Here’s the usual story:

Doc, I’ve been itching but I don’t think it is yeast. My vagina itches on the outside, more on one side than the other. Over-the-counter yeast medications don’t work, and the symptoms are sometimes worst at night.

Well, here are my top five usual suspects and what you can do about them. I will also provide links to products that I recommend for my patients practically every day. As a self-proclaimed Amazon Prime addict, that’s were I’m sending y’all. #PrimeEnabler

Eczema or Vaginal Dryness

From NationalEczema.org:

Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed. There are several types of eczema: atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis and stasis dermatitis.

Wait, I can get that in the vulvar area? (Reminder: The vulva is the term for the external vagina.) Yes, a person can develop eczema of the vulva. This is a diagnosis that is usually made by a dermatologist and may require a biopsy. If you suspect that Eczema may be your diagnosis, try Aquaphor twice a day.

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Vaginal dryness needs a vaginal moisturizer #Menopause

Sometimes itching is caused by dryness. Menopause a prime culprit for this symptom. Though hormonal modulation can help, like oral, topical or transdermal patches, hormones do come with some slight risks that can be more relevant depending on a persons medical or family history.

If you are looking for a non-hormonal option to manage vaginal dryness, Replens is a long-lasting moisturizer that should last 2-3 days per application. Some of my patients use it when they plan to be sexually active, and others use it when they are just dryer than usual. It’s nice to have on hand.

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Herpes or other Sexually Transmitted Infections

I have written so, so many posts about this topic, from lumps and bumps to things to know about chlamydia to top STDs to know about. Suffice it to say that some sexually transmitted infections can cause symptoms like itching. Even if you don’t suspect a partner’s infidelity, recurrent irritation that doesn’t respond to antifungal (anti-yeast) medication may warrant a rule-out-STD doctor visit. Just take it off the table.

Also, take a mirror and look down there. If itching or irritation is followed by painful bumps or broken skin areas, you may need testing for herpes. It is important that you see your doctor WHILE you are having the symptoms and have the lesions swabbed with a q-tip. That is the best way to rule in or rule out Herpes as a diagnosis. Google images are often FAR MORE INTENSE than day-to-day herpetic lesions. They can be subtle in appearance, but they are usually painful to touch.

Contact Dermatitis

One of my first questions is often: Have you changed your detergent, soaps, fabric softener? This is because irritation can come from new products in contact with the skin. This is especially true for those who travel for work and use hotel products that change frequently.

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Try using sensitive skin soaps for the external vulva. Remember, the inside does not need soap. Fresh water only. For clothing, try washing undergarments in products for sensitive skin, like All Free and Clear.

My new favorite body wash is this one:

Click the pic to be taken to Amazon

I don’t often come across a body wash that I can use on my whole body. I have sensitive places that are very particular about products. This one is my latest favorite, for those who want a whole body solution that actually gets you clean. Let me know what you think in the comments. Again, this one isn’t based on any evidence, just personal preference.

Lichen Sclerosis or other Inflammatory Disorders

The hallmark of this one is itching that occurs primarily at night. The itching is not responsive to anti-fungal creams and lumps or bumps are not often present. Women say that the itching wakes them up at night and they are compelled to scratch.

Here is the crazy part though: This chronic inflammation is worsened by scratching. It’s call the itch-scratch cycle. One of the ways to manage this is with topical steroids to control the inflammation. The other thing that is important is for you to NOT SCRATCH IT. If that means applying a cold compress, or taking a Benadryl as a sleep aid for a few nights, try that. If none of that helps, you should definitely see your doctor because your itching could be caused by a…

Precancerous changes of the skin

Yes, pre-cancer and cancer of the vulva can manifest with itching. How do we differentiate that from other causes? By biopsy. My usual process is to first test for yeast, bacterial vaginosis and STDs. Then I may try a topical steroid as long as there aren’t any visible lesions that I should swab or biopsy.

If NONE OF THAT WORKS, a biopsy is necessary. It just is. I have been surprised before by an area on a woman’s body that looked normal, but just was itchy. If you think about it, itching can save a woman’s life. A biopsied area that reveals advanced pre-cancer can be treated with removal of the affected skin. Most times, the remove area does not leave a woman with any deformities. The vulva heals so well, sometimes it’s hard to even see what was removed.

The Point Is, Don’t Ignore Itching

If you are not getting relief from natural or over-the-counter remedies, PLEASE see your doctor. We can help you get to the BOTTOM of the situation. Please forgive me for that pun. #punlife

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