Itching is a symptom of mild inflammation and is caused by irritation of nerve endings in the skin. If the irritation increases in severity, it is felt as pain – there is actually a continuum of itching that merges into pain.
It is therefore not always easy to separate the two symptoms. However, specific conditions tend to cause a fairly predictable amount of inflammation and are associated mainly with either itch or soreness.
Vulval Itching
Useful clues to the causes of vulval itch are the presence of other symptoms. For example, if you also have an abnormal vaginal discharge, Candida is probably the most likely culprit. If you also have a skin condition, such as eczema, in another part of your body, it may have spread to your vulva.
Some forms of vulval itch can last for months, and have a major effect on your quality of life. Skin conditions such as eczema are a typical example. Frequently, the problem is a manifestation of the “itch/scratch” cycle. It begins with an itch. You scratch the area and after some time, the scratched skin becomes thickened – a common condition known as lichen simplex. This is the body’s natural response to rubbing but, unfortunately, thickened skin is itchy.
So the itching and scratching continue. Often, by the time you see a specialist; the original cause of the itch is not apparent or may even have disappeared.
Generalized Skin Conditions
Many women suffering from skin conditions in other parts of the body do not realize that the vulval skin can also be affected as well. Eczema and Psoriasis, for example, commonly affect the vulva and can be difficult to diagnose because they often look and feel different in this area.
Vulval skin conditions
Lichen sclerosus and Lichen planus are rare skin conditions affecting the vulva. There is inflammation causing itching for months or years, coupled with increasing discoloration and scarring and shrinkage of the skin and vulva.
Many women with these conditions experience long and frustrating delays before the diagnosis is made, which is a great shame because the treatment is remarkably simple. The diagnosis is normally made by biopsy taken by a dermatologist.
The treatment is a strong steroid treatment twice daily until the symptoms subside followed by occasional applications to keep them away. There is a slightly increased risk of the affected skin becoming cancerous and so, because of this and the powerful steroids, it needs careful long term surveillance by experts.
Vulval pain
Pain in the vulva may be felt over the whole area, especially when it is caused by severe inflammation. The classic cause for generalized pain such as this is the soreness of infection Trichomonas vaginalis. A bad attack of Candida can also be very painful, although you will probably have noticed a worsening itch for several days beforehand.
Localized sores on the vulva are commonly the result of herpes simplex infections. These vary from small, single ulcers, which are only mildly uncomfortable, to a widespread blistering rash, which is so painful that you can hardly sit or walk. Herpes sores are blisters that break to form small ulcers and they are usually very obvious in appearance.
