From the Guidelines
Vulvovaginal pruritus is most commonly caused by vulvovaginal candidiasis, a condition characterized by yeast colonization, typically by Candida albicans, as reported in the 2022 study by 1. The causes of vulvovaginal pruritus can be multifactorial, including:
- Yeast infections, such as vulvovaginal candidiasis, which affects 70-75% of women during their lifetime 1
- Bacterial vaginosis, which can cause vaginal discharge, odor, and irritation 1
- Sexually transmitted infections, such as trichomoniasis, which can cause vaginal discharge, odor, and irritation 1
- Skin irritation, which can be caused by mechanical, chemical, or allergic factors 1 It is essential to note that the diagnosis of vulvovaginal pruritus should be based on a combination of clinical presentation, microscopic examination, and laboratory testing, as some cases may have negative microscopic findings, but still be positive for yeast or other pathogens 1. To manage vulvovaginal pruritus, it is crucial to:
- Practice good hygiene, such as wiping from front to back after using the bathroom
- Avoid douching or using scented products in the vaginal area
- Wear breathable cotton underwear
- Practice safe sex to reduce the risk of sexually transmitted infections If symptoms persist or worsen, it is essential to seek medical attention to rule out more serious conditions, such as complicated vulvovaginal candidiasis or other infections 1.
From the Research
Causes of Vulvovaginal Pruritus
The causes of vulvovaginal pruritus can be attributed to various factors, including:
- Infectious causes:
- Noninfectious causes:
- Atrophic vaginitis, which is treated with hormonal and nonhormonal therapies 2
- Irritant, allergic, and inflammatory vaginitis, which are less common and account for 5% to 10% of vaginitis cases 2
- Desquamative inflammatory vaginitis and vaginal erosive disease, which are also noncandidal causes of vaginitis 3
Symptoms and Diagnosis
The symptoms of vulvovaginal pruritus can vary depending on the underlying cause, but common symptoms include:
- Abnormal vaginal discharge, odor, irritation, itching, or burning 2
- Malodorous vaginal discharge and vaginal burning or itching in bacterial vaginosis 4
- Itching, burning, white discharge, vulvar or vaginal erythema, painful intercourse, and stinging on urination in candidal vulvovaginitis 5
- Profuse, yellow-green discharge and vaginal or vulvar irritation in trichomoniasis 5 Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing, including Amsel criteria, Gram stain, and molecular tests 2, 4
Treatment
Treatment of vulvovaginal pruritus depends on the underlying cause, and may include:
- Oral or topical antifungal agents for candidal vulvovaginitis 5
- Oral or topical metronidazole or clindamycin for bacterial vaginosis 2, 5
- Oral metronidazole or tinidazole for trichomoniasis 2, 5
- Hormonal and nonhormonal therapies for atrophic vaginitis 2
- Topical clindamycin and steroid application for inflammatory vaginitis 2