Gardella C, Eckert LO, Lentz GM. KOH = potassium hydroxide; PCR = polymerase chain reaction. This is very common among women of childbearing age. Wearing loose-fitting clothes and not wearing panty hose. Poor hygiene (eg, in patients who are incontinent or bedbound) can lead to chronic vulvar inflammation due to chemical irritation by urine or feces. Review of systems should seek symptoms suggesting possible causes, including the following: Fever or chills and abdominal or suprapubic pain: Pelvic inflammatory disease (PID) or cystitis, Polyuria and polydipsia: New-onset diabetes. In: Rakel RE, Rakel DP, eds. The irritation of labia may be accompanied by a white or brown discharge, or no discharge at all. Vaginal itching (pruritus), discharge, or both result from infectious or noninfectious inflammation of the vaginal mucosa , often with inflammation of the vulva (vulvovaginitis). Noninfectious vulvitis accounts for up to 30% of vulvovaginitis cases. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. To use the sharing features on this page, please enable JavaScript. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Use condoms to avoid catching or spreading infections. Vaginal itching is the most common symptom of candida vulvovaginitis. The most common types are, Trichomonal vaginitis (usually sexually transmitted). Check if your vaginal discharge is normal. A common contributing factor in girls aged 2 to 6 years is poor perineal hygiene (eg, wiping from back to front after bowel movements, not washing their hands after bowel movements). Forgotten tampon or foreign body. All women have vaginal discharge or secretions which help to keep the vulva and vagina moist and remove bacteria and dead cells. Vaginal discharge is not always present in yeast infections, but when occurring it is typically odorless, thick, white, and clumpy. Dry thoroughly afterward. Rather than using a towel to dry, you may find that gentle use of warm or cold air from a hair dryer may result in less irritation than the use of a towel. This happens due to the change in hormone levels in the body. is among the first to achieve this important distinction for online health information and services. Factors that predispose to overgrowth of bacterial vaginal pathogens include, Use of antibiotics (which may decrease lactobacilli), Alkaline vaginal pH due to menstrual blood, semen, or a decrease in lactobacilli, An intravaginal foreign body (eg, a forgotten tampon or vaginal pessary). Colonization by these bacteria keeps vaginal pH in the normal range (3.8 to 4.2), thereby preventing overgrowth of pathogenic bacteria. Estrogen levels are high in the following situations: During the first 2 weeks of life (because maternal estrogens are transferred before birth), During the few months before menarche and during pregnancy (when estrogen production increases), With use of drugs that contain estrogen or that increase estrogen production (eg, some fertility drugs). The saline wet mount is examined using a microscope as soon as possible to detect motile trichomonads, which can become immotile and more difficult to recognize within minutes after slide preparation. Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning. You usually get heavier discharge during pregnancy, if you're sexually active or if you're using birth control. An itchy vagina or vulva itch is commonly caused by yeast infections. In: Ralston SH, Penman ID, Strachan MWJ, Hobson RP, eds. If clinical criteria and in-office test results are inconclusive, the discharge may be cultured for fungi and trichomonads. This may cause a foul odor. Textbook of Family Medicine. 7th ed. The evaluation of vaginitis requires a di… Vaginal itching is an uncomfortable and sometimes painful symptom that often occurs due to irritating substances, infections, or menopause. Spotting may occur due to scratching the vulva or from vaginal bleeding in the case of a severe infection. Depending on the reason for the irritating vaginal itch, you may also experience burning, swelling, irritation, and an unpleasant vaginal odor with thicker discharge. Vaginal discharge refers to secretions from the vagina. The external genitals are examined for erythema, excoriations, and swelling. Besides itching, other symptoms that come with bacterial vaginosis are inflammation, burning, discharge, and a fishy-smelling odor. An underlying cause can usually be identified from the history and examination. Vaginal itching (pruritus), discharge, or both result from infectious or noninfectious