What is vaginal itching?

Vaginal itching is an unpleasant sensation experienced by many women. Vaginal itching is one of the most common gynaecological complaints. Some women may experience vaginal itching without any other symptoms, while other women may have abnormal vaginal discharge and other symptoms accompanying their itching.

Although vaginal itching is uncomfortable and occasionally painful, it can usually be prevented or treated.

Causes

There are many different causes of vaginal itching. Some causes are infectious, while others are non-infectious.

A normal and healthy vagina contains the bacteria Lactobacillus acidophilus, which colonises the vagina and plays a vital role in the production of acidic vaginal secretions. Maintaining this acidic environment is important, as it makes it more difficult for microbial growth to become excessive. Any changes to the acidity of the vaginal environment can make it more likely for a vaginal infection to set in.

Infectious causes of vaginal itching

Bacterial infection

Bacteria normally live in a healthy vagina in smaller numbers, but when their growth becomes excessive, it can cause a condition called bacterial vaginosis. Bacterial vaginosis is associated with vaginal itching and irritation around the genital area that may be accompanied by abnormal discharge that has a strong odour. 

Other bacteria that do not normally live in the vagina can be the cause of vaginal itching. Neisseria gonorrhoea and Chlamydia trachomatis are two species of bacteria that can be transmitted sexually and whose infection is associated with symptoms that may include abnormal vaginal discharge, burning, painful urination, pain during sexual intercourse and bleeding between periods. 

Yeast infection / thrush

The most common species of yeast associated with vaginal yeast infections is Candida albicans. A yeast infection, also known as thrush or candidiasis, can cause vaginal itching that is usually accompanied pain or a burning sensation during urination and/or sex and an abnormal vaginal discharge.

Common cause of vaginal itching; yeast infection of vagina.

A yeast infection can cause vaginal itching.

Parasitic infection

Parasites do not normally live in a healthy vagina, but when they grow in the vagina or genital area, they cause a range of symptoms.

Trichomonas vaginalis is the parasite that causes trichomoniasis. Trichomoniasis is an infection that is associated with vaginal itching and may be accompanied by irritation of the genital area, abnormal vaginal discharge and pain during urination.

Scabies is an infection that is caused by Sarcoptes scabiei, which are mites that burrow under the skin, sometimes including in the genital area. Scabies can be associated with severe vaginal itching that is sometimes accompanied by a rash with blisters.

Enterobiasis is an infection of parasitic worms that can be spread from the anus area and is associated with severe vaginal itching that is often worse at night.

Viral infection

Viruses do not normally live in a healthy vagina and some sexually-transmitted infections (STIs) can be caused by viruses.

The herpes simplex virus (HSV) can be sexually transmitted and its infection can result in vaginal itching – and often pain – that is accompanied by blisters around the genital area, redness and flu-like symptoms.

The human papillomavirus is usually sexually transmitted and infection may result in genital warts and vaginal itching. Some cancers are associated with infection by certain strains of human papillomavirus and vaccination is an effective means of its prevention.

Non-infectious causes of vaginal itching

Allergic vaginitis/contact dermatitis

The vagina is delicate and can easily be traumatised by the use of aggressive cleaning agents and methods such as vaginal douching (washing out the inside the vagina). Repeated exposure to certain cleaning gels, soaps, tampons or pads may irritate the vagina and cause allergic vaginitis (contact dermatitis), whereas douching can upset the normal balance of microbes in the vagina and lead to yeast or bacterial overgrowth.

Psoriasis

Psoriasis is an inflammatory skin condition. It can affect different areas of the body, but when psoriasis affects the genital area symptoms can include red scaly patches, itchiness and flaking of the skin. 

Seborrheic dermatitis

Seborrheic dermatitis, or dandruff, in the genital area may be associated with red, greasy skin and vaginal itching.

Vaginal / vulvar dystrophy

Vaginal dystrophy causes changes in the skin or inside the vagina. It presents as white or grey thickened areas of skin. Some causes are conditions such as lichen sclerosus or nutritional deficiencies in iron, folic acid and vitamins B1, B2 and B12.

