Why am I so itchy?!?
July 11, 2019 10:16 AM   Subscribe

I’m a mid-thirties lady with a frustrating, uncomfortable amount of vulvar itchiness. What should I be doing differently to fix it?

I get a lot of vulvar itchiness. It’s frustrating and uncomfortable. What should I do or what kind of doctor should I see to fix this?

The itching is almost always external. Typically, it’s right inside my labia majora, where the skin shifts from pubic hair to softer skin, usually only on one side. Right now, it’s totally external, in the middle center of my pubic hair. Very occasionally, it will feel farther down and like it’s right near/inside my vagina.

The itching tends to come in cycles. It’ll be totally fine for a week or two, then come on really strong for another week or two. It tends to happen later in my cycle, after ovulation, and then calm down when I’m on my period.

Sometimes the itchiness seems to be worse after I’ve pooped, but I’m not sure if that’s irritation from tiny bits of leftover poop despite thorough wiping or just psychosomatic/paying more attention to that region.

I’ve had multiple rounds of treatment for BV, but sometimes I go in to get checked and there’s nothing under the microscope. I also only get the yellow/green smelly discharge of BV occasionally. Most of the time I’m just itchy.

One time I tried Monistat over the counter. The burning was waaaay worse than the itchiness, so I’m not super excited about trying that again.

I wear cotton underwear and try to wear breathable pants. My underwear get washed with all the other laundry on cold or warm with free and clear detergent, no sprays, and no dryer sheets.

I do have some eczema/psoriasis/other undefined skin stuff on my hands, knees, and other less sensitive parts of my body. Could this be more of the same but in a more annoying place?

I keep my pubic hair long and untrimmed. I’m almost 20 months postpartum with my first child and still breastfeeding, but the itchiness started before I got pregnant. I’m not having any PIV sex and not much non-PIV sex because we have no energy/time with a small child.

Any ideas? Would love to get a handle on this. Thank you!
posted by anonymous to Health & Fitness (34 answers total) 4 users marked this as a favorite

Could it be your soap, conditioner, or laundry detergent? Try hypoallergenic/fragrance free stuff, and if that doesn't solve it, try additionally avoiding propylene glycol (for that, I use Stony Brook unscented shampoo/conditioner or Desert Essence unscented, which I currently have to mail order, and Seventh Generation free & clear detergent, which is more available at retail stores).
posted by amtho at 10:20 AM on July 11 [1 favorite]

I do have some eczema/psoriasis/other undefined skin stuff on my hands, knees, and other less sensitive parts of my body. Could this be more of the same but in a more annoying place?

It definitely could. The other thing you might try is moisturizing with something very simple and gentle like sweet almond oil, jojoba oil, or squalane. I would avoid coconut oil since it can cause clogged pores.
posted by fiercecupcake at 10:25 AM on July 11 [2 favorites]

Could you have one of the bacterial strains other than gardnerella? The typical swab at your gyno tests just for that one strain of BV unless you request otherwise.
posted by shaademaan at 10:25 AM on July 11 [1 favorite]

This is hard as hell to differentiate from actual dermatological symptoms, but I have had this happen as a result of how I was sitting. I'm not entirely sure if it's circulatory (basically, my biz falling asleep) or nerve-related, as I also have sciatica that flares on and off and seems to maybe not like how I'm sitting sometimes, and the two don't 100% correlate but they don't not correlate either.

I bring it up because it does often happen only on one side (opposite side of my sciatica, most of the time), like you mentioned. There is no visible irritation unless I do something unwise trying to mitigate the itching.

I finally bought a very chunky gel-and-foam seat cushion and it seems like it has gone away, but I've also reached perimenopause since the last time I had serious itching so who the hell knows, that might have changed something.
posted by Lyn Never at 10:33 AM on July 11 [1 favorite]

I would strongly recommend you get patch tested for allergies. At the very least it'll help you narrow down the problem. At best it'll solve lots of your problems.
posted by matrixclown at 10:35 AM on July 11 [1 favorite]

Pelvic floor dysfunction can cause genital itching, which might be in line with the negative BV tests and increased itching after pooping. You don’t always have incontinence or other issues when you have pelvic floor dysfunction so it can be really hard to tell on your own. Ask your gynecologist or urologist if they can refer you to a physical therapist who specializes in pelvic floor issues. Pelvic floor PT is a drag—the physical therapist has to feel around in your vagina for trigger points—but it’s so worth it to not be uncomfortable and frustrated.
posted by corey flood at 10:42 AM on July 11 [8 favorites]

