What could be causing vaginal itching after intercourse, especially after shaving the vulva and engaging in oral intercourse?

Vaginal Itching After Intercourse: Most Likely Diagnosis and Management

The most likely cause of your vaginal itching is irritant contact dermatitis from shaving, possibly complicated by vulvovaginal candidiasis (yeast infection), and you should start with a topical antifungal cream while avoiding further irritation to the area. 1

Primary Differential Diagnosis

The timing and context strongly suggest irritant contact dermatitis as the primary culprit:

• Shaving-related irritation is the most probable cause given the temporal relationship between shaving the vulva and symptom onset 2
• The vulvar skin is uniquely sensitive and prone to barrier disruption from mechanical trauma like shaving 2
• Oral intercourse can introduce additional irritants (saliva contains enzymes and bacteria) that may exacerbate compromised skin 3

Vulvovaginal candidiasis is the second most likely diagnosis:

• Characterized by pruritus (itching), vulvovaginal erythema, white discharge, and burning 1, 4
• Affects 75% of women at least once in their lifetime 5
• Can be triggered by disruption of the vulvar barrier from shaving 1

Immediate Management Algorithm

Step 1: First-Line Treatment (Start Now)

Apply topical antifungal therapy empirically:

• Use clotrimazole 1% cream or miconazole 2% cream applied to affected areas 1
• Alternative: Fluconazole 150mg oral single dose for convenience 1
• The Centers for Disease Control and Prevention recommends empiric treatment even without confirmed yeast on microscopy, as microscopy misses 20-50% of cases 1

Step 2: Eliminate Irritants Immediately

• Stop shaving the vulvar area - this is critical to allow barrier restoration 2
• Avoid all potential irritants: scented soaps, douches, tight clothing, synthetic underwear 2
• Use only lukewarm water for cleansing 2

Step 3: Restore Barrier Function

• Apply vaginal moisturizers 3-5 times weekly to the vagina, vaginal opening, and external vulvar folds 6
• Use water-based lubricants during sexual activity to reduce friction 6

Follow-Up Timeline

If symptoms persist after 2 weeks of antifungal treatment:

• Return for re-examination and consider culture for Candida species 1
• Evaluate for alternative diagnoses including contact dermatitis, lichen sclerosus, or desquamative inflammatory vaginitis 1, 7

If symptoms recur within 2 months:

• Medical evaluation is necessary to rule out recurrent vulvovaginal candidiasis (≥4 episodes per year requires different management) 1

Partner Considerations

Your partner does NOT need treatment unless symptomatic:

• Vulvovaginal candidiasis is not sexually transmitted, and routine partner treatment is not recommended 5
• Only treat your partner if he develops balanitis (redness, itching, or irritation of the penis) with topical antifungal agents like clotrimazole or miconazole 5
• Oral intercourse can alter vaginal microbiota but does not require partner treatment in asymptomatic individuals 3

Critical Pitfalls to Avoid

Do not continue shaving during treatment:

• Repeated mechanical trauma will prevent healing and perpetuate the cycle of irritation 2

Do not assume this is solely a yeast infection:

• Multiple causes often coexist simultaneously (irritant dermatitis + candidiasis) 2
• Treatment must address both the infection and the barrier disruption 2

Do not delay evaluation if symptoms persist:

• Persistent vulvar itching despite treatment may indicate lichen sclerosus, which requires biopsy if suspected and carries malignant transformation risk 6

When to Seek Urgent Evaluation

• If you develop visible lesions, ulcers, or significant depigmentation 6
• If symptoms worsen despite 2 weeks of appropriate treatment 1
• If you develop systemic symptoms (fever, severe pain) suggesting a more serious infection 1