From the Guidelines
Self-management of vaginal pruritus can be approached with several at-home treatments before seeking medical care, including maintaining good hygiene, wearing loose-fitting cotton underwear, and applying over-the-counter antifungal creams like clotrimazole or miconazole for 1-7 days if a yeast infection is suspected. The most recent and highest quality study, 1, provides guidance on the management of vulvovaginal candidiasis, which is a common cause of vaginal pruritus. According to this study, uncomplicated vulvovaginal candidiasis can be effectively treated with either single-dose fluconazole or short-course fluconazole for 3 days, both of which achieve >90% response.
Key Self-Care Measures
- Maintain good hygiene with gentle, unscented soap and water to clean the external genital area, avoiding douching which disrupts vaginal pH
- Wear loose-fitting, cotton underwear and avoid tight clothing to reduce moisture and irritation
- Apply over-the-counter antifungal creams like clotrimazole (Canesten) or miconazole (Monistat) according to package instructions, typically for 1-7 days, if a yeast infection is suspected
- Use cold compresses or cool baths with colloidal oatmeal to provide temporary relief
- Avoid potential irritants such as scented products, bubble baths, and fabric softeners
When to Seek Medical Care
If symptoms persist beyond 7 days, worsen, recur frequently, or are accompanied by unusual discharge, odor, fever, or pelvic pain, consult a healthcare provider. These self-care measures work by reducing irritation, maintaining proper vaginal pH balance, and addressing common causes like yeast infections, which account for many cases of vaginal itching. Remember that persistent symptoms may indicate other conditions requiring professional diagnosis and treatment, as noted in 1, 1, 1, and 1.
From the FDA Drug Label
Use treats vaginal yeast infections relieves external itching and irritation due to a vaginal yeast infection Directions ... external cream: use the same tube of cream if you have itching and irritation on the skin outside the vagina. Warnings ... When using this product do not use tampons, douches, spermicides, or other vaginal products Stop use and ask a doctor if symptoms do not get better in 3 days
For self management of vaginal pruritus, the patient can use clotrimazole (TOP) to relieve external itching and irritation due to a vaginal yeast infection.
- The patient should insert one applicatorful of cream into the vagina at bedtime for 3 days in a row.
- For external itching and irritation, the patient can apply a small amount of cream to the itchy, irritated skin outside the vagina, 2 times daily for up to 7 days as needed.
- The patient should not use tampons, douches, spermicides, or other vaginal products while using clotrimazole.
- If symptoms do not get better in 3 days, the patient should stop use and ask a doctor 2, 2, 2.
From the Research
Self-Management of Vaginal Pruritus
- Vaginal pruritus, or itching of the vagina, can be caused by various factors including vulvovaginal candidiasis, chronic dermatoses, and other conditions 3.
- The most common cause of vulvar pruritus is vulvovaginal candidiasis, which can be treated with topical or oral antimycotic drugs such as clotrimazole 4, 5.
- Clotrimazole has been shown to be effective in treating vulvovaginal candidiasis, with high cure rates and minimal adverse reactions 4, 5.
- In addition to antimycotic treatment, basic moisturizing care and avoidance of potential triggering factors are essential elements of treatment for vulvar pruritus 3.
- For recurrent candidiasis, a combined systemic and topical therapy approach has been proposed, using fluconazole and metronidazole plus clotrimazole, along with adjuvant oral probiotic therapy 6.
- Oral contraceptive use has been correlated with a higher incidence of positive vaginal cultures at four weeks posttherapy, suggesting that hormonal factors may play a role in the development of vulvovaginal candidiasis 7.
Treatment Options
- Topical clotrimazole cream or vaginal tablets can be used to treat vulvovaginal candidiasis 4, 5.
- Systemic fluconazole can be used in combination with topical metronidazole and clotrimazole for recurrent candidiasis 6.
- High-potency glucocorticoids can be used to treat chronic dermatoses such as lichen sclerosus and vulvar eczema 3.
Prevention and Management
- Basic moisturizing care and avoidance of potential triggering factors can help prevent and manage vulvar pruritus 3.
- Probiotic therapy may be useful in restoring the vaginal lactobacillus species and preventing recurrence of candidiasis 6.
- Avoiding oral contraceptive use or using alternative methods may help reduce the risk of developing vulvovaginal candidiasis 7.