The symptoms are a vaginal discharge with a foul or fishy odor Itchingfishy odor. However, irritation, burning, and pruritus are never normal. Comprehensive Gynecology. Brown or bloody discharge is usually normal, especially when it occurs during or right after your menstrual cycle. The most common types are, Trichomonal vaginitis (usually sexually transmitted). The Merck Manual was first published in 1899 as a service to the community. Some vaginal discharge is normal, particularly when estrogen levels are high. Itching and/or irritation areand/or irritation are less commonless common. Abdominal pain, cervical motion tenderness, or cervical inflammation suggests PID. However, some STDs, a broken skin on labia lips and even rough waxing can cause vaginal itching. The cervix is inspected for inflammation (eg, trichomoniasis) and discharge. Clear, cloudy, bloody, white, yellow, or green. An underlying cause can usually be identified from the history and examination. If vaginal discharge is present, patients should be asked about the color and odor of the discharge and any exacerbating and remitting factors (particularly those related to menses and intercourse). Small cracks on the skin of the vulva. ‡ Such inflammatory conditions are an uncommon cause of vaginitis. URAC's accreditation program is an independent audit to verify that A.D.A.M. Here are 10 reasons your vagina is itchy and how to stop vaginal itching. Pruritus vulvae is itching of the vulva (which includes the mons pubis, labia majora, labia minora, clitoris, perineum and the external openings of the urethra and vagina). The following findings are of particular concern: Trichomonal vaginitis in children (suggesting sexual abuse), Fecal discharge (suggesting a fistula, even if not seen). Vaginitis may also result from foreign bodies (eg, a forgotten tampon). Vaginal discharge. It may also occur as a … Changes that could indicate a problem such as infection include: Treatment depends on the cause of your symptoms. All patients require the following in-office testing: Testing for gonorrhea and chlamydial infections is typically done unless a noninfectious cause (eg, allergy, foreign body) is obvious. This infection inflames the vaginal and vulvar tissues causing soreness, burning and itchiness. Infections spread during sexual contact. In women of reproductive age, discharge due to vaginitis must be distinguished from normal discharge: Normal vaginal discharge is commonly milky white or mucoid, odorless, and nonirritating; it can result in vaginal wetness that dampens underwear. Other common causes of decreased estrogen in older women include oophorectomy, pelvic radiation, and certain chemotherapy drugs. Ovulation (the release of an egg from your ovary in the middle of menstrual cycle). This is called bacterial vaginosis (BV). But aggressive cleansing can add to the irritation. Poor hygiene (eg, in patients who are incontinent or bedbound) can lead to chronic vulvar inflammation due to chemical irritation by urine or feces. This health condition is characterized by itching or soreness of the vagina. Discharge that is watery, bloody, or both may result from vulvar cancer, vaginal cancer, or cervical cancer; cancers can be differentiated from vaginitis by examination and biopsy. If symptoms are moderate or severe or do not respond to other measures, drugs may be needed. Another common response of women faced with a vaginal discharge or itch is to wash the vulvar skin vigorously, on the assumption that this will disinfect the area or remove irritants. Vaginal itching is an uncomfortable and sometimