Itching in the intimate area in women

If itching in the intimate area in women – in the area of the external genitalia and perineal area (in the perineum) – lasts for more than a few days and becomes more severe, or if accompanying symptoms appear, such as redness or discharge, you should consult a doctor. Because burning and itching, wherever they appear, are never a normal condition.

Causes female intimate itching

In determining the key causes of itching in this location, doctors pay attention to the decisive role of normal vaginal microbiota, which in healthy women of reproductive age consists of 80-90% of a complex of lactobacilli (Lactobacillus spp.). These commensal bacteria, secreting lactic acid and hydrogen peroxide, maintain the necessary pH level (from 3.8 to 4.4) and thus prevent the proliferation of opportunistic and pathogenic microorganisms: either those present in the polymicrobial flora of the vagina, or infections transmitted primarily through sexual contact.

Lack of lactobacilli leads to vaginal dysbiosis – vaginal dysbacteriosis. And the imbalance between beneficial and pathogenic bacteria in favor of the latter can result in even greater trouble – bacterial vaginosis. [ 1 ] With vaginal inflammation, recognized as the most common cause of vulvovaginal gynecological problems, symptoms such as slight or severe itching in the intimate area in women, burning, and vaginal discharge appear.

It is the nature of the discharge and the results of laboratory tests of their sample that determine the specific infection: bacterial, fungal or protozoal, including STIs. Thus, if vaginosis is caused by the facultative bacteria Gardnerella vaginalis, women experience itching and vaginal discharge with a smell that is defined as fishy.

The Candida albicans fungus is part of the normal flora in at least 15% of women, and is often asymptomatic. But when it becomes opportunistic, the fungal infection leads to candidal vaginitis or vulvovaginal candidiasis, called thrush. The itching associated with thrush is accompanied by characteristic discharge (cheesy in appearance), swelling of the labia majora and minora, the vestibule of the vagina and perineum, dysuria, and discomfort when urinating. [ 2 ], [ 3 ]

But sexually transmitted Trichomonas vaginalis leads to trichomoniasis, and vaginal discharge, severe itching and redness in the intimate area in women appear - with swelling of the vulva and vagina and desquamation of epithelial cells. [ 4 ]

Severe burning, itching and pain in the external genitalia and perineum are felt by women in cases of genital infection caused by the herpes simplex virus (HSV type 2). It is with this viral lesion of the skin of the external genitalia that itching and burning are observed in women without vaginal discharge. The first signs of vaginal herpes are a burning sensation in the genital area, their hyperemia and slight swelling, followed by itching and small vesicular rashes. [ 5 ]

When infected with the human papillomavirus (HPV), which most often becomes active when the general immune system is weakened, papillomatous growths on a stalk that resemble papillae are observed on the genitals, in the vagina and on the cervix - itchy genital warts or pointed condylomas in women. If the condylomas grow strongly, there may be itching and burning in the perineum. [ 6 ]

In a third of cases, inflammation of the external female genitalia (vulvitis) may be a consequence of hypersensitivity or reaction to soap or parabens in shower gels, synthetic underwear, hygiene products, spermicides, vaginal creams, and condoms.

The causes may also be skin diseases such as atopic and contact dermatitis, which account for a significant proportion of diagnosed cases of chronic itching of the vulva and vagina in women of any age. Redness and the formation of vesicles, papules or plaques; burning, itching and swelling in the intimate area are the main symptoms of these vulvodermatoses. Chronic course of the disease often leads to lichenification (thickening) of pathologically altered areas of the epidermis. Similar symptoms are observed in chronic simple lichen (neurodermatitis).

Itching in the intimate area during postmenopause

In addition to the beneficial vaginal microbiota, local protection of intimate areas is provided by a sufficient level of estrogens, the receptors of which are present on the membranes of keratinocytes. Estrogens have a proliferative effect on the vulvovaginal epithelium, improve blood circulation and hydration of the skin and connective tissue, that is, they help maintain the necessary thickness of the mucous membranes of the female genital organs. [ 7 ]

The consequences of a decrease in this hormone after the onset of menopause are manifested by deterioration of skin hydration, a reduction in the content of collagen in the epidermis and glycosaminoglycans in the mucous epithelium, a decrease in fat depots in the area of the external genitalia. In addition, in women of this age category, the pH of the vagina increases, and the cellular immunity of the skin weakens, which increases the risk of dermatological diseases.

