By Gretchen Fermann, MD
Over-the-counter (OTC) remedies for yeast infections became commonplace years ago and there must have been an audible, collective sigh of relief from women around the world to have that remedy readily available. Women couldn’t be happier to be able to self-diagnose and treat this common and bothersome condition straight away and privately. When, you may ask, should one consider being seen for further evaluation and treatment? Does anything else cause itchiness in the vulvar area (skin at the outside of the vagina)? Here is a brief list of some common culprits that might warrant further evaluation.
- A YEAST INFECTION would be the most common reason for vulvar itching and usually it is accompanied by a thick white vaginal discharge and sometimes with mild swelling or an external rash. This would usually respond to a one, three, or seven-day OTC anti-fungal cream. If the symptoms don’t respond or recur shortly thereafter, follow-up should be sought. If the symptoms are severe or not classical as above, then evaluation for other possible causes of itching should be considered.
- A SKIN CONDITION in the vulvar area, called Lichen Sclerosus, which is a benign condition, causes visible whitish changes to the skin and itching is a hallmark of this condition. Reaction of the skin to allergens or irritants can also cause the skin to thicken and itch and this is called Lichen Simplex Chronicus and is benign but vexing. Pre-cancerous or cancerous growths or rough spots in the vulvar area can also cause itching.
- AN STD such as Trichomoniasis or Herpes Simplex Virus (HSV) can also have itching as a component of the symptoms. The former is usually accompanied by excessive foul vaginal discharge and the latter with painful sores. Request an appointment if either of those symptoms are present with the itching.
- GENITOURINARY SYNDROME OF MENOPAUSE is a term for a collection of symptoms women can manifest in the menopause or at anytime when there is a lack of estrogen for a period of time. Common symptoms can include dryness, itching, and/or burning of the vulvar area with or without some bladder symptoms or sexual discomfort.
So, if your itch is not classic for yeast, not responding to an OTC treatment, recurring in less than two months, or accompanied by any of the symptoms above, call your provider for further guidance.