Vaginal itching: causes, red flags and when to get it checked

The skin of the vulva and the lining of the vagina is sensitive to changes in acidity, hormones, moisture and irritants. When balance is upset or the skin barrier is damaged, itch results. Telling apart infection, hormonal change and skin disease usually needs a swab or an examination rather than guesswork.

• Vaginal thrush (candida): itch, soreness, thick white discharge, redness, often after antibiotics or in pregnancy or diabetes.

• Contact dermatitis from soaps, wipes, scented products, pads, latex, detergents and douching.

• Menopausal dryness and thinning (genitourinary syndrome of menopause).

• Bacterial vaginosis and trichomoniasis, with altered discharge and smell.

• Sexually transmitted infections such as herpes, genital warts and pubic lice.

• Skin conditions: eczema, psoriasis, lichen planus and lichen sclerosus.

• Threadworms, urine or faecal leakage irritating skin, and diabetes.

• Vulval precancer or cancer, which is uncommon and causes persistent itch, a lump, ulcer or skin change.

Persistent itching despite treatment, a lump, ulcer or sore, white or red patches, skin thinning or scarring, bleeding, pain, bloody or foul discharge, recurrent infections, and itching with symptoms of diabetes need further assessment.

• Same-day GP or sexual health clinic: itching with fever, severe pain, blisters or ulcers.

• Urgent GP: a persistent lump, sore, ulcer or skin change on the vulva.

• GP or sexual health clinic within a week or two: itching that recurs, does not respond to treatment, or with unusual discharge.

• Pharmacist: typical thrush symptoms in someone who has had it before.

The doctor asks about duration, discharge, smell, soreness, products used, antibiotics, diabetes, contraception, menopause, sexual partners and previous infections. They examine the vulva for redness, skin changes and sores, and may do a speculum examination and take swabs.

• Vaginal swabs: for thrush, bacterial vaginosis and trichomonas, and pH testing.

• STI screening where indicated.

• Blood glucose or HbA1c: if recurrent thrush suggests diabetes.

• Vulval biopsy: for persistent skin changes or suspected lichen sclerosus.

• Patch testing: for suspected allergic contact dermatitis.

Wash with water or a gentle emollient wash only, avoid perfumed products, douching and tight synthetic clothing, and wear cotton underwear. Use emollients as a barrier. Antifungal creams or tablets are available from pharmacies for typical thrush, but see a doctor if it recurs or the diagnosis is uncertain. Treat dryness with vaginal moisturisers or prescribed oestrogen.

The NHS route is a pharmacist, GP or sexual health clinic, with vulval clinics for chronic conditions. Private gynaecology and dermatology offer direct access to swabs and biopsies.