Antibiotics

Antibiotics are used to eliminate harmful bacterial infections, but they also reduce the number of normal and beneficial bacteria that live in the vagina. Yeast that are normally only found in smaller numbers can overproduce and cause unpleasant symptoms. Yeast infections can lead to symptoms of vaginal itching, abnormal discharge and a burning sensation during urination and/or sex. 

Poor hygiene

Women of menstruating age may develop a bacterial or yeast infection if they use tampons, but fail to change them regularly. Tampons left in the vaginal canal too long can make it easier for an infection to develop.

Stress

Stress can contribute to the development of many health conditions, including vaginal itching.

Wearing tight underwear/clothing

Yeast and bacteria thrive in moist and warm environments. Women who frequently wear overly tight clothing, pantyhose or underwear may be more likely to develop bacterial or yeast vaginal infections. 

Diabetes

Poorly-controlled diabetes is associated with fluctuations in blood glucose levels. Vaginal secretions of diabetic women contain higher levels of glucose. Because yeast cells thrive with excess glucose, they are able to multiply, so women with diabetes are more likely to experience yeast infections.

Risk factors

Females of any age can potentially experience vaginal itching, but it is a very common and treatable condition.

Some risk factors of developing vaginal itching may include:

  • Being pregnant;
  • Taking oral contraceptive pills;
  • Being postmenopausal;
  • Taking antibiotics;
  • Having poorly-controlled diabetes;
  • Having multiple sexual partners and not using condoms, and;
  • Being immunocompromised.

Signs and symptoms

Itching may be experienced around the vagina and vulva and may be accompanied by a range of symptoms, depending on the cause. Some common symptoms that may accompany vaginal itching may include:

  • Abnormal vaginal discharge that is atypical in colour, smell, texture or amount;
  • Redness around the affected areas;
  • A burning sensation;
  • Pain during urination and/or sexual activity;
  • Blisters or warts around the genital area, and;
  • Flaky skin around the genital area.

Methods for diagnosis

The diagnosis of the cause of vaginal itching may involve a physical exam and the doctor taking a detailed medical history and a physical exam. During the examination, a swab may be taken from the vagina. This is used to identify what, if any, microbial growth is present. Depending on the age and sexual history, other testing might be carried out to check for the presence of bacteria that cause gonorrhoea and chlamydia, which are sexually transmitted. Based on the symptoms, history and examination, a Pap test may be performed to check for the presence of atypical cells. 

Types of treatment

The types of treatment used for vaginal itching vary, depending on its cause.

Treatment for infectious causes of vaginal itching

For vaginal itching that is caused by an infection, the treatment is as follows:

Yeast infection

Yeast infections are usually treated with antifungal agents that come in the form of a tablet or a vaginal pessary. 

Bacterial infection

Bacterial infections are usually treated with antibiotics. 

Parasitic infection

The treatment for a parasitic infection depends on its type. It may include a course of oral medication or a topical cream. 

Treatment for non-infectious causes of vaginal itching

Contact dermatitis and other skin conditions

These are generally treated by avoiding irritants such as soaps, tampons and douching. Topical steroid creams may also be recommended depending on the location and severity.

Diabetes

Following a healthy and balanced diet, getting regular exercise and properly controlling blood glucose levels can reduce the likelihood of getting vaginal yeast infections. 

Potential complications

Vaginal itching generally poses no significant complications. However, chlamydia or gonorrhoea infections, if left untreated, may progress to pelvic inflammatory disease, which can lead to other complications including infertility. Rarely, vaginal itching may be associated with a more serious underlying condition such as cancer.

Prognosis

The conditions that cause most cases of vaginal itching respond well to treatment. 

Prevention

Once the cause of your vaginal itching has been identified, there are some strategies that may help prevent its recurrence. Some ways of reducing your risk of experiencing vaginal itching may include:

  • Avoiding douching;
  • When going to the bathroom, wiping from front to back to avoid contaminating your vagina with bacteria from faecal matter;
  • Choosing underwear made from natural fibres, as synthetic fibres can promote sweating, and;
  • Practising safe sex to reduce the risk of acquiring sexually-transmitted infections. 

If you are experiencing vaginal itching it is important to see your doctor to diagnose and treat the cause and to exclude more serious conditions that may be associated with this symptom.

Last Reviewed: 03/10/2018

Reproduced with permission from Health&.