Vaginal Itching without Discharge
Written by : Dr.M.D.Mazumdar, MD
Previous: Causes of Vaginal Itching without Discharge
Treatment of vaginal itching starts with diagnosis of the cause of the itching. A thorough examination will identify causes like lichen sclerosis, lichen simplex, eczema or psoriasis.
Lice and scabies can also be diagnosed by physical examination.
Swabs may be necessary for diagnosis of a bacterial or fungal infection or menopausal changes in the vagina. Patch tests are necessary to see if any contact allergy is present.
A skin biopsy will help in cases where there is itching with ulcers, sores, growths or depigmented areas to identify leukoplakia or skin cancers.
Treatment is as per the cause.
Postmenopausal Vaginitis Postmenopausal vaginits occurs due to a low estrogen level in the blood causing thinning and drying of the vaginal tissues. These thin tissues are also less resistant to fungal infections.
The standard treatment is to prescribe a course of estrogen cream to be applied thice daily for a week and then gradually tapered off in the next 2-3 weeks. Simultaneous treatment of fungal infections can be carried out by using vaginal tablets or creams of antifungal substances like miconazole or clotrimazole. Oral estrogen tablets are usually not necessary unless the itching is very severe, or, if the itching is not controlled by vaginal cream application.
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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.
Scabies is treated by 5% permethrin cream or lotion.
Skin conditions Skin conditions like psoriasis or eczema need specialized treatment. The intense itching can be controlled by hydrocortisone ointment, moisturisers and soothing oatmeal baths. But this may not be adequate and ointments like Tacrolimus may be necessary.
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.
Lichen Sclerosis/Lichen simplex These are both uncommon causes of vaginal itching without discharge but both can cause severe, intense itching. A skin biopsy may be necessary to diagnose these conditions and appropriate ointments must be used for a long time.
Vulvodynia This condition can be treated by neuropathic drugs like gabapentin (Neurontin). In some cases, antihistaminics or sedative tricyclic antidepressants like amitriptylline may be needed.
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 supplementary 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.
Some general measures are beneficial in all cases of vaginal itching:
- Improve the general hygiene. Wash the genital area well with lukewarm water at least twice daily, being particularly careful to wash within the folds of skin.
- Use clean vaginal pads and wipes.
- Wash the anal and vulval area carefully from front to back.
- Wear loose, cotton underclothes and outer wear.
- Avoid nylon and other synthetic material.
- Vaginal douches and perfumed and coloured toilet paper are best avoided.
- Avoid scratching the area as far as possible.
- Take a probiotic or a cup of yogurt daily to maintain the vaginal ph.
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