Vulvar Pruritus

Aka: Vulvar Pruritus, Pruritus Vulvae, Vulvar Itching, Vulvar Itch

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II. Definition

  1. Vulvar Itching

III. Causes: Prepubertal Girls

  1. Poor hygiene
  2. Contact Dermatitis
  3. Atopic Dermatitis
  4. Bacterial Infection
    1. Group A Beta-hemolytic Streptococcus
    2. Escherichia coli
  5. Pinworms
  6. Scabies
  7. Vaginal Candidiasis (uncommon in prepubertal girls)
  8. Lichen Sclerosus

IV. Causes: Young women

  1. Vaginitis or infection
    1. Vaginal Candidiasis or rarely Tinea Cruris
    2. Trichomonas
    3. Bacterial Vaginosis
    4. Herpes Simplex Virus (associated with burning pain)
    5. Scabies
    6. Pediculosis Pubis
    7. Human Papillomavirus or Molluscum Contagiosum
  2. Vulvar Dermatitis
    1. Contact Dermatitis
    2. Lichen Simplex Chronicus
    3. Lichen Planus
    4. Hidradenitis Suppurativa
    5. Psoriasis
    6. Seborrheic Dermatitis
  3. Other causes
    1. Vulvar intraepithelial neoplasia (HPV)
    2. Mechanical Trauma

V. Causes: Post-menopausal women

  1. Includes causes seen in young women
  2. Atrophic Vaginitis
  3. Lichen Sclerosus
  4. Paget's Disease of the vulva
  5. Vulvar Cancer (Squamous Cell Carcinoma)

VI. Evaluation

  1. Biopsy atypical vulvar lesions (rule-out cancer)

VII. Management: Prevention

  1. Treat specific causes
  2. Use loose fitting cotton (100%) underpants
    1. Consider not wearing underwear overnight
  3. Use only unscented (hypoallergenic) soaps and lotions
  4. Use unscented laundry detergent without dyes
  5. Avoid fabric softeners
  6. Wipe front to back after urinating or defecating
  7. Use white, unscented toilet paper
  8. Urinate with knees spread apart
  9. Maintain Ideal Weight
  10. Manage Incontinence
  11. Consider sitz bath for 10 minutes daily (girls)
  12. Pruritus Management with Sedating Antihistamine
    1. Hydroxyzine (Atarax) 50 mg PO at bedtime (adult dose)
  13. Wear cotton-liner gloves at night
  14. Use Vaginal Lubricants liberally before intercourse
    1. Use K-Y liquid instead of K-Y Jelly
    2. Astroglide
  15. Dry vulvar area gently after bath
    1. Pat dry or use hair dryer and
    2. Apply Skin Lubricant to vulva
      1. Vaseline
      2. Eucerin
      3. Crisco shortening (very effective)
  16. Avoid exacerbating factors
    1. Avoid scrubbing vulva
    2. Avoid douching
    3. Avoid panty liners or pads (use tampons instead)
    4. Avoid contraceptive foams
    5. Avoid Alcohol wipes
    6. Avoid bubble baths or prolonged soap exposures
      1. Use only Mild Soap or no soap on vulva
      2. Avoid hard water for bathing
    7. Avoid prolonged wearing of wet bathing suits
    8. Avoid tight restrictive clothing that causes sweating
    9. Avoid nylon tights or underwear
    10. Avoid frequent shaving of pubic hair (Folliculitis)

VIII. References

  1. Goroll (2000) Primary Care, Lippincott, p. 693-95
  2. Noble (2001) Primary Care, Mosby, p. 282
  3. Paek (2001) J Am Acad Dermatol 44:795-802 [PubMed]

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