Care during Pregnancy
Amenorrhoea / Lack of Menses
Sexually Transmitted Diseases (STD)
VAGINAL ITCHING WITHOUT DISCHARGE
Written by : Dr.M.D.Mazumdar, MD
Vaginal itching without discharge is very rare. 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
- 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.
- Skin diseases : Skin diseases like psoriasis, seborrhoeic dermatitis and scabies may affect the vulval area alone or may simultaneously affect other parts of the body. Commonly, infection of the genital area by these organisms is a result of spread from the disease from other parts of the body by contaminated fingers.
- 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.
- 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.
- Glycosuria : The passage of glucose in the urine 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. But, glycosuria is more commonly a predisposing condition for infections like candidiasis 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 antiseptics used to bathe as well as 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.
- 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.
Treatment is as per the cause.
- Fungal infections of the vulva: Fungal infections can be cured by using vaginal tablets or creams of antifungal substances like miconazole or clotrimazole. These creams or ointments should be applied two times a day on the affected parts of the vulva and vagina for at least 1 week.
Tablets of either miconazole or clotrimazole can also be used to prevent spread of infection from the vulva into the vagina. The tablets are used in the dose of 1 tablet 2 times a day to be inserted deep into the vagina for 3 days or 6 days depending on the seriousness of the infection.
Combination packs of antifungal creams and tablets are also available. These contain both prefilled applicators to be applied inside the vagina as well as an external cream to be applied on the vulva.
- Parasitic infections of the vulva:: Parasites like threadworms (also called pinworms) are treated by the anti-worm drugs like Pyrantal Pamoate, PinX, Combantrin etc which are all available without prescription.
Anti-lice medicines like Nix or Elmite or Permethrin 1% should be used to remove lice from pubic hair. Nix and Elmite are contraindicated in pregnant and breastfeeding women.
- Deficiencies of vitamins and minerals: Supplements of the deficient nutrients should be taken - Vitamins like B-Complex Capsules, High strength Multivitamin Capsules, Iron capsules to correct anemia and Folic Acid tablets should be taken.
Other sypplementary vitamins and minerals that increase the resistance of the body to infections of various types are Vitamin C 500 mg tablets taken once daily, Acidophilus tablets to stimulate growth of healthy lactobacilli in the vagina and to increase the acidity of the vagina and prevent infections and Zinc tablets.
- Diagnosis of Glycosuria (sugar in the urine): All women with vaginitis should have their blood sugar level checked, more so if she is above 35 years of age. Home test kits for glycosuria can be used at home if necessary.
If the blood sugar is high, it should be brought under control under medical supervision.
- Unidentified cause of Vaginitis with itching: If a cause cannot be identified, it is best to advice the patient to improve her general hygiene, use clean vaginal pads and wipes, avoid synthetic underclothes, wash the anal and vulval area carefully and to wear loose, cotton clothes. Vaginal douches and perfumed and coloured toilet paper are best avoided.
A course of antifungal creams and pills like miconazole or clotrimazole, even when fungus cannot be absolutely identified can be used. Antihistaminics to control the itching and 1% cortisone creams locally may also be helpful.
Treatment results are best when the patient is examined by a gynecologist and a swab taken from the vagina or vulva to identify the cause of vaginal itching without discharge.
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