Vulvar itching: causes of intimate itching and what to do

What is vulvar itching?

Vulvar itching (pruritus vulvae) means itching of the vulva, the external genital area: the outer and inner lips (labia), clitoris, vaginal opening and perineum. It is a very common reason for seeing a doctor, at any age.

The skin of the vulva is thin, moist and exposed to friction. It reacts quickly to irritation, and scratching sets up a vicious circle: the skin thickens, itches even more, and the original problem becomes harder to recognise. A careful examination of the vulva, sometimes with a swab or a biopsy, usually identifies the cause.

Causes vary with age. In young girls, irritation, threadworms or lichen sclerosus come first to mind. In young women, thrush and irritation are the most common. After the menopause, dryness of the lining, lichen sclerosus and, more rarely, precancerous lesions become more important. Several causes can also combine: thrush on top of lichen sclerosus, or eczema triggered by a cream applied for relief.

Diagnostic procedures and surgery of the vulva are described on the gynaecological surgery page.

What causes sudden intimate (vulvar) itching?

• Vulvovaginal thrush (yeast infection), most often due to Candida albicans: intense itching, burning, redness, thick white discharge. It is more likely after antibiotics, during pregnancy or with poorly controlled diabetes.
• Irritant or contact dermatitis: soaps, intimate washes, wipes, scented panty liners, spermicides, washing powders, sometimes condoms or lubricants. This is a very common and often overlooked cause.
• Trichomoniasis, a sexually transmitted infection: frothy yellow-green discharge, itching, burning.
• Genital herpes: tingling followed by small painful blisters that leave raw areas.
• Genital warts (caused by the human papillomavirus, HPV), which sometimes itch.
• Parasites: scabies, pubic lice, threadworms in children.

Bacterial vaginosis mainly causes greyish, unpleasant-smelling discharge and rarely itches. Bartholin's gland infections and inflammation of the vestibule tend to cause pain rather than itching. For discharge, see the article on vaginal discharge.

What causes chronic vulvar itching?

When itching persists or keeps coming back, it is often due to a skin condition. The table below summarises the most common ones.

After the menopause, falling oestrogen levels make the lining more fragile and prone to burning and itching: see the article on vaginal dryness.

Can vulvar itching be a sign of cancer or precancer?

It is rare, but this is why persistent itching should be examined. Some lesions cause chronic itching:

• Vulvar intraepithelial neoplasia (precancerous lesions), linked to HPV (HSIL, formerly called Bowen's disease or bowenoid papulosis) or to lichen sclerosus (differentiated VIN);
• Vulvar Paget's disease, a persistent red and white patch often mistaken for eczema;
• Vulvar cancer, most often squamous cell carcinoma, which mainly affects older women; more rarely a melanoma (a pigmented spot that changes).

The 2023 European guidelines from ESGO (European Society of Gynaecological Oncology) stress that any suspicious vulvar lesion should be biopsied before treatment. This is done under local anaesthetic during a consultation and usually leaves no visible scar. Vulvoscopy, an examination of the vulva under magnification, can guide the biopsy.

How is the cause of vulvar itching diagnosed?

The doctor asks how long the itching has lasted, which products you use, treatments already tried, sexual activity, menopause, and any personal or family history of skin conditions. They examine the vulva, the vagina and often the skin elsewhere (mouth, skin folds, scalp).

Depending on the situation:

• vaginal swab to look for thrush, bacterial vaginosis, trichomonas or other sexually transmitted infections;
• vulvar biopsy for a patch, an ulcer, a lesion that does not heal or treatment that has not worked;
• blood tests (blood sugar in particular) if thrush keeps coming back;
• dermatology opinion or allergy tests if contact allergy is suspected.

Unless told otherwise, it is preferable to stop creams and pessaries a few days before the appointment so that swab results can be interpreted.

How is vulvar itching treated?

Treatment depends on the cause:

• Thrush: antifungal pessary, cream or tablet. If it keeps coming back, maintenance treatment is discussed.
• Trichomoniasis and other STIs: a suitable antibiotic, with treatment of the partner.
• Lichen sclerosus: according to British Association of Dermatologists guidelines (BAD 2018), a very potent steroid cream applied daily, then less often as maintenance. Long-term monitoring is recommended.
• Eczema, psoriasis, lichen simplex: suitable steroid creams, avoiding the product responsible, emollients.
• Menopausal dryness: vaginal moisturisers, lubricants, vaginal oestrogen if needed.
• Precancerous or cancerous lesions: specialist medical or surgical management.

Antihistamines have little effect on the vulvar itching itself; some may help reduce scratching at night. Avoid repeating antifungal treatments without medical advice: much itching "treated as thrush" turns out to be something else.

How should I care for my vulva day to day?

• Wash the vulva once a day with lukewarm water, with a soap-free, fragrance-free cleanser if you wish.
• Do not douche: the vagina cleans itself.
• Avoid wipes, intimate deodorants, bubble baths and scented panty liners.
• Pat dry rather than rubbing.
• Choose cotton underwear and loose clothing; sleep without underwear if possible.
• Rinse laundry well and choose an unscented washing powder.
• Use a water-based lubricant if you are dry during sex.
• Keep your nails short and apply something cool instead of scratching.

See a doctor if itching lasts more than a few days despite these measures, or as soon as you notice a patch, a sore, a wart, a spot that changes, bleeding or abnormal discharge. Fever with a painful swelling of the vulva needs a same-day appointment.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.