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Hi Aunt Vadge,
I’ve been having vulval itching for a while now. It started in mid-April when I washed my vulva with soap, which I stopped soon after the itching began. I saw an ob-gyn a few days later, who prescribed a corticosteroid for two weeks. For a month and a half everything was fine, but it came back after I moved states. A second doctor in July told me to use aloe vera gel, which worked for a day and then the itching came right back.
Things I’ve tried: an over-the-counter antifungal cream, an unscented soap, corticosteroids for two weeks, and plain water (which is all I ever used before this started). Both ob-gyns say it isn’t an STI or a yeast infection, and that it’s nothing to worry 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 to an unscented, sensitive laundry detergent.
The itching is only on the outside, where the hair grows – nothing seems wrong inside. No odour, no discharge. It settles on the first few days of my period (maybe because I take anti-inflammatory painkillers for cramps then), and it settled for a while after the first corticosteroid. My cycle is regular, every 21 days. I don’t use contraception or douches, and I haven’t been sexually active since April. The skin usually looks normal, occasionally a bit red around a follicle, or grey-ish and dry after a shower. I scratched today and noticed some small tears on the vulva and perineum. How do I heal the tears and get rid of the itching my doctors can’t explain?
Yours,
Itchy, age 22, USA
Dear Itchy,
Thanks for writing, and for such a careful history – it really helps. What you’re describing has the shape of an inflammatory dermatitis, most likely kicked off by that first soap and then kept going by other triggers. You’re already doing the sensible things: washing with plain water and avoiding irritants.
Often the best thing for irritated vulval skin is to put almost nothing on it and let it settle. But there are a few gentle things you can try, and a couple of little experiments to work out what’s actually driving the itch.
First, the small tears
Vulval skin heals quickly when it’s left alone. Keep the area clean with warm water only, skip anything scented, and try not to scratch (easier said than done at 3am, I know). A little plain vegetable oil, or a moisturising, vulva-friendly cuts cream, can keep the skin supple while it knits back together. The tears should close over within a few days.
Working out what’s driving the itch
It’s telling that it started after soap, and that it eases when you take your period painkillers. Those are usually anti-inflammatories (ibuprofen and the like), which work by interrupting the inflammatory response – a different pathway to paracetamol. If the itch quietens when the inflammation is dampened, that points us towards an inflammatory cause.
A little experiment: on a day when you don’t have cramps, try the same anti-inflammatory and see whether the itch eases. This is just to gather information, not a treatment plan – don’t use painkillers as ongoing medicine.
Stress feeds this too. Moving interstate, away from friends and family, is a big deal in anyone’s book, and stress hormones can make your skin flare and react to things it normally wouldn’t. Once you’ve had this kind of low-level immune response, you become a bit prone to it. So anything that genuinely calms you down – exercise, sleep, time with friends, less on your plate – is doing real work here, not just being nice to yourself.
Is it allergy or inflammation?
An over-the-counter antihistamine, tried on a different day to the painkillers, can help you tell the two apart. If the itch responds to an antihistamine, histamine (allergy) is likely part of it; if not, you’ve learned it’s probably not an ongoing allergic reaction. Ask your pharmacist which one and what dose – that’s exactly what they’re there for.
Calming things from the inside
To settle an over-reactive inflammatory response, two well-studied options are vitamin D and fish oil. Vitamin D gently modulates the immune system, and omega-3s are genuinely anti-inflammatory (they’ll take the edge off period pain too, as a bonus).
For an acute flare like this I’d usually suggest around 4,000 IU of vitamin D a day, plus the equivalent of 500 mg EPA from a good fish oil. Each 1,000 mg fish oil capsule often only has 80–160 mg EPA, so check the label – you may need four or more capsules a day to get there. Take them with fatty food (avocado, nuts) so the fat-soluble vitamins absorb properly. Buy the best fish oil you can afford; the good ones aren’t fishy or cheap, but they’re worth it.
An anti-inflammatory diet, for a couple of weeks
Food matters more than people think. For a fortnight, lean into oily fish, plenty of vegetables, lean protein (eggs, legumes, fish, chicken), wholegrains, raw nuts and seeds, and lots of water. Ease off dairy, bread, pasta, sugar and heavily processed food. If the itch settles, that tells you something useful. It doesn’t have to be forever.
Soothing the itch from the outside
You want to protect the skin’s natural barrier. A plain nappy-rash cream can help, and an oat bath is surprisingly good – oats contain compounds that actively calm itch and inflammation (if you have a bath available).
Some soothing herbs you can use as a cool compress, or drink as a tea (chamomile would be my pick, it’s delicious):
- Marshmallow root
- Chamomile
- Burdock
- Clivers
- Comfrey (topical only)
For a tea, steep a tablespoon of the raw herb in boiling water for 10 minutes. For a compress, use two tablespoons, let it cool, then soak some cotton or cloth and apply. Buy loose, good-quality herbs rather than cheap teabags, which are often more sawdust than active ingredient.
The one thing I want you to rule out
I’d gently disagree with your doctors on one point: an itchy vulva that won’t quit is not ‘nothing to worry about’. It’s abnormal, and it’s worth solving. Most likely it’s a straightforward contact dermatitis, but a persistent itch is also how lichen sclerosus and lichen planus often begin.
These need to be caught early, because untreated they can slowly change vulval skin. Everything above is gentle enough to help with any of them, but if the itch hasn’t budged in two weeks, go back and specifically ask to be checked for lichen sclerosus and lichen planus. That needs a proper look by someone who examines vulvas – a doctor’s or dermatologist’s job, not something we do here.
A good naturopath or medical herbalist can also help you work through the inflammatory side in more depth, if that’s an option where you are.
Try a few of these, give it a couple of weeks, and write back and tell me how you go. If anything worsens or changes, see your gynaecologist again.
Warmest regards,
Aunt Vadge
This is general information, not a substitute for personalised medical advice. A persistent or worsening itch, or any skin change, should be assessed in person.