In addition, all of the above factors often provoke the development of postmenopausal atrophic vaginitis, the first signs of which are dryness and itching in the intimate area. For more details, see the publication - Vaginal Dryness During Menopause [ 8 ]

The appearance of bordered papular-plaque skin rashes (white-yellow or grayish) on the genitals corresponds to the clinical picture of lichen sclerosus, a chronic inflammatory dermatosis. [ 9 ]

Irritation, burning, itching and cracks in the intimate area in women who have gone through menopause may be due to erosive or hypertrophic flat lichen (lichen planus). More information in the article - Itching, burning of the skin in the intimate area during menopause

Risk factors

Risk factors that predispose to the activation of pathogenic bacteria include:

• insufficient hygiene and hypertrophied sensitivity;
• increased sexual activity and unprotected sex;
• frequent douching;
• long-term use of antibiotics (which can reduce the number of lactobacilli and reduce the protection of the mucous membrane of the vulva and vagina);
• alkaline vaginal pH (due to menstrual flow, semen, or bacterial imbalance);
• state of immunosuppression, including during pregnancy and after radiation therapy of the pelvic organs;
• history of diabetes mellitus, thyroid disease, metabolic syndrome, ovariectomy;
• deficiency of iron, zinc, vitamins A or D;
• postmenopausal age.

Pathogenesis

The mechanism of regulation of microbial colonization of the lower female genital tract is not fully understood. Thus, the disease does not necessarily develop with the entry of exogenous bacteria; on the other hand, inflammation can begin due to increased replication of endogenous (present in the normal vaginal flora), but having pathogenic potential anaerobic microorganisms, in particular, Gardnerella vaginalis, Atopobium vaginae, Prevotella spp., Mobiluncus spp., Mycoplasma hominis, Ureaplasma urealyticum, as well as individual species of Bacteroides, Porphyromonas, Peptostreptococcus. Apparently, their dominance - against the background of a decrease in the number of beneficial lactobacilli - leads to the development of vaginosis, accompanied by discharge and itching.

In determining the pathogenesis of this process, researchers have identified the ability of G. vaginalis bacteria to adhere to the cells of the vaginal mucosa and cover it with a kind of biofilm, which allows microorganisms to accumulate in significant quantities and protects them from immune cells, i.e., plays a leading role in the development of inflammation.

Vaginal discharge is the result of increased transudation of epithelial cells and their exfoliation (separation from the general layer). The unpleasant odor of the discharge is explained by the fact that pathogenic anaerobic microbes produce a large number of proteolytic carboxylase enzymes, which decompose vaginal peptides with the formation of volatile amines - ammonia derivatives.

And the mechanism of itching development in all infectious and atrophic vaginoses is caused by changes in the condition of the mucous membranes, which arise due to the activation of proinflammatory cytokines, polymorphonuclear cells and macrophages, as well as the release of histamine from mast cells. This is the main mediator that affects receptors (H1 and H2) and ensures the conduction of afferent nerve signals.

Epidemiology

According to WHO, more than 350 million people worldwide are infected with STIs every year (almost 143 million with trichomonas); over 500 million people with the herpes simplex virus (HSV).

According to clinical statistics, at least 290 million women are infected with the human papillomavirus (HPV).

Although the prevalence of bacterial vaginosis varies considerably from country to country, in Europe and South America it is estimated to be between 4.9% and 36%; in Asian regions it is approximately 65%. Bacterial vaginosis can occur in any age group, but it is diagnosed much more often among women of childbearing age. On average, 7.5 million women in all countries visit gynecologists for vaginal inflammation per year.

Vulvovaginal symptoms, including dryness, irritation, and itching, occur in 27% of postmenopausal women (according to other data, at least 80%).

Diagnostics female intimate itching

In case of itching in the area of the external genitalia, diagnosis is carried out by a gynecologist and/or a dermatovenerologist, and the main objective of the examination is to determine the cause of this symptom.

To do this, a complete patient history is required, a standard gynecological examination is performed, and the following tests are taken:

• general clinical and biochemical blood test;
• blood test for STIs;
• analysis of vaginal microflora based on samples of gynecological cervicovaginal smears;
• PCR analysis for detection and identification of inflammatory pathogens.

