Persistent Vulvar Itch: Causes & Solutions

Hello Aunt Vadge,

I first wanted to say thank you for this wonderful website; it is a great source of comfort. I have been suffering from a recurrent itch mostly in the labia around the clitoris and also at times raw skin under the clitoris, since early March 2016.

On Tuesday March 1 after my high intensity interval training at spinning class (indoor cycling), I went back home to shower after the class, I noticed a little bit of blood on my underwear and when I examined my labia, I noticed a little cut on my right labia minora.

I asked my gynaecologist whether I should do anything, and he said no. So I continued my usual routine, and washed myself as usual (maybe a little more vigorously because I was worried about infections) with the special intimate wash that I use (Roger Cavailles) (noting that I pour it on my fingers and clean myself with my fingers and not a sponge).

Three days later, I started feeling an itch. I got worried that it would be a yeast infection, given that back in 2012 I had a recurrent yeast infection caused by taking Augmentin; I therefore took a Diflucan [antifungal]; the itch went away but eventually came back, so I took another Diflucan; given that the itch kept coming and going, I took several Diflucan (in total maybe 4) and applied also an anti-fungal cream (at first I tried one cream that burned a lot, so I switched to another and that was fine). I also stopped exercising for a week. But the itch kept on coming and going.

I went to see another doctor as mine was on travels, and she said she saw nothing wrong so she prescribed vaseline before I exercise (I exercise 3 to 4 times a week) and a cream called NystaLocal for 10 days. But the itch kept coming and going; so I went to my gynaecologist; upon examination, he was worried because of a small sore/cut that he saw on the left side of my labia, and asked for a full STD panel; it came out clear, i.e. no herpes or other, but mentioned that I had Gardnerella vaginalis.

My doctor therefore prescribed an antibiotic for a week and SudoCrem [emollient/skin protectant] twice a day; I took the antibiotic (with one Diflucan on the first day and one on the penultimate day to avoid a yeast infection) but only used SudoCream once or twice.The itch went away but eventually came back.

Noting also that this period was rather stressful for me given that I was moving apartments.

I went to a third doctor, who said he did not see any sign of infection, and that it would therefore have to be a skin issue, and prescribed a steroid: Betnovate Ointment [topical corticosteroid], twice a day for 5 days; by fear that it would be too strong, I used Elocon cream [topical corticosteroid] instead, once a day; the itch went and came back, so I called the doctor and he said to stop everything for 2 days, then do the treatment he had asked me to do; which I did; the itch went and eventually came back.

Basically, this itch comes and goes, though recently it is less frequent and less intense than at first; and also, usually when it itches, my skin seems a little red; and sometimes (but not always) it feels raw. There is no out of the ordinary discharge; although sometimes I see a little bit of white mucus around the clitoral glans (but this is not all the time).

On another note, having done research, I took probiotics (at first general, and then targeted for vaginal flora), and sometimes other supplements also; I also made sure to shower as soon as possible after exercising, wearing as often as possible cotton underwear and loose clothes, and cutting down on sugar; I also stopped indoor cycling since the incident.

While in London last week, I spoke to a homeopath, who considered that this was due to Candida overgrowth in my gut (FYI, I often have sinus problems leading to colds/flu, have had often muscle pain in the past, and was diagnosed around 2006 with IBS but the symptoms went away when I started exercising).

He advised to eliminate sugar and yeast for 3 weeks, take probiotics and grapefruit seed extract, as well as zinc and magnesium.

I started this on Monday; the itch came back yesterday and seems to be going away today.

I have also changed what I wash myself with: I am now using Aveeno, and making sure no shampoo or anything other than Aveeno is running down on my vagina.

I am however worried that maybe the treatment they do to the water in the new building where I live is causing me irritation; could this be the cause of an itch that comes and goes? Or in such a case, would the itch be constant?

This situation is really affecting me, as it seems to me that no one knows what is going on, and doctors in Lebanon seem to treat it lightly, whereas it is causing me anxiety and also affecting my sexual life with my boyfriend, with whom I have not had intercourse since this started in early March.

Many thanks in advance for your help!

Sincerely,
Itchy
Age: 32
Country: Lebanon
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Dear Itchy,

Thank you for all that information. So let’s dissect it. You have tried approximately one million antifungal and corticosteroid treatments that haven’t worked, have only itching on the vulva (not inside the vagina), and some small cuts appear.

You have an overgrowth of G. vaginalis, which doesn’t necessarily mean that much – many women have this, and it can go away by itself. It is considered to be bacterial vaginosis (BV), which is very likely been able to proliferate because of a dearth of antibiotics and antifungals. This won’t cause vulvar itching.

It sounds like either a contact allergic reaction, some form of dermatitis, or even perhaps a lichenoid condition. Those are characterised by the itch, and unusual vulvar behaviour like cuts appearing for ‘no reason’.

Some options to look into the symptoms of are:

Contact dermatitis (also see LSC below)
Lichenoid conditions (lichen sclerosus (LS), lichen planus (LP), lichen simplex chronicus (LSC)
Genital psoriasis
Scleroderma

The process of elimination

Without knowing what is in the water in Lebanon, it is hard to know if it could be causing your problem. If it is contact dermatitis, it should clear up as soon as the irritant is removed, so it could even be worth doing a test on the water (if you suspect it) by not using the water at all for two or three days, and only wiping your body with bottled water and a face cloth, no soap.

That means no wipes either – they can be really irritating. Pure bottled water (you can heat it up in the microwave or on the stove if you want), then just wash your dirty areas (armpits, groin, butt, vulva, whatever) and see if your itching disappears. If it is really bad (itching) at that time, it may need longer to do a real test. Do you have irritation on any other part of your body? I would have thought if you were sensitive to something in the water, then you would show other signs, but that isn’t always true.

If the water is ok, I’d start with simpler things like toilet paper and laundry liquid. Essentially just remove anything that could possibly be causing a problem, even if it says ‘hypoallergenic’ including your special wash. You could be reacting to something in that, despite the fact that it is designed for delicate areas.That doesn’t automatically mean it’s ok for your body.

If you do have a lichenoid condition, the diagnosis is clinical, which means they diagnose you by looking at you, and eliminating other problems.

Additionally, it might pay to go and see a dermatologist. One of the major issues we have in our western medical system is the separation of body systems and specialists. Many conditions may also present in the mouth (like lichen planus), so your dentist knows about it in your mouth, not realising that it also impacts your vagina, but your gynaecologist may not be very familiar. Or gut problems like Crohn’s disease that can have vaginal symptoms – we think they are different, but actually they can be the same condition affecting nearby or similar tissues.

This means that a dermatologist could see something that your gynaecologist can’t.

I would recommend that after you have exhausted your testing and western medical diagnoses (you need a proper diagnosis if you can get one – sometimes that isn’t possible though), go and see a herbalist. Take all your medical tests and records to avoid a repeat trip, and have a good timeline of events, things you’ve tried, what the outcome was, and then get their thoughts on some treatment options. It could be quickly solved with a good herb mix and a bit more time taken investigating the issue and other body systems that may be involved – doctors aren’t really taught to view the body has a whole, instead it is separated out into its systems.

Sometimes these problems have unexpected causes, so keep looking, and check out this other Aunt Vadge article – there are some tips in there that you might find useful.

Please write back and let us know how you go!

Warmest regards,
Aunt Vadge