‘My private parts are itchy and irritated’
QI am in my early 40s and have recently been experiencing discomfort in my private parts. The outside of my vagina has become irritated and itchy and I feel it is down to dryness. I don’t think I am menopausal as I have regular periods but I wonder could it be related to that? Also, what can I do about it? It doesn’t seem important enough to go to the GP about but I find it debilitating.
AVaginal dryness, itch and discomfort is a common complaint in GP practice. Given that your menstrual cycle is regular and you are in your early 40s, you are right to think these symptoms are unlikely to be anything to do with the perimenopause.
You really should attend your GP for a full history and physical examination as you may need a prescription for a combined steroid and anti-fungal cream like Daktacort, to be applied twice daily for two weeks to get immediate relief. When the skin barrier is broken, secondary bacterial or fungal skin infection can become a problem.
Your main complaint appears to be vaginal itch and discomfort which you feel may be due to dryness. I wonder have you tried over-the-counter canesten pessaries for internal application, with the cream applied externally? Have you ever suffered with thrush in the past? Often a once-off dose of oral Diflucan 150mg capsule with the pessaries and cream will clear up these symptoms. However, if you have already tried this and your symptoms persist, you could be suffering with atopic dermatitis (eczema) known as vulvular dermatitis.
It can develop in the vulval region alone or in combination with other areas on the body. The key to conquering vulvular dermatitis is understanding there is an irritant (typically something applied to the skin), and in some cases an allergen (where a trigger induces an immune response), that is causing skin inflammation. Inflammation of the skin then causes the intense itch, often exacerbated by the person scratching and ultimately leading to a compromised skin barrier. The itch-scratch cycle continues unless you avoid the irritant and restore the skin barrier, thereby break the cycle. The stratum cornerum layer of skin forms an important part of the skin’s barrier mechanism. This part of the vulval region’s skin appears to function less efficiently making it particularly vulnerable to irritants. In order to avoid any potential irritants to the vaginal region, you need to stop using all shower gels and use aqueous cream as a soap substitute all over your body when showering.
Secondly, you need to apply an emollient to the vaginal region twice daily. Compliance is the most important factor in picking a product, in other words, the product that is best for you is the one you will use twice daily. Only your patience and persistence will pay off.
Rewinding back a little to discuss other potential irritants. Try to avoid wearing occlusive clothing, such as tight lycra sport leggings or jeans,
‘When the skin barrier is broken, secondary bacterial or fungal skin infection can become a problem’
non-cotton underwear, or thongs.
If you must wear them, then at least put time limits on them such as a only few hours per day. Think more along the lines of breathable cotton underwear, a maxi-dress or skirt until you have built up the normal skin barrier.
When wiping the vulval region avoid using wet wipes, wetting toilet paper or using haemorrhoid treatments. Ideally you should have a quick douche in warm water with or without aqueous cream.