How genital warts are diagnosed, in detail in the material - Papillomavirus infection

Instrumental diagnostics are used: colposcopy, ultrasound examination of the pelvic organs.

To exclude diagnostic errors, all examination results are compared – laboratory and those obtained by visualization, that is, differential diagnostics are carried out.

Bacterial vaginosis is usually suspected by elevated vaginal pH (>4.5), but it is also elevated in trichomoniasis, atrophic vaginitis and desquamative vaginal inflammation, so conclusions are made based on microbiological and bacterioscopic examination of vaginal discharge.

It is important to consider the possibility of a neuropathic origin of itching, which may occur with spinal compression, postherpetic neuralgia or diabetic neuropathy.

Treatment female intimate itching

The occurrence of this symptom immediately poses two questions to a woman: why does it itch and burn THERE, and how to relieve itching in the perineum and in the genital area?

Treatment should be aimed at the real cause (which should be identified by a doctor), but in some cases only symptomatic therapy is possible - to reduce and relieve itching.

The basis of traditional (etiological) treatment of bacterial vaginosis is the antibacterial drugs Metronidazole (other trade names are Metrogil, Trichopolum, Trikhazol, Ginalgin, Flagyl) or Clindamycin (Dalacin, Klimitsin, Zerkalin). These drugs are available in various forms and can be used both systemically (internally) and externally. Following the instructions of the attending physician, itching and burning in women are treated at home with the prescribed antimicrobial agents.

Antiprotozoal and antimicrobial drug of the nitroimidazole group Metronidazole - suspension and tablets for oral administration; vaginal tablets, gel, cream and suppositories (candles) - are used daily, twice a day, the course of treatment can last one to two months. As clinical practice shows, treatment with this drug for 4 weeks gives a positive result in 80% of patients, but on average in 25% of cases after two to three months a relapse is observed. And the list of side effects of Metronidazole includes erythema and rashes, itching and local loss of skin sensitivity, muscle and joint pain, urine staining, development of thrush.

Clindamycin can be administered orally (four times a day, 0.15-0.45 g with a minimum duration of administration of 10 days). Vaginal cream with clindamycin - Vagitsin (Kindacin, Clindes) - is used for a maximum of a week (contraindicated for pregnant women). Possible side effects include the development of a fungal infection, menstrual irregularities, vaginal pain and burning, and problems with urination. Although compared to Metronidazole, Clindamycin is more active against Gardnerella vaginalis and Atopobium vaginae, it also affects lactobacilli, which affects the effectiveness of treatment and increases the likelihood of relapses and the development of superinfection.

Practicing physicians note the higher efficiency of the nitrofuran derivative Nifuratel (synonyms: Macmiror, Methylmercadone, Methylmercadon, Thiodinon), which acts on Trichomonas vaginalis, Gardnerella vaginalis, Atopobium vaginae, fungal infection, but does not affect lactobacilli.

What suppositories for itching in the intimate area in women are recommended by doctors, read in the materials:

• Vaginal suppositories for infections
• Vaginitis suppositories
• Candles for thrush
• Suppositories for vaginal dryness

Also in gynecology and dermatology, ointments and creams for itching in the perineum, vulva and vagina are widely used.

In case of severe inflammation of bacterial etiology, ointments containing the antibiotic chloramphenicol (Levomekol, Contricomycetin, Iruksol, syntomycin emulsion), ointments with silver sulfadiazine (Sulfargin, Dermazin), etc. are prescribed.

For the treatment of viral vaginosis caused by the Herpes simplex virus, special ointments, liniments and creams for herpes are intended: Acyclovir (other trade names - Herpevir, Zovirax), Gossypol, Riodoxol, Bonafon, Florenal.

Treating scleroatrophic and other vulvovaginal lichens is difficult; if a bacterial or fungal infection does not join, antihistamines are used systemically: Cetirizine (Cetrin, Zyrtec, Allertek), Loratadine (Lorizan, Lomilan, Claritin, Claridol), and locally - moderately or fairly strong topical corticosteroids in the form of an ointment for itching, as well as steroid and non-hormonal creams for itching. However, local corticosteroid therapy is carried out in short courses, since these drugs can aggravate atrophic processes in the dermis.

