Aunt Vadge: neverending itch

Hi Aunt Vadge,

I’ve been having vaginal itching for a while now. It started in mid-April this year when I used soap to wash my vulva, which I stopped soon after the itching started. I went to an obgyn a few days later.

He prescribed me an corticosteroid to use for 2 weeks and I did. For a month and a half everything was fine, but then later when I moved states, it came back. I went to another doctor in July who told me to use aloe vera gel, since at the time it seemed to help. It worked for a day and then the itching came right back.

I’ve tried:

  • Over-the-counter Lotrisone [antifungal cream]
  • An unscented soap
  • Corticosteroids for 2 weeks
  • Plain water (which is what I had always used before this happened except for a few days when it started, I used soap when I became sexually active)

Both obgyns have concluded it is not an STD or a yeast infection. They’ve all said it’s nothing to be concerned about, but it is extremely annoying. It itches most at night and in the morning, and actually feels better when I wear underwear. I’ve switched my laundry detergent to an unscented sensitive detergent.

The itching is only on the outside parts (where hair grows); nothing seems to be wrong on the inside of my vagina. No odor, or discharge, etc. The itch goes away on the first few days of my period (it might be because I take painkillers for cramps on the first few days) and it also went away for a while after I used the corticosteroid that my first ob-gyn prescribed, this was in April – May, I used it for 2 weeks. However, when I moved out of state, the itching came back (around July). So June and early July this year was the only time it stopped, since it first started. 

  • I have a regular menstrual cycle it comes every month every 21 days.
  • I do not use birth control, contraceptives or douches. 
  • I have not been sexually active since April when it first started.
  • I do not have any medical skin conditions, or at least none that a doctor has pointed out.
  • I usually do not scratch the itch, and I do not scratch in my sleep the only time I have scratched was a 3 days ago the day before my menstrual cycle because the itch became more intense then while I was in the shower.
  • The skin looks normal rarely it looks quite red (even if I don’t scratch), especially around the follicle and also rarely it looks gray-ish or dry when I get out of the shower, however it typically looks perfectly normal even when it’s itchy.
  • The texture is the same for the most part.
  • There is no unusual odour, no bleeding, no discharge, growths or changes in my vagina other than the itching.
  • I scratched it today and noticed some small tears in the vulva and on the perineum.

How do I heal the tears and get rid of the itching which my doctors can’t explain?

Yours,
Itchy
Age 22, USA

______

Dear Itchy,

Thanks for writing. As I’m sure you have researched on your own, it seems as if you are experiencing a type of inflammatory dermatitis. This could be from several sources.

You seem to be doing all the right things – just washing with water, avoiding irritants, etc. It does appear that the soap has triggered off a small dermatitis reaction, which is resulting in an inflammatory response – the itch and sometimes redness. Putting nothing on it is often a good idea in these cases, however there are some tactics you can use to reduce the itch and inflammatory response from the inside and out. Additionally, the problem may be in your hair follicles, and not the top layer of your skin. This remains to be seen, but following is a couple of very scientific (ha!) experiments and a few suggestions on how to manage – and maybe eliminate – the itch.

The inflammatory response and triggers

It is interesting and noteworthy that it happened after using soap (and also being sexually active, though we haven’t addressed that element). It’s also important to note that stress can also trigger off a low-lying immune response – once you’ve had that particular response, you do become prone to it. Moving states (without knowing any of the details) was no doubt stressful (even in a good way), and has contributed to the problem flaring up again. Stress causes inflammation in the body.

What is interesting is that it disappears when you take your pain medication, which presumably is some sort of anti-inflammatory containing ibuprofen or something similar.

The reason people take anti-inflammatories for pain relief during their periods (as opposed to Tylenol/paracetamol), is because the two painkillers work on different pathways, and regular pain relievers actually don’t do much for pain caused by inflammation.

Anti-inflammatories reduce pain by interrupting the inflammatory response. When you get period cramps, it’s because your poor uterus is on fire, cramping away like nobody’s business, inflamed and red and hot. It’s normal, but, well, it’s painful. Your uterus contracts to get your period blood out of your body.

What this tells us is that there is an inflammatory tempering happening somewhere that could be related to your itch – try taking the same period cramp medication on a day where you are not experiencing cramps, and see if it works. (Don’t use this as medicine! This is an experiment only to see if you actually respond to anti-inflammatories. This is very helpful information for treatments and management.)

Alternatively, it could be due to the hormonal changes that occur with your period onset. This seems less likely, but not impossible. We are focusing on the inflammatory elements here, but that will be something we consider if none of this makes a lick of difference.

Antihistamines – You may benefit in this case (and it will help with your detective work) to try some over-the-counter antihistamines on a different day to the period painkillers (you need to know which works – is this an allergic reaction or an inflammatory response or both?).

Ask the pharmacist what they think – it’s best to get advice about these things, and while the pharmacist may not know precisely what your labia itch is all about, he or she can advise the best dosage for the problem, and tell you how much to take, and how often.

If so, we have a pathway to work on. If not, at least you know it is not an ongoing allergic reaction. (Histamines are produced in large quantities with allergies, and cause some of those symptoms, which is why antihistamines are prescribed for hayfever and mild allergic reactions.)

Why stress can cause these flare-ups

If you are anxious or stressed, make a concerted effort to reduce it because stress hormones cause high blood levels of cortisol and adrenalin, which can cause funny little symptoms and reactions if left unchecked. It can make you extra sensitive to things you might not usually react to. So run, dance, sing, laugh, do yoga, meditate, read, go and get drunk with your friends, watch hours and hours of trashy TV – anything you like. Stress and anxiety is really worth examining, because moving house is a big deal, but moving to another state, away from family and friends to embark on a different and new life is a really big deal in anyone’s book. You won’t lose anything by making sure you are calm as a cucumber, and making that a priority. If you are stuck with happiness or anxiety, see someone who can talk you through it.

Supplements to arrest inflammation and the immune response

Supplements you can try include vitamin D and fish oils – vitamin D suppresses (in a good way) your immune system, and fish oils reduce inflammation pretty effectively. (They will also, when taken in high enough doses, really kick your period pain in the butt.)

My usual recommendation for acute conditions like this is to take 4,000IU of the vitamin D per day and the equivalent of 500mg EPA (each 1,000mg high-quality fish oil capsule has maybe 80-160mg usually – check the back of the label, because you will need to take probably 4 or more capsules per day).

Take both capsules with fatty food like avocado or nuts – fats help digest fat-soluble vitamins. They sort of piggyback into your system, meaning more is absorbed. You want to make the most out of your supplements because good ones are not cheap.

At 22 you no doubt don’t have much money, but buy the best fish oils that you can afford – good fish oils aren’t smelly, they have more of the important stuff in them, and the manufacturing process focuses on quality over quantity. Nordic Naturals make great fish oil, but there are a handful of good brands.

The shift to a more anti-inflammatory diet

Diet matters, so check  for any inflammatory triggers (fried foods, dairy, fat, sugar, bread, cheap crappy food in general, additives, preservatives, colours), and while you try to solve this problem, aim for as much of an anti-inflammatory diet as you can.

This means oily fish, lots of vegetables, good sources of lean protein (eggs, legumes, fish, chicken), wholegrains (brown and black rice), raw nuts and seeds, drink plenty of water, and ditch dairy, bread, pasta, burgers, pizza, red meat in any great quantities, and sugar.

I know, it’s a lot, but if you do that for at least two weeks, you should be able to tell if it is making a dent in your itching. It doesn’t mean forever, but let me tell you right now before you turn 23 – what you eat really, really matters.

Soothing the itch from the outside

Soothing the itch could come in several forms, in terms of topical applications. You want to maintain the protective layer that sits on all our skin surfaces, and perhaps add to it.

Nappy/diaper rash cream can help, and you can also try oat baths – an oat bath can sound like true hocus pocus, but oats actually contain compounds that actively stamp out itch and inflammation. It might not resolve it for long, but it could be a nice addition to your daily bathing. Many people don’t even have a bath at their house, so this might not be an option for you.

Herbs to use topically (in a compress) and drink as tea (take your pick – chamomile would be my first choice because it’s delicious!):

  • Marshmallow root
  • Chamomile
  • Burdock
  • Clivers
  • Comfrey (topical only)

These herbs are all calming and soothing the skin in some way, and can add to the effect of all the other treatments.

For teas, add a tablespoon of the raw herb to boiling water, and let steep for 10 minutes, and drink, leaving the leaves in. Discard the leaves (or eat them if you want!).

To make a compress, add two tablespoons of the raw herb to boiling water for 10 minutes, then as it cools after that, get a stocking, fill one foot with the herb and then stick it into your underwear. You may want to use a panty liner underneath so your underwear doesn’t get saturated, . Drink the leftover water. Alternatively soak some material or cotton wool in the very strong tea water, and continually apply.

Be very wary of commercial tea bags – they usually contain the sawdust variety of herbs, and don’t contain much of the active ingredients. Find raw herbs at good tea shops, health food stores, and online shops. Don’t let someone sell you crap at a high price – tea is now big business, so a shop that sells herbs to professionals is your best bet. You can find these online, but the US is totally unregulated for this stuff, and there are a lot of fakers selling non-refundable junk. Choose carefully.

Other options

It’s important to note that we don’t know what’s wrong with you either – these are just some suggestions of what it might be, and some strategies to figure it out.

Check out allergic contact dermatitis, and then have a look at lichen sclerosus and lichen planus, as they both often start off with the itch. It’s important to make sure you do not have LS or LP, because if you do, you really need to start treatment ASAP, since it can really do some serious damage to your vulva.

All of the above strategies work just as well for lichenoid conditions, and so if the itch can’t be arrested in two weeks from these, you will need to go back to see your gynaecologist to be tested further.

I would also like to disagree with your gynaecologists – this is something to worry about! Having an itchy vag not only sounds super bloody annoying and uncomfortable, but it’s abnormal and needs solving.

It indicates something else is going on in your body that needs addressing, because things do not happen for no reason. We might not always get to find out what the reason was, but we can look at the clues and work backwards from there.

You can also visit a naturopath in your area (or a herbalist) who will be more than happy to help you based on an in-depth talk with you about what’s going on. If you can afford it, find an experienced, qualified naturopath or herbalist. They are such a great resource, and we have so many tricks up our sleeves.

If you try all of the above suggestions in any variation and find no change at all, please write back and we’ll see if we can dig a little deeper and get to the root cause of this. If your condition worsens or your symptoms change, see your gynaecologist again, and if you think you are reacting badly to a suggestion above, stop.

We’d love to know how you go, so if you get time, write back!

Warmest regards,
Aunt Vadge

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
Read more about Jessica and My Vagina's origin story.