Differential Diagnosis for Vaginal Itching after Menopause

Single Most Likely Diagnosis

• Vulvovaginal Atrophy (VVA): This condition is a common cause of vaginal itching in postmenopausal women due to the decrease in estrogen levels, leading to thinning and drying of the vaginal walls.

Other Likely Diagnoses

• Yeast Infections: Candidiasis can cause vaginal itching and is common in women of all ages, including postmenopausal women, especially if they have factors like diabetes or use antibiotics.
• Bacterial Vaginosis: An imbalance of vaginal bacteria can lead to symptoms including itching, and while more common in premenopausal women, it can still occur after menopause.
• Allergic or Irritant Contact Dermatitis: Exposure to soaps, douches, or other products can irritate the vaginal area, causing itching in postmenopausal women.

Do Not Miss Diagnoses

• Lichen Sclerosus: A chronic skin condition that can cause itching and is important to diagnose because it can lead to scarring and increase the risk of vulvar cancer if left untreated.
• Vulvar Cancer: Although rare, vulvar cancer can present with itching and should be considered in the differential diagnosis to ensure early detection and treatment.
• Invasive Infections (e.g., Herpes Simplex): Certain infections can cause severe symptoms, including itching, and require prompt diagnosis and treatment to prevent complications.

Rare Diagnoses

• Lichen Planus: An autoimmune condition that can affect the skin and mucous membranes, including the vagina, causing itching and other symptoms.
• Psoriasis: Although more commonly associated with skin lesions, psoriasis can rarely cause vaginal itching in postmenopausal women.
• Vaginal Intraepithelial Neoplasia (VaIN): A precancerous condition that can cause symptoms like itching and should be considered in the differential, especially in women with risk factors for cervical or vulvar cancer.