If you happen to have lanolin around anyway, maybe that would help?
posted by teremala at 10:52 AM on July 11 [1 favorite]

Could be thrush?
posted by quacks like a duck at 11:03 AM on July 11

I have a lot of sensory/nerve issues and body hair is a bad trigger for me wrt the way it pulls on the skin it's growing from, moves from clothing chafing, and touches skin nearby. When I still had a uterus, it always got worse during the pms week. Whether or not hair is a trigger for you, increased sensitivity to irritation is very common during that week for many women. It's up to you if you want to consider trimming (not shaving) your hair a little to see if it helps but I can't see how it would hurt.

However, the fact that it's mostly unilateral, and also that it occasionally worsens after poop straining, makes me wonder if it's nerve-related. Have you ever had any kind of bruising injury in the groin area, like maybe from jumping onto a bike seat too quickly or something? Or even a badly pulled groin muscle? If it had started postpartum I would've guessed it could be birth related, assuming a vaginal birth.
posted by poffin boffin at 11:16 AM on July 11 [1 favorite]

If you've already asked your GYN if it were me I'd see a dermatologist next. While it could be caused from something going on inside I would want a dermatologist to try their skin stuff too in case any of that works.
posted by bleep at 11:55 AM on July 11 [1 favorite]

I am experiencing the same symptoms, for a couple years now. Using only Dove sensitive soap anywhere near there has helped a little. I'm going to try this salve next but I can't personally recommend it yet.
posted by mcgsa at 11:58 AM on July 11

I keep my pubic hair long and untrimmed.

Trim it closely. Whenever I start getting itchy in that area, it nearly always starts up when I haven't done a proper trim down there. I would try that and sleeping without underwear for a week or two since they're low effort fixes, and if neither of those work, then move on to some of the other suggestions above.
posted by yasaman at 11:59 AM on July 11 [1 favorite]

Have you been tested for a yeast infection in addition to BV? Yeast often thrives as BV dies. I'm going to link to a comment I made in a thread yesterday about BV: the latest thinking is that the penises in our lives could be a carrier for this, which is why BV recurs so frequently. Even if you're not having much or any PIV sex, it could be you have some lingering issues from BV treatment. And there are pill treatments for yeast, too, not just suppository and cream treatments, but they're by prescription in the US, as I understand it.
posted by bluedaisy at 12:07 PM on July 11 [2 favorites]

Definitely get tested for a yeast infection. You can take an oral med if the topical and inserts dont play nice with your skin. It could also be dry skin, so seconding jojoba oil as a possible remedy.

Long shot -- it might be a small cyst deep under the skin. They can be quite itchy. Can you feel a small lump under it? If so you can get it lanced and removed so it doesnt come back.
posted by ananci at 12:33 PM on July 11 [1 favorite]

Did your gyn specifically clear you for yeast? I mention it just because I wouldn't discount yeast as the culprit here - whenever I've had a yeast infection, my symptoms have almost exclusively been been exterior, which was counter to what I thought they felt like before I had my first one.

Assuming your doctor didn't rule out a yeast infection entirely: on the off chance that you tried the Monistat one day dose or three day dose, it might be worth giving the seven day dose a try. It's gentler. If Monistat is a no go altogether, I would definitely ask about the fluconazole pill. It's low-stakes and if it doesn't work, you can eliminate yeast as a cause and go on to try the other suggestions here.
posted by superfluousm at 12:35 PM on July 11 [3 favorites]

Your symptoms sound just like mine and I'm happy to report the home remedy from my dermatologist rid me of the scourge.

I did the patch tests and other things, but in my case, the labial itching was due to ringworm.

The treatment was simple, if a bit weird. Fungi (ringworm is a fungus) do not do well with acid. For 10 minutes twice a day, I soaked black teabag bags in vinegar and used them as a poultice on the area.

Completely cleared up, I'm happy to report.

I sit a lot for my job sometimes and, once I a while, I prophylacticly apply a poultice if things start to feel dicey. The OTC medicines did burn. So did the vinegar for a bit, but it was also soothing. Tea is also acidic on its own.