inflammation of the vaginal mucosa , often with inflammation of the vulva (vulvovaginitis). In postmenopausal women, atrophic vaginitis is a common cause. For menopause-related itching, replacing the depleted hormones with creams or tablets may take care of the problem or lessen it. Here are 10 reasons your vagina is itchy and how to stop vaginal itching. In children, a vaginal discharge suggests a foreign body in the vagina. Redness and swelling on the vulva and labia (lips of the vagina) Blisters on the vulva. Some vaginal discharge is normal, particularly when estrogen levels are high. An etiology can be obtained in most cases with careful external inspection and, if necessary, blind vaginal cultures. Besides, people with vaginal itching can experience dry vaginal skin area, vaginal pain, vaginal swelling, vaginal redness, vaginal bleeding and other discomforts, especially at night. The sensation of itch in this site in the absence of a known skin condition is referred to as pruritus vulvae. URAC's accreditation program is an independent audit to verify that A.D.A.M. Then, a cotton swab is used to place secretions on 2 slides; secretions are diluted with 0.9% sodium chloride on one slide (saline wet mount) and with 10% KOH on the other (KOH preparation). follows rigorous standards of quality and accountability. Causes of vaginal pruritus and itching vary depending on the patient’s age. 9th ed. Vulvar itching that gets worse at night has many possible causes. However, pruritus vulvae means the itch is persistent and causes distress. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. 's editorial policy editorial process and privacy policy. Please confirm that you are a health care professional. Philadelphia, PA: Elsevier; 2017:chap 23. Intermittent use of ice packs or warm sitz baths (with or without baking soda) may reduce soreness and pruritus. Another common response of women faced with a vaginal discharge or itch is to wash the vulvar skin vigorously, on the assumption that this will disinfect the area or remove irritants. Prepubertal girls should be taught good perineal hygiene (eg, wiping front to back after bowel movements and voiding, washing their hands, avoiding fingering the perineum). Wearing cotton underwear (rather than synthetic), or underwear that has a cotton lining in the crotch. Dyspareunia is common, and vaginal tissue appears thin and dry. Until the problem is diagnosed, it's best to follow a gentle skin care routine (see "Gentle vulvar care"). Symptoms may also include irritation, burning, erythema, and sometimes dysuria and dyspareunia. The risk of yeast vaginitis may be greater if doxycycline is used for malaria chemoprophylaxis or if other broad-spectrum antibiotics are used for the treatment of traveler's diarrhea or other medical problems. It can also occur on its own. The symptoms are a vaginal discharge with a foul or fishy odor Itchingfishy odor. Itching and/or irritation areand/or irritation are less commonless common. All patients require the following in-office testing: Testing for gonorrhea and chlamydial infections is typically done unless a noninfectious cause (eg, allergy, foreign body) is obvious. Brown or bloody discharge is usually normal, especially when it occurs during or right after your menstrual cycle. They should also be asked about use of hygiene sprays or perfumes, spermicides, vaginal creams or lubricants, latex condoms, vaginal contraceptive rings, and diaphragms. However, some STDs, a broken skin on labia lips and even rough waxing can cause vaginal itching. Thick white vaginal discharge also characterizes this infection. In women of reproductive age, discharge due to vaginitis must be distinguished from normal discharge: Normal vaginal discharge is commonly milky white or mucoid, odorless, and nonirritating; it can result in vaginal wetness that dampens underwear. Differential Diagnosis of Common Complaints. Symptoms may also include irritation, burning, erythema, and sometimes dysuria and dyspareunia. If a soap is needed, a hypoallergenic soap should be used. The KOH preparation is sniffed (whiff test) for a fishy odor, which results from amines produced in trichomonal vaginitis and bacterial vaginosis. Learn about more these and … If no foreign body is present and children have trichomonal vaginitis, sexual abuse is likely. The link you have selected will take you to a third-party website. You have fever or pain in your pelvis or belly area. You have blisters or other sores on your vagina or vulva. Chemicals