Itching of the vulva

Pruritus vulvae is literally, itching of the vulva.

Frequency of the condition is unknown, but it is speculated that majority of women suffer from it at some time in their lives (mostly during postmenopausal period due to oestrogen deficiency) (1).

The history of the condition and a thorough clinical examination may suggest the cause.

• the presenting complaint should be considered in context of the general health of the patient and examination for signs of generalised skin conditions should be undertaken.
• history should inquire about:
  • onset, severity and quality of itch, timing of itch
  • relieving/exacerbating factors
  • bathing/skin care history
  • previous treatments
  • itchy contacts, pets, sexual exposure
  • relation to coitus and menstruation
  • contraception
  • travel history
  • topical application to identify irritants and allergens
  • previous history of itch/rash
  • past medical history like atopy, diabetes mellitus, etc.
• physical examination
  • vulva and genital tract should be examined.
    • primary skin lesions and secondary skin lesions resulting from scratching (excoriation, hyperpigmentation and lichenification),
    • look for any discharge
• laboratory examinations
  • a cervical smear should be taken
  • vulval and high vaginal swab should be taken
  • if there is leukoplakia present then the patient should be referred for vulval biopsy.

Patients presenting with this condition should be screened for diabetes (urine test for glucose).

Reference:

• (1) Swamiappan M. Anogenital Pruritus – An Overview. Journal of Clinical and Diagnostic Research : JCDR. 2016;10(4):WE01-WE03.