In short, I 2nd the visit to a dermatologist who can test for ringworm.
posted by rw at 12:36 PM on July 11 [4 favorites]

The itching is almost always external. Typically, it’s right inside my labia majora, where the skin shifts from pubic hair to softer skin, usually only on one side. Right now, it’s totally external, in the middle center of my pubic hair.

I strongly suspect I know what this is, it happened to me too! I think you have a recurring fungal infection - but on your skin, not in your vagina. Jock itch. The outer labia is a very common place for this because (despite your best efforts) it's damp, it's dark, and due to the hair and nearby sensitive bits it's more difficult to really scrub the skin there effectively.

If I'm right, a dermatologist can give you a cream that should clear this right up.
posted by showbiz_liz at 12:39 PM on July 11 [2 favorites]

Other than the current itchiness being (I assume) on your mons, this sounds exactly like lichen sclerosis, especially the fact that it also affects your anal region. It frequently affects people with other autoimmune skin diseases, too.
posted by HotToddy at 12:54 PM on July 11 [2 favorites]

Agreeing that this sounds a lot like tinea cruris or jock itch.

It's very easy to keep passing back and forth from your feet to vulva, so if you have any symptoms of athlete's foot (yellow, opaque nails or dry, cracking heels are symptoms I don't think people realize is often due to fungus) it's important to treat both.
posted by Juliet Banana at 12:56 PM on July 11 [1 favorite]

PS - topical treatments will only help so much if your body is naturally susceptible to fungal infections (in addition to getting jock itch, I also have issues with my scalp, for example). I can't recommend daily probiotics enough to beef up your body's natural immunity to this stuff.
posted by Juliet Banana at 12:57 PM on July 11

Midwife and NP here (TINMA, etc.). If you’ve got eczema and psoriasis, my guess is that it’s one of those things, in which case an NP, CNM, or doctor (gyn/derm/PCP) should be able to see on exam and treat you. It’d be helpful if you can get an appointment to be seen when symptoms are present. Other possibilities are yeast (though typically this would be seen under microscope on exam in office; however, if you haven’t had a culture sent out, could be missing some spores and/or BV); could be hormonal (cycle timing makes me think it might be—this could be causing an eczema flare perhaps?); lichen (again, would be seen on physical exam); dry skin exacerbated by postpartum and breastfeeding estrogen shift; other fungal infection (eg, tinea-would have same treatment as yeast).

A couple of other thoughts/questions: what type of delivery did you have and did you have any stitches? I know you said you had this before baby, but perhaps labor and delivery affected the tissues or you have itching where the stitches were. Also, what are you using to wash? If you’re using soaps, gels, bubble baths, etc., I’d stop that immediately, as it’s likely drying out your skin and can lead to BV. Finally, for anyone who comes to me with a long history of itching, I offer an STI screen, even if you’re not sexually active right now. Knowing that you don’t have an STI now will help narrow down the diagnosis, and if you do have one, it can be treated.

Hope you’re feeling better soon.
posted by stillmoving at 1:00 PM on July 11 [2 favorites]

After spending thousands of dollars on dermatologists for this issue, here is what I have been told:

never wash your vulva with soap, not even unscented soap;

never wash your vulva with hot water;

keep your fingernails as short as humanly possible [no white bits of fingernails, or close to no white bits] so that you don't scratch in your sleep, and also to protect your vulva from tiny abrasions when you're washing in the shower or patting yourself dry after urinating - even the tiniest of abrasions can sting/itch when urine gets on them;

always wear 100% cotton underwear. No exceptions, ever;

avoid wearing pantyhose or skinny jeans;

your underwear should preferably be in a natural [unbleached cotton] colour, dye can leach out and irritate your skin. Of all the dyes, black is the most likely to leach out and irritate your vulva;

changing your underwear 2-3 times a day in summer when you sweat can help, as sweat is very irritant;

toilet paper is harsh, consider using fragrance-free facial tissues [like Kleenex Hypoallergenic silk touch] instead, and very gently blot your vulva dry, don't rub;

always use fragrance-free laundry liquid. Laundry liquid dissolves better than laundry powder, and is less likely to leave vulva-irritating residue;

NEVER use Canesten hygiene laundry rinse in the wash, according to my dermatologist it gets into the seams and irritates your skin for the next TWELVE TO THIRTEEN washes;