in bubble baths or soaps may cause inflammation and pruritus of the vulva, which often recur. Pruritus vulvae is itching of the vulva (which includes the mons pubis, labia majora, labia minora, clitoris, perineum and the external openings of the urethra and vagina). Chemicals found in detergents, fabric softeners, feminine sprays, ointments, creams, douches, and contraceptive foams or jellies or creams. There may be a whitish vaginal discharge and a burning sensation. The symptoms of vulvitis can also suggest other disorders or diseases of the genitals. Changes that could indicate a problem such as infection include: Treatment depends on the cause of your symptoms. The vulva is the area of skin just outside the vagina. 1, 3 The discharge can be clear, yellow or green and may be offensive smelling. A.D.A.M. Odorless or have a bad odor. Philadelphia, PA: Elsevier Saunders; 2016:chap 25. Sometimes another infection (eg, gonorrhea, chlamydial infection) causes a discharge. You are concerned that you may have a STI or you are unsure if you have been exposed. You have symptoms that get worse or last longer than 1 week despite home care measures. 7th ed. Call 911 for all medical emergencies. But aggressive cleansing can add to the irritation. Vaginal discharge. Other causes of discharge include vaginal cancer, cervical cancer, and endometrial cancer and, in women who are incontinent or bedbound, chemical vulvitis. Alternative names: Pruritus vulvae; Itching – vaginal area; Vulvar itchingDefinition: Vaginal discharge refers to secretions from the vagina. Vaginal yeast infection, caused by a fungus. Symptoms of vaginitis are one of the most common gynecologic complaints. The colour, smell, and consistency of the discharge can vary, depending on the cause of the problem. Foreign bodies may cause nonspecific vaginitis, often with a scant bloody discharge. Small cracks on the skin of the vulva. The discharge may be: Itching of the skin of the vagina and the surrounding area (vulva) may be present along with vaginal discharge. Other symptoms of vulvovaginitis include redness and soreness (74–82%), 3 pruritus (45–58%) 1, 3 and dysuria (19%). Women may also experience burning, soreness, irritation, pain during urination, or pain during sex. Sexually transmitted disease ( STDs ). Clear vaginal discharge is an often common and normal symptom from the female reproductive system. Last full review/revision Mar 2020| Content last modified Mar 2020, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Some Causes of Vaginal Pruritus and Discharge, Musculoskeletal and Connective Tissue Disorders, National Institute of Child Health and Human Development (NICHD) Protocol. is also a founding member of Hi-Ethics. Many women feel cleaner when they douche, but it may actually worsen symptoms because it removes healthy bacteria that line the vagina. A late discharge at the end of your period can look brown instead of red. It may also occur as a … Avoid douching. verify here. Vaginal secretions are tested using pH paper with 0.2 intervals from pH 4.0 to 6.0. In atrophic vaginitis, discharge is scant and may be watery and thin or thick and yellowish. Past medical history should note risk factors for the following: Candidal infection (eg, recent antibiotic use, diabetes, HIV infection, other immunosuppressive disorders), Fistulas (eg, Crohn disease, genitourinary or gastrointestinal cancer, pelvic or rectal surgery, lacerations during delivery), Sexually transmitted diseases (eg, unprotected intercourse, multiple partners). After menopause, risk of cancer increases, and a bloody or watery discharge is more likely to be due to cancer; thus, any vaginal discharge in postmenopausal women should be promptly evaluated. Clear stretchy discharge is a sign of ovulation, while clear watery vaginal discharge occurs between periods, sexual arousal, or pregnancy. Ovulation (the release of an egg from your ovary in the middle of menstrual cycle). This organism usually causes a thick cottage cheese-like white discharge with vulvar and vaginal itching. If symptoms are moderate or severe or do not respond to other measures, drugs may be needed. If they have unexplained vaginal discharge, cervicitis, which may be due to a sexually transmitted disease, should be considered. Itching related to menopause can be treated with oestrogen cream or tablet. It helps the child report information about the experienced event and improves the quality of information obtained. Vaginal itching can be due to bacterial or yeast infections, eczema, or using harsh soaps and body washes that irritate the delicate skin around the vulva. Vaginal discharge usually isn't anything to worry about if it: doesn't have a strong or unpleasant smell; is clear or white; is thick and sticky; is slippery and wet; You can get vaginal discharge at any age. Allow more air to reach your genital area. A bimanual examination is done to identify cervical motion tenderness and adnexal or uterine tenderness (indicating PID). Also, high estrogen levels maintain vaginal thickness, bolstering local defenses. Wash thoroughly before and after using the bathroom. These include: Dermatological conditions. Symptoms of vaginitis are one of the most common gynecologic complaints. Glands in the cervix and the walls of the vagina normally produce clear mucus. Itching of the skin of the vagina and the surrounding area (vulva) may be present along with vaginal discharge. Clear, cloudy, bloody, white, yellow, or green. Discharge due to cervicitis (eg, due to PID) can resemble that of vaginitis. Abdominal pain, cervical motion tenderness, or cervical inflammation suggests PID. These include bacterial vaginosis, yeast infections, and allergies. Vaginal or vulvar itch (pruritus vulvae) can be both distressing and embarrassing, and more so if it is accompanied by burning, discharge or odor, as is quite often the case.Determining the cause of an itchy vagina is important so as to be able to initiate proper treatment in order to relieve the symptoms and ultimately lead to complete resolution of the condition. † If sexual abuse of a child is suspected, a structured forensic interview based on the National Institute of Child Health and Human Development (NICHD) Protocol can be used. These bacteria help protect against infection. The amount of mucus produced varies during the menstrual cycle. Other causes of vaginal discharge and itching may be: Keep your genital area clean and dry when you have vaginitis. You have burning with urination or other urinary symptoms. Philadelphia, PA: Elsevier; 2018:chap 33. However, irritation, burning, and pruritus are never normal. Which of the following symptoms of premenstrual dysphoric disorder most likely differentiates this disorder from premenstrual syndrome? Normally in women of reproductive age, Lactobacillus species is the predominant constituent of normal vaginal flora. Oral antihistamines lessen pruritus and cause drowsiness, helping patients sleep. The Merck Manual was first published in 1899 as a service to the community. * If discharge is present, microscopic examination of a saline wet mount and KOH preparation and cultures or PCR for sexually transmitted organisms are done (unless a noninfectious cause such as allergy or a foreign body is obvious). The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Genital herpes sometimes causes vaginal itching but typically manifests with pain and ulceration. Learn more about A.D.A.M. Candidal vaginitis produces a white discharge that resembles cottage cheese, often increasing the week before menses; symptoms worsen after sexual intercourse. Vaginal itching (pruritus), discharge, or both result from infectious or noninfectious inflammation of the vaginal mucosa (vaginitis), often with inflammation of the vulva (vulvovaginitis). If you have diabetes, keep your blood sugar levels in good control. If sexual abuse of a child is suspected, a structured forensic interview based on the National Institute of Child Health and Human Development (NICHD) Protocol can be used. Normal bacteria that live in the vagina overgrow and cause a gray discharge and fishy odor. Nonspecific vulvovaginitis is a diagnosis of exclusion. These include chlamydia, gonorrhea (GC), and trichomoniasis. Most women experience a slight vulval itch now and again. You think that your symptoms may be related to a medicine you are taking. BV is not spread through sexual contact. Comprehensive Gynecology. Avoid using hygiene sprays, fragrances, or powders in the genital area. Seller RH, Symons AB. Scaly, thick, whitish patches on the vulva. Dyspareunia is common, and vaginal tissue appears thin and dry. Make sure to seek help from health care provider for the best treatment. Less commonly, a vaginal discharge in children results from sexual abuse. Soaps and unnecessary topical preparations (eg, feminine hygiene sprays) should be avoided. Some vaginal itching may require steroid creams or specially medicated lotions. The amount of discharge varies. 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