Itchiness of the vulva is almost never caused by a sexually transmitted infection, but is usually a result of thrush or a skin condition. The lips of the vulva (the labia) are covered by ordinary skin, so the area can be affected by conditions such as eczema and psoriasis. And sometimes only the vulval skin is affected, so the diagnosis may come as a surprise.

The usual mistake with vulval itching is to assume that you have thrush, and keep on applying anti-thrush creams that you have bought from a pharmacy. This may actually worsen the condition, because you can become allergic to some of the ingredients. If an anti-thrush cream does not deal with the problem within a few days, or if the itching comes back, see your doctor. If you have a skin condition, and not thrush, you need the appropriate treatment.

This section explains the most common causes of vulval itching and what you can do about them. And you can find more information about thrush and trichomoniasis in the section on genital infections.

Thrush is a fungal infection caused by a yeast called Candida albicans. About 1 woman in 5 has Candida in her vagina without it causing any symptoms. Hormones in the vaginal secretions and the friendly vaginal bacteria keep it at bay. But problems can arise when this natural balance becomes upset (for example after a course of antibiotics or due to overwashing), and Candida multiplies. Thrush does not always cause a discharge – the main symptom is itching or soreness, and this can get worse in the week before a period. If there is a discharge, it is usually only slight, does not smell and looks thick and white like cottage cheese. Thrush can be treated by a cream, pessary or tablet available from any pharmacy. If treatment doesn’t help, or you get symptoms recurring, it is best to speak to a doctor to make sure the diagnosis is right, and rule out other causes. You should avoid using thrush creams for a long time, as the sensitive area can develop hypersensitivity to the ingredients, making symptoms worse; or you may be missing the real cause and correct treatment.

Trichomoniasis. Infection with Trichomonas vaginalis can be itchy, cause pain during sex, pain on passing urine, lower abdominal pain, and discharge (often described as frothy, fishy smelling, yellowy-green in colour). However, in 70% it will cause no symptoms at all. It’s a sexually transmitted infection, easily treated but best treated earlier to avoid complications later.

Psoriasis is a skin condition that can be extremely itchy when the genitals are involved. The skin usually becomes bright red, often with painful cracks. The affected area may extend to the groin and to around the back passage (the anus) and between the buttocks. Psoriasis on other parts of the body is scaly (check your scalp, knees and elbows), but in the vulval area it tends to be smooth. You can have psoriasis on the vulva without having it anywhere else on your body.

Lichen sclerosus is another extremely itchy skin condition affecting the vulva. The itching is often so bad that it can affect a sufferer’s sleep. It is most common around the menopause and in girls just before puberty, though it can occur at any age. Its cause is a mystery. The skin looks thin and pale, and the area around the anus may also be affected. If it is not treated, the lips of the vulva eventually shrink, the vaginal opening narrows and sex becomes painful and can tear the skin. Treatment of this condition is simple, with a steroid cream prescribed by a doctor.

Allergies and sensitivities can cause redness and itching. The vulval area seems to be very sensitive to chemicals, probably because the vulva is moist and warm conditions that favour the absorption of chemicals by the skin. It is possible to develop an allergy to almost any chemical substance that comes into contact with the vulva, such as may be present in:

  • skin creams (including anti-thrush creams)
  • perfumes in soaps, bubble baths, shower gels and shampoos
  • disinfectants
  • washing powders and fabric softeners
  • clothing dye (especially yellow)
  • self-adhesive sanitary pads
  • deodorants (including ‘intimate’ ones).

 Excessive washing can irritate the vulval area. Older women who may find it difficult to get into a bath may worry about personal hygiene, with the result that they wash the area too much. There is no need to wash several times a day – once is sufficient with water or plain, unperfumed soap.

Vulval intraepithelial neoplasia is a condition that usually affects older women, and causes itchiness in only a small area. It occurs because the skin in that area has become abnormal. There is a risk that it could develop into a skin cancer of the vulva, so it is important to see your doctor if you suspect you have this condition. Cancer of the vulva is very rare, and tends to affect mainly older women; itching can be the first sign, or there may be a lump or a sore.

Stress or anxiety can cause itching. When you are stressed or anxious, your nervous system is on alert, and small sensations can become amplified into unpleasant itching or even pain. So it is not imaginary, it is real. Treatment with tricyclic antidepressants such as amitriptyline help to reduce the stress and anxiety as the underlying cause, but also help with the oversensitive nerve signals themselves. Psychotherapy may also be of benefit to address underlying stressors.

What You Can Do about Vulval Itching

  • Start by trying to eliminate anything that could be causing an allergy or sensitivity.
  • Avoid swimming while you have the irritation – the chlorine may make it worse.
  • If you have been applying cream from the pharmacy for more than 1 week, and you still have the problem, stop using it. You may have developed a sensitivity to one of the ingredients.
  • If the itch is really bad, you may be scratching in your sleep, causing more damage. Keep your fingernails short and wear cotton gloves when you go to bed (you can buy them from a pharmacy).
  • If you think thrush is a possibility, and you have not already tried thrush treatment, this is available in pharmacies.
  • Antihistamine tablets can help reduce itch, and if itching is particularly disturbing sleep, a sedating antihistamine rather than one of the modern “non drowsy” ones might be helpful.
  • Avoid using bubble baths or shower gels in the area.
  • Do not put disinfectant in the bath.
  • Avoid allowing shampoo from your hair running down and become trapped in the vulval skin folds. You may try washing your hair in the sink or leaning forward in the shower.
  • Do not use ‘intimate’ deodorants or apply deodorant to sanitary towels.
  • Do not squirt soapy solution or antiseptic into your vagina to clean it (douching) – the vagina cleans itself very efficiently, so douching in this way is not necessary, and may be harmful.
  • Don’t wear tight, elasticated ‘support’ pants, instead choose cotton underwear.
  • Choose a detergent labelled ‘for sensitive skin’ for washing your underwear, and avoid fabric softeners.
  • Try adding two handfuls of ordinary salt to your bath water, or bathe the area with salted water (a heaped tablespoon of table salt in a sinkful of warm water).
  • If you are so sore that passing urine is very painful, pee in the bath, or wash the urine away from the vulval area using a jug of warm water while you are on the toilet.
  • Gently dab yourself dry after peeing rather than rubbing too hard with tissue.
  • Use a barrier cream or Vaseline (petroleum jelly) in the area.
  • Wash with plain water, an unperfumed soap or wash with an emollient (unperfumed moisturiser) like aqueous cream.


First published on:
Reviewed and edited by: Dr Laura Gush
Last updated: May 2021

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