Most itchy/scratchy problems down there are caused by some form of eczema, and most types of eczema on the vulva are the same as similar problems you might have on other parts of your skin.
There are two sorts of eczema: one sort that happens when something irritating contacts this skin (Irritant contact eczema), and eczema that comes from an internal tendency to skin problems (Internal or endogenous eczema).
Irritant contact eczema
This is where something that comes in contact with your vulval skin might cause an irritation that gives you eczema. The list of potential irritants is almost endless, but the most common culprits are:
Soaps, cleansers, bath additives, perfumes and colourings in toilet paper and pantiliners, “feminine hygiene products”, condoms, sexual lubricants, urine, diarrhoea, sweat, and even creams to treat thrush.
Things that cause heat and friction
Tight pants (especially stretch), G-strings, shaving, waxing, bicycling, too much sex.
Internal (endogenous) eczema
This type tends to occur because of a change from inside your body (we’re not really sure why). Many people who have this tendency also have asthma and hay fever or many have had eczema as children, something we call "atopy". Many people find that they get patches of eczema on their skin if they are tired, run down, or ill. Similarly, lots of women get more eczema in winter, especially in dry weather. This type of eczema tends to run in families. Unfortunately endogenous eczema can also flare up because of contact with irritating things (life wasn’t meant to be easy).
Eczema and thrush
Eczema and thrush are completely different problems, yet they can cause almost identical symptoms. To make matters worse, they can also happen “down there” at the same time.
In general, eczema gives you an itch, and if there is a discharge it is often smelly. Acute thrush, on the other hand, gives makes your vulva itchy and swollen, and also produces a thick “cheesy” discharge which does not smell.
Sorting out eczema
If you think you might have eczema, try to answer the following questions:
- What were you doing/wearing when it started?
- Were you using a different soap/menstrual pad?
- Were you ill, or had gastro-enteritis?
- Had you started taking new medicine, especially antibiotics?
If you can’t get to see your health professional, we suggest that you first try to eliminate any possible cause, and then buy some 1% hydrocortisone ointment (you don’t need a prescription for this however when you ask for it at the chemist you may be asked questions about what you intend to use if for and told not to use it for more than a few days. You DO NOT have to answer intimate questions, simply say you are using it for eczema and will see a doctor if it doesn't work. Don't be scared to use it. See Caring for your skin down there and follow those instructions. Put your 1% hydrocortisone ointment on the itchy spot twice a day for one week. If this hasn’t helped, hopefully you will have been able to see your health professional by then.
A word of caution: everyone tends to assume that vulval itch is usually thrush. This is why most women reach first for thrush creams if they have vulval itch. We think this is a bad idea, for the following reasons:
- If you have eczema, thrush treatments might make it worse
- Eczema treatment won’t make thrush worse
- Eczema treatment costs less than over-the-counter thrush treatments!