Vaginal or vulvar itch (pruritus vulvae) can be both distressing and embarrassing, and more so if it is accompanied by burning, discharge or odor, as is quite often the case. Determining the cause of an itchy vagina is important so as to be able to initiate proper treatment in order to relieve the symptoms and ultimately lead to complete resolution of the condition.
Scratching and self-medication changes the appearance of the vaginal surface and diagnosis by clinical examination alone may become difficult. Therefore further tests and investigations will be necessary. It is advisable to see doctor immediately once a persistent vaginal itch before attempting to treat the condition with creams and douches.
Any sign of abnormal vaginal bleeding accompanied by an itchy vagina, pain and/or discharge should be immediately investigated by a medical professional.
Why does the vagina itch?
Pathophysiology of an Itchy Vagina
Bacterial infections are the most common cause of vaginal itching although other allergic and inflammatory causes may also responsible. The close proximity of the vulva to the anus and the warm, moist environment within the vagina makes it prone to infections from bacteria around the anus.
Before the onset of puberty, there is lack of endogenous estrogen. This deficiency causes the vaginal lining (epithelium) to be extremely thin and deficient in glycogen, which makes the vagina highly susceptible to bacterial infections.
Woman of Reproducing Age
The vaginal epithelium matures under the influence of estrogen and there is a large amount of glycogen present in these cells. This produces lactic acid, resulting in an acidic environment which favors the growth of lactobacillus. From the time of puberty till menopause, the lactobacilli present in the vagina keep the vaginal environment acidic and thus discourage bacterial infection.
However, other factors come into play, which tend to increase the susceptibility to vulvovaginal infections, such as :
- sexual activity,
- contraceptive agents,
- vaginal douching,
- use of tampons, and
- wearing of tight, nonabsorbent, heat-retaining, synthetic clothing (such as a pantyhose).
Factors which are likely to make the vagina alkaline are :
- infected cervical mucus,
- menstrual discharge,
- vaginal discharge occurring during sexual activity, and
- male ejaculate.
In this age group, the level of endogenous estrogen falls, making the vaginal epithelium and the vulvar skin thin and atrophic. In addition, there is a decrease in vaginal acidity. All these factors acting together predisposes the delicate vaginal tissues to become prone to injury and infection. Postmenopausal atrophy can thus cause vaginal itching and dryness.
Obesity, excessive vaginal discharge and incontinence often exacerbate the symptoms of an itchy vagina.
Causes of Vaginal Itching
Vaginal itching is a common symptom and the causes can be divided into a number of broad headings, such as –
- Foreign bodies.
- Skin diseases.
- Cancerous and pre-cancerous conditions.
Vaginal infection, causing inflammation of the vagina (vaginitis), is the most common cause of vaginal discharge, itching, burning and odor.
There are 3 types of vaginal infection that are normally encountered – bacterial, fungal or protozoal.
Itching around the vulva and vagina may be accompanied by a thin discharge, usually white or gray in color, which has a typical fishy odor. A burning sensation during urination may be present. Bacterial vaginal infection usually occurs when there is a change in the normal vaginal flora, most frequently with an overgrowth of Gardnerella vaginalis.
Pregnancy, contraceptive devices, douching and multiple sexual partners may be some of the risk factors associated with a bacterial vaginal infection, although it is not generally a sexually transmitted disease.
Vaginal fungal infection
Candida vaginitis, vaginal thrush, vaginal yeast infection, or vaginal candidiasis
Severe itching of the vulva and vagina is very frequently caused by a fungal infection (Candida albicans). The vulva and vagina may be red and fissured and there is often a thick, white, curdy or “cottage cheese” discharge. The discharge is usually odorless. Itching, burning and pain may be aggravated with sexual activity.
Candida albicans may normally be found in the vagina without causing any symptoms as long as there is a balance between the fungi and the normal bacterial flora of the vagina. Any imbalance causing destruction of the bacterial flora leads to excessive proliferation of the fungi and subsequent infection.
Risk factors include :
- antibiotics, and
- immunodeficiency states.
A fungal infection of the vagina is usually not transmitted sexually.
Trichomoniasis of the Vagina
Infection with the protozoa Trichomonas vaginalis causes trichomoniasis of the vagina, which is a sexually transmitted infection. Vaginal itching and a burning sensation while passing urine are common symptoms. There is usually a copious amount of thin, bubbly, foul smelling discharge, which is yellowish-green or gray in color
Other Infectious Causes of Vaginal Itching
- Sexually transmitted infections such as chlamydia and gonorrhea, which are infections of the cervix caused by bacteria.
- Sexually transmitted diseases (STDs) such as genital warts and genital herpes.
- Urinary tract infection (UTI).
- Pubic lice.
- Allergy to latex condoms and spermicide gels.
- Chemicals present in bubble baths, detergents, soaps, lotions, sprays, colored or perfumed toilet paper, deodorant pads or tampons.
- Semen allergy.
- Poor personal hygiene.
- Improper hygiene – causing bacteria to enter the vagina from the anal region.
- Wearing tight, synthetic underwear or wet swimwear for long.
- Frequent douching.
- Foreign body in the vagina such as a forgotten tampon or a piece of toilet paper.
- Retained condom.
- Other articles.
- Postmenopausal atrophic vaginitis.
- Prepubertal atrophic vaginitis.
- Oral contraceptives.
- Sexual abuse.
- Abrasions while inserting a tampon or during sexual intercourse.
- Lichen planus.
Cancerous and Pre-cancerous Conditions
- Lichen sclerosus.
- Cancer of the vulva, vagina, cervix or endometrium may produce a watery or blood stained discharge.
- Any disorder causing generalized itching or pruritus, such as chronic liver disease, thyroid disease, or side effects of some medicines.
- Urinary incontinence.
- Radiation therapy.
- Surgery. Vaginal itching and discharge after a procedure like a dilation and curettage should be investigated as post-operative infections are possible.
- Vaginal itching could be psychogenic in origin.
Causes in Children and Infants
- Usually from fecal infection.
- Prepubertal atrophic vaginitis – alkalinity due to lack of vaginal estrogen.
- Staphylococcus and streptococcus infection may cause discharge with pus.
- Pinworm infestation.
- Foreign body.
- Sexual abuse.