Vaginal Itching without Discharge
Written by : Dr.M.D.Mazumdar, MD
Vaginal itching without discharge (alt name : Prurutis Vulvae) is uncommon. In most women, vaginal itching is caused by organisms which also cause noticeable leaking of vaginal discharge. There are certain conditions however, that can cause vaginal itching without discharge.
Causes of Vaginal Itching without Discharge
Postmenopausal Vaginitis A low grade vaginitis may occur after the menopause due to a low estrogen level and dryness of the vagina. The inflammation of the vaginal tissues can cause intense itching. Scratching can cause small cuts and tears in the area which can become secondarily infected by pathological organisms.
Skin diseases Skin diseases like psoriasis, seborrhoeic dermatitis and eczema may affect the vulval area alone or may simultaneously affect other parts of the body.
Parasitic infections Parasites like lice may infect the hairy part (mons pubis) of the vulva simultaneously with the hair on the scalp. Threadworms may also migrate from the anus to the vagina to cause itching, especially at night. Scabies is another parasitic condition which can cause severe itching in the vulva. Commonly, infection of the genital area by lice or scabies is a result of sexual intercourse with an infected person or due to spread of the disease from other parts of the body by contaminated fingers.
Genital Warts Genital warts are caused by infection by HPV (Human Papilloma Virus). The warts may be flat on the tissues or may be large leaflike growths. In both cases, there may be a mild chronic itching or irritation in the vulval and vaginal areas. Vaginal discharge is usually absent or may be very minimally present.
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Diseases of the anus and rectum Diseases like piles and fissure-in-ano can cause itching around the anus and the vulva. Both these conditions may sometimes cause the secretion of a thick, mucopurulent (mucous mixed with pus) discharge that spreads anteriorly to the vaginal opening to cause itching.
Lichen sclerosis This is a condition which causes intense vaginal and vulva itching without any discharge. There may be small depigmented spots or patches in the vulva. It is more common in postmenopausal or elderly women.
Diabetes with Glycosuria The passage of glucose in the urine in women with diabetes can cause soreness and severe itching in the vulva. It can cause a burning sensation while passing urine. The urine may be turbid and milky in colour with a faint, rich odour. Glycosuria is more commonly a predisposing condition for infections like candidiasis or yeast and trichomoniasis because the sugar in the urine provides a good media for the growth of infective organisms.
Allergy and drug sensitivity The patient with vulval and vaginal itching may be sensitive to various soaps, bath salts and deodorants used to bathe or to wash the underclothes. Underclothes made of synthetic material like nylon may also cause allergy in some women. Vaginal douches, especially those with perfumes or with synthetic dyes, coloured and synthetic toilet papers can also be responsible for allergic vaginitis. Besides itching, there may be other symptoms like redness and swelling of the vulva and vagina,
Generalized itching Itching around the vulva and vagina may be a part of a generalized disease process that causes itching all over the body, e.g. in jaundice, uraemia and other toxic states.
Deficiency Deficiencies of vitamin A, B2 and B12, iron and folic acid may cause itching . These are however more likely to cause itching by decreasing the natural immunity of the body, making it possible for infections to occur. Deficiency of these vital minerals can also cause vaginal dystrophies with itching. This type of vaginal dystrophy is commonly seen in chronic anaemia and in a Vit B-deficiency state called pellagra.
Psychological factors In many women it is seen that extreme nervousness, tiredness, or mental disturbances may cause her to scratch, either at her genitals or at any other part of her body. This scratching increases at night.
The patient may not realize that it is
her scratching that is causing the vulva and vagina to become sore and irritated, not the itching. These irritated and inflamed parts then begin to itch. The itching is secondary to the scratching, not the other way around. It however can cause the beginning of a vicious circle of scratching and itching and scratching again.
Chronic vulval dystrophies White patches or plaques called leucoplakia, may appear on the skin around the vulva due to changes in the skin itself.
These changes may be due to old age when there is atrophy of the skin layers or due to long term irritation by uncomfortable clothes, allergy, autoimmune reactions and fungal infections.
Vulvar cancers Cancers like vulval intraepithelial neoplasia (VIN) or even invasive vulval cancer can cause itching. Other symptoms of these cancers can be a rash or sore whch does not heal, bleeding from the affected areas and a nodular lump on the skin.
Vulvodynia This is a neuropathic condition in which the nerves are inflamed and highly irritable causing intense itching or pain in the vulval and vaginal areas. The trigger may be an infection like a yeast or bacterial infection, but the nerves remain inflamed even after the infection clears up. Intense itching with no identifiable cause is the main complaint in cases of vulvodynia.
Next: Treatment of Vaginal Itching without Discharge
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