Dear Dr Jennifer: My vagina is so dry and itchy. Please help!!

By | October 25, 2020

Question: I 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’s down to dryness. I don’t think I am menopausal as I have regular periods — but I wonder could it be related to that? It doesn’t seem important enough to go to the GP about, but I find it debilitating. What can I do?

Answer:
Given that your menstrual cycle is regular and you are in your early 40’s, you are right to think these symptoms are unlikely to be anything to do with the menopause. I wonder have you tried the over-the-counter Canesten pessary 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 pessary 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 vulvar dermatitis. It can develop in the vulvar region alone or in combination with other areas on the body.

The key to conquering vulvar 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 breaking the cycle. The stratum corneum layer of skin forms an important part of the skins barrier mechanism. This part of skin the vulvar region 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.

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Secondly, you need to apply an emollient (e.g. Aveeno Dermexa or Doublebase Dayleve) to the vaginal region twice daily. 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.

Rewinding back a little to discuss other potential irritants. Try to avoid wearing tight clothing, such as lycra sport leggings or jeans, and think more along the lines of breathable cotton underwear until you have built up the normal skin barrier.

When wiping the vulvar 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 an aqueous cream.

One last skin condition to consider is when persistent vulvar dermatitis results in chronic histological changes known as lichen simplex. This condition typically has an intense itch that it out of proportion to the rash and can occur around the nape of the neck, on the elbows/forearms, lower legs/ankles, vulva/scrotal region or perianal region. Management involves applying a potent or very potent steroid ointment for a few weeks and back to avoiding all irritants by using a soap substitute all over your body when in the shower and using emollients twice daily.

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Dr Jennifer Grant is a GP with the Beacon HealthCheck screening programme at Beacon Hospital.

Dr Jennifer Grant is a GP with the Beacon HealthCheck screening programme at Beacon Hospital.

Dr Jennifer Grant is a GP with the Beacon HealthCheck screening programme at Beacon Hospital.

If you have any queries, email askthedoctor@independent.ie

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