Most respond to simple measures, such as avoiding irritants and using substitutes for soap while bathing. Often antihistamines or anti-itching drugs may help,
 
Supervised use of steroid ointments may be needed in case of lichen sclerosus or lichen planus. This will improve symptoms for most women. However, these are called chronic conditions and tend to recur and need prolonged treatment.
 
Vulvar atrophy may need estrogen creams whereas candida is treated with antifungal tablets and creams.
In case of VIN, a biopsy confirms the diagnosis and also makes sure there is no cancer present. Treatment is predominantly surgical and involves removal of affected skin.
 
Tips for care of the vulva:
 
Vulval skin is very sensitive and therefore one needs to identify and avoid irritants that can aggravate the symptoms.
Using soap substitutes for washing soothes as well as protects the skin and will stops the skin from becoming dry and irritated. Aqueous cream or moisturisers can be used instead of soap. It is helpful to add an emollient.
Women with sensitive skin should avoid wearing panty liners or sanitary towels on a regular basis. Avoid coloured toilet paper.
A large number of the commonly available shower gels, soaps, bubble baths and scrubs contain irritant chemicals and should be avoided. In fact, a few of the baby wipes and douches also may contain similar skin irritants.
Women long nails need to be careful while itching, to avoid injuring the sensitive vulvar skin.
 
Women with chronic vulvar conditions are advised to change their inner wear and wear loose-fitting cotton or silk underwear rather than synthetic, dyed underwear. Tight clothes such as leggings, jeans and cycling shorts may exacerbate the problems and are best avoided
Moisturising creams and ointments (called emollients) help protect the skin. It is advisable to use a moisturiser even when you do not have symptoms can prevent flare-ups.
Vulvar diseases are often complicated and often involves a psychosomatic component. Treatment requires a team effort between a dermatologist, gynaecologist, gynae-oncologist and occasionally inputs from a psychologic counsellor. It’s important that women do not ignore vulvar symptoms and talk to their doctor at the earliest.