Pruritus Vulvae

What is pruritus vulvae?

Pruritus vulvae means 'itchy vulva'. The vulva is the area of skin just outside the vagina. Most women have a slight vulval itch from time to time. However, pruritus vulvae means the itch is persistent, and causes distress. Itch at night may be particularly bad, and disturb your sleep. About 1 in 10 women see a doctor about persistent vulval itch at some stage in their life. It can affect any woman, at any age.

What causes pruritus vulvae?

Pruritus vulvae can occur in many different conditions. These include the following.

• Infections. For example: thrush, threadworms, scabies, and some sexually transmitted infections.
• Skin conditions may affect vulval skin. For example: eczema, psoriasis, lichen simplex, lichen planus, and lichen sclerosus.
• Sensitisation of the vulval skin to soaps, perfumes, deodorants, excessive sweat, etc.
• Urinary incontinence.
• Menopause. The vulval skin tends to become thinner and drier after the menopause, which can make it prone to itch.
• Pregnancy can cause itch due to vulval engorgement.
• Any cause of a generalised body itch may include the vulva. For example, a side effect of some medicines, some blood disorders, some thyroid problems.
• A tumour of the vulval skin (uncommon).
• Unknown cause. In some cases, no cause can be found.

So, if you have a persistent vulval itch, you should see a doctor to find the underlying cause.

What are the treatments for pruritus vulvae?

Treating the cause
Treatment varies, depending on the cause. For example, anti-fungal cream for thrush, antibiotics for certain infections, steroid cream for various skin conditions, hormone cream or HRT (hormone replacement therapy) if the itch is related to the menopause. Your doctor will advise.

Moisturisers
Bland moisturisers (emollients), such as aqueous cream or emulsifying ointment, can ease the itch whatever the cause. You can use these in addition to most other treatments. Use them liberally. You can buy these at pharmacies, or get them on prescription.

Try to avoid the 'itch-scratch cycle'
The itch-scratch cycle is where scratching causes more itching - which causes more scratching - which causes more itching - etc. So, if you scratch, it may make the itch worse. So, apart from any other treatment, try not to scratch if at all possible. Keep your nails cut short. Consider wearing cotton gloves at night to stop scratching in your sleep.

General vulval skin care and other advice
The following may also help ease a vulval itch, whatever the cause.

• Clothes
• Wear loose 100% cotton underwear. Avoid nylon or synthetic underwear material which tends to block 'fresh air', and causes you to sweat more.
• Change your underwear daily. If necessary, put a tissue in your underwear to absorb moisture which may be irritating.
• Avoid wearing tight fitting clothes, such as cycling shorts or tight leggings. Skirts and dresses are probably better than trousers. Also, stockings are probably better than tights. The aim is to allow some air to get to the vulva, and not to allow it to become too sweaty. Consider not wearing any underwear at all.
• Washing
• Wash your vulva gently, once or twice a day. Do no scrub or wash vigorously. Wash with water only, or use a bland, unscented moisturiser as a soap substitute.
• Do not put on your underwear until your vulva is fully dry. A hair dryer may be useful to dry properly.
• It may be best to wash your hair separately to the rest of your body, as shampoo which runs down your body in a shower may irritate your vulva.
• General
• Sometimes soaps, perfumes, bubble baths, deodorants, scented creams, the dye in toilet tissue, etc, can sensitise (irritate) the delicate vulval skin. Don't use any of these on your vulva. Use plain, non coloured toilet tissue.
• Some people develop a skin sensitivity to a washing powder or fabric conditioner. This is uncommon, but it may be worth considering changing to a different brand.
• Do not use condoms that are lubricated with spermicide, which can be 'sensitising'.

What if no cause is found?

No cause can be found for some cases of pruritus vulvae. The general advice given above on clothes, washing, etc, will usually help. In addition, a mild steroid cream such as hydrocortisone, may be advised. It often settles the itch within a few days. This may also help to break any 'itch-scratch cycle' that has developed. You can use a mild steroid cream for 2-3 days every now and then. You should not use steroid cream regularly on the vulva, as it can have a 'thinning' effect on the skin with long term use.

Note: steroid cream can make some conditions of the vulva worse. So, you should see a doctor about persistent vulval itch before using any treatment.

Help with sleep

An antihistamine medicine at bedtime may help if sleep is affected. They do not have a great effect on the itch, but some antihistamines cause drowsiness, which may help you to sleep. A doctor or pharmacist can advise on which antihistamines are 'sedating'.