Anything you eat can get into your urine. So watch out for eating chilli/paprika and [less of a problem, but still some problem] ginger - it produces urine that irritates skin further if it is already irritated. And if you're allergic to Balsam of Peru, don't eat cinnamon - people who are allergic to Balsam of Peru will react to traces of cinnamon in their urine.
posted by Murderbot at 1:08 PM on July 11 [4 favorites]

You can absolutely get psoriasis in that area - it's not the most common presentation, but it's a thing. (Ask me how I know.)
posted by restless_nomad at 1:18 PM on July 11

I got rid of this by using OTC anti-itch cream w/no steroids or other meds, just lidocaine iirc. It was supposed to be a stopgap until I could see someone but it turns out it was just a weird brain blip or I was subconsciously scratching/irritating it. After like a week of aggressive anti-itch treatment it went away forever!
posted by internet fraud detective squad, station number 9 at 1:23 PM on July 11

Seconding lichen sclerosis.
posted by seemoorglass at 1:23 PM on July 11 [1 favorite]

Thirding lichen sclerosis. My dermatologist diagnosed it correctly and set me up with clobetasol, which worked a charm. It's easy for a dermatologist to recognize.
posted by Dolley at 1:37 PM on July 11 [1 favorite]

How much water are you drinking? Dehydration could be a factor.
posted by bile and syntax at 1:50 PM on July 11

A fourth for lichen sclerosus. I had it for years, and my GYN had no clue what was going on, so I ended up going to a vaginal specialist. A dermatologist is probably easier to find, though!
posted by velvet_n_purrs at 3:02 PM on July 11

I had this!!! After a lichen sclerosus diagnosis and a year of steroids that just made everything worse I found out that I’m allergic to blue dye. Shouldn’t have been an issue because I too used plain white cotton underwear EXCEPT that I eventually figured out that the dye was leaching out of my jeans when I washed everything together.

5 years of terrible pain and itching and a lifetime of discomfort and all I needed to do to fix the issue entirely was... wash my underwear separately. I don’t even have to limit myself to white underwear anymore, though cotton is a must. It was absolutely life changing for me.
posted by lydhre at 3:46 PM on July 11 [2 favorites]

I'm diabetic and just as a datapoint, if my blood sugar runs particularly high for a week or so, I get the most exhaustingly awful itching around my vulva and labia. I don't often have any other symptoms apart from maybe a watery discharge, sometimes, but I know thrush is common in similar situations. It really is excruciating.
posted by Martha My Dear Prudence at 4:11 PM on July 11 [3 favorites]

Is your underwear too small? Once I sized up to an appropriate size, I had no more itching.
posted by yueliang at 4:54 PM on July 11

If you are diabetic you are much more vulnerable to jock itch - it might be worth getting your sugars tested just in case.

Post partum your hormones may have taken a nose dive in order to space the kids or be doing some eccentric fluctuations - Does the itching get better or worse according to your cycle, if you have one? Sometimes going on the pill will help with itchies if hormones are part of the picture.

Is anyone touching you with hands that haven't been washed? You could try making sure that you wash your hands before using the toilet to see if that helps. I've heard of cases where women were getting infections from their partner's hands also.
posted by Jane the Brown at 6:23 PM on July 11

N-th-ing getting specifically tested for yeast infection, and if relevant, asking your doctor about the oral fluconazole pill. Monistat pessaries can indeed burn badly — and don’t always kill the yeast infection anyway. The oral fluconazole tablet will generally knock it out fast, with no burning. Absolute worst case I’ve ever had required two oral doses, and that was a real outlier of a persistent one.

You may also want to get tested for a UTI at the same time as yeast. They can be co-morbid. It is extremely uncomfortable when they occur together, and doesn’t necessarily feel the same as either thing by itself.
posted by snowmentality at 7:27 PM on July 11 [1 favorite]

Seconding see a pelvic floor physio to see if you have pelvic floor dysfunction, specifically hypertonic PF muscles. Especially if you have any other pelvic symptoms (bloating, pelvic pain or discomfort, constipation, anything urinary like frequency or urgency, a sore tailbone). If you have no other symptoms, then see a gyno first and get tested for yeast. In the meantime you could try a good probiotic and cutting down sugar/carbs to see if it helps at all.
posted by DTMFA at 8:39 PM on July 11 [1 favorite]

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