Additional information in the article - Treatment of postmenopausal atrophic vaginitis: suppositories, folk remedies

Condyline or Condilox ointments (with podophyllotoxin), Imiquimod cream (Aldara) are prescribed for genital warts and papillomatosis. Read also: Ointment for condylomas

For candidiasis, use the ointments Mikoseptin or Tsinkundan (with undecylenic acid), Nystatin, Amikazol, Clotrimazole, Okticil, Esulan. Detailed information on the treatment of candidal vaginitis - Effective treatment of thrush with creams, gels and suppositories

Cervical vaginal lavage or douching is practiced for thrush, for which a saline solution, an aqueous solution of furacilin (0.02%), and antiseptic solutions Miramistin or Chlorhexidine are used.

Homeopathy

Homeopathic remedies can also be used:

• to moisturize dry, flaky rashes that cause itching, and relieve erythema – Graphites;
• for inflammation with rash and itching – Arsenicum iodatum, Thuja (oil), Hydrastis;
• for pustular rashes and itching in skin folds – Sulphur;
• if pruritis is of allergic origin – Mezereum.

For dry, cracked, flaky and itchy skin of any localization, homeopaths – after examination – prescribe Petroleum, Lycopodium and Sepia (in an individually selected dosage).

Treatment of itching in the perineum in women with folk remedies

In most cases, the use of folk remedies involves herbal treatment, although it is difficult to imagine modern medicine without herbal medicine.

For itching in the intimate area, sitz baths or douching with decoctions of chamomile flowers, calendula, tansy; peppermint, thyme, horsetail, centaury, purple deadnettle, cornflower; calamus roots, elecampane; barberry and oak bark are recommended.

Also effective is the use of essential oils: tea tree (Melaleuca alternifolia), palmarosa (Cymbopogon martinii), lavender, thyme, oregano, sage, citronella (lemongrass).

Surgical treatment

Itching may not be an indication for surgical intervention, but surgical treatment may be required in cases of serious complications. For example, when the fallopian tubes become inflamed and pus accumulates around them. Or the urethra narrows in patients with lichen sclerosus.

They also resort to removing pointed condylomas that have grown on the genitals and in the perineum.

Complications and consequences

Recently, in gynecology, the consequences and complications of bacterial vaginosis have been particularly closely examined, which is considered a predisposing factor for infection with the herpes virus, HIV, Chlamydia trachomatis, Trichomonas vaginalis and Neisseria gonorrhoeae.

In cases of STIs, the consequences can be expressed in the development of an acute inflammatory process in the fallopian tubes (salpingitis) with the formation of pus in their lumens, which is diagnosed as pyosalpinx.

Bacterial vaginosis can be especially dangerous during pregnancy: it greatly increases the risk of spontaneous abortion in the later stages, premature birth, rupture of the amniotic sac and the development of inflammation of its membranes (chorioamnionitis), as well as inflammation of the uterine mucosa (endometritis) after childbirth.

The chronic nature of vulvodermatoses in postmenopause reduces the quality of life. Atrophy of the skin and partly subcutaneous tissues in the genital area can make sexual intercourse, urination and defecation painful. In addition, complications of scleroatrophic and chronic simple lichen include narrowing of the urethra, secondary infection and local skin atrophy (due to long-term use of steroids). There is also a risk of precancerous changes (neoplasia) in the epithelium of the cervix and the development of vulvar carcinoma.

Prevention

General recommendations regarding the advisability of visiting a gynecologist from time to time, the need to maintain absolute hygiene and avoid anything that is harmful to the body as a whole are clear. Of course, lifestyle choices and overall health are the main factors that help prevent many problems. But there are only specific methods of preventing STDs/HIV

Prevention of vaginal dysbiosis, and, consequently, bacterial and fungal vaginosis, consists of maintaining the vaginal microflora in the norm, and for this purpose, they now resort to the help of vaginal pro- and prebiotic agents with lactobacilli.

It is also necessary to monitor the blood glucose level, and try to avoid sugar-containing foods in the diet. The intestines must function normally, since problems with its microflora affect almost all organs, including the genitals. A good help in maintaining the balance of intestinal microbiota are yoghurts with a live bacterial culture, sauerkraut (and all other lacto-fermented vegetables) and also foods with dietary fiber (i.e. food of plant origin).

Forecast

With regard to any symptoms, the prognosis correlates with the cause of its occurrence. Therefore, the most disappointing prospects are for atrophic vaginitis developing during the postmenopausal period, as well as for scleroatrophic lichen in older women experiencing itching in the intimate area.