Vulvar Itching: Causes and Treatment Options for Women

Genital issues

Hello, doctor.
My mother is about 58 years old and had her uterus removed in her 40s due to uterine fibroids.
Recently, she has been experiencing itching in the genital area for the past year.
She visited a doctor at Chang Gung Memorial Hospital, who performed the surgery, but the doctor said it cannot be cured and did not explain the reason.
She was prescribed topical ointments and oral medications, but none have been effective.
The oral medication caused hair loss, and the ointment did not help at all.
She is so itchy at night that she cannot sleep, and it is difficult for her to cope during the day as well.
She scratches until there are scabs, and sitting down provides some relief, but the itching persists.
She has been on the oral medication for two months with no improvement and feels no difference.
My mother is also worried about the side effects of hormone medications, so she stopped taking them.
She has only been using a topical ointment brought back from Japan, which has provided slight relief.
However, last night, she couldn't sleep and was sitting in her room.
I am unsure how to help her; the hair loss has progressed to the point where she is nearly bald.
What symptoms is my mother experiencing? Could this be related to her having had her uterus removed? She mentioned that there is no discharge, but it feels like something is crawling and biting, causing intense itching in the entire vulvar area and near the vaginal opening, with scabbing present.
Could you please help clarify which specialty she should see and what kind of condition this might be? Thank you.

kiki, 50~59 year old female. Ask Date: 2016/10/09

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, I apologize for being unable to diagnose based on the described symptoms.
If you continue to feel unwell, I recommend consulting another obstetrician-gynecologist for an examination.
Wishing you good health.

Reply Date: 2016/10/09

More Info

Vulvar itching can be a distressing condition, particularly for women who have undergone significant medical procedures, such as a hysterectomy. In your mother's case, her history of uterine fibroids and subsequent removal of the uterus may contribute to her current symptoms, but it is essential to explore other potential causes as well.

Possible Causes of Vulvar Itching
1. Hormonal Changes: After a hysterectomy, especially if the ovaries were also removed, women often experience hormonal changes that can lead to vaginal dryness and vulvar itching. This is due to decreased estrogen levels, which can affect the mucous membranes and skin in the genital area.

2. Infections: Vulvar itching can be caused by various infections, including yeast infections, bacterial vaginosis, or sexually transmitted infections. These conditions can lead to inflammation and discomfort.

3. Dermatological Conditions: Skin conditions such as eczema, psoriasis, or contact dermatitis can also cause itching. If your mother has sensitive skin or has come into contact with irritating substances (like soaps, detergents, or certain fabrics), this could trigger her symptoms.

4. Allergic Reactions: Allergies to personal care products, laundry detergents, or even certain foods can lead to localized itching and irritation.

5. Lichen Sclerosus: This is a chronic skin condition that can cause severe itching and discomfort in the vulvar area. It often requires specific treatment and can lead to skin changes if left untreated.

Treatment Options
Given your mother's situation, it is crucial to approach her symptoms comprehensively:
1. Consult a Specialist: Since her symptoms are persistent and have not improved with over-the-counter treatments, it would be advisable for her to see a gynecologist or a dermatologist specializing in vulvar disorders. They can perform a thorough examination and possibly conduct tests to determine the underlying cause of her itching.

2. Hormonal Therapy: If hormonal changes are suspected, discussing the possibility of localized estrogen therapy (such as vaginal creams or rings) with her doctor might be beneficial. This can help alleviate dryness and itching without the systemic effects of oral hormone replacement therapy.

3. Topical Treatments: While she has tried some topical medications, it may be worth exploring other options. A dermatologist can prescribe stronger topical steroids or other medications that can help reduce inflammation and itching.

4. Antihistamines: If allergies are suspected, oral antihistamines may help reduce itching. However, this should be discussed with her healthcare provider.

5. Lifestyle Modifications: Encourage her to avoid irritants such as scented soaps, bubble baths, and tight clothing. Wearing breathable cotton underwear and maintaining good hygiene can also help.

6. Moisturizers: Using vaginal moisturizers or lubricants can help alleviate dryness and discomfort, especially if hormonal changes are contributing to her symptoms.

Conclusion
Your mother's vulvar itching could be multifactorial, involving hormonal changes, infections, or dermatological conditions. It is essential for her to seek specialized medical advice to identify the root cause and receive appropriate treatment. Encourage her to be open with her healthcare provider about her symptoms, concerns regarding medications, and any side effects she has experienced. With the right approach, it is possible to find relief from her symptoms and improve her quality of life.

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