HOW TO BE HEALTHY 50+ AT

Dr Philippa’s talks about what causes vulval itching and what you can do about it…

Laurie tried ever ything she could think of… she bought over the counter remedies, changed her washing powder, bought all new knickers, tried washing more with different products, and tried washing less, but none of it made any difference to the itching all around her vulva, or external genitals. Often it was all she could think about! She had thought it was thrush but didn’t have any discharge and had used at least three over the counter antifungal thrush tablets, pessaries and creams, but to no avail. She was also finding sex painful, feeling as if there was a cut at the entrance to the vagina.

Laurie is in her late 50s and went through the menopause about ten years earlier. Thrush, which is an overgrowth of a Candida species of yeast in the vagina, can cause itching and a vaginal discharge, but is actually relatively rare after the menopause and before puber ty, as the pH of the vagina is not conducive for the infection. In fact, no matter your age, we can’t presume that vaginal and vulval itching is due to thrush, so please do see your doctor.

A common cause of vulval and vaginal irritation after the menopause is atrophic vaginitis, which is related to oestrogen deficiency after

the menopause, but this was not the cause in Laurie’s case. On examining her, it was clear she had lichen sclerosus, which causes itching, generally in the genitals, but it can occur around the anus, perineum and also on other par ts of the skin. There tends to be thickened whitish patches in the skin of the vulva, but over time there can be scarring, leading to smooth skin and shrinking of the labia. Commonly these are found around the entrance of the vagina and there can be

The first por t of call for treatment is to remove all irritants. There is no need to wash your vulva with soap, even one supposedly marketed as a feminine hygiene product. Avoid bubble baths, talcs or other products and use water instead. You can wash with an emollient such as aqueous cream.

Treatment tends to be with high dose steroid ointments, used daily for a month, then on alternate days for a month then twice a week for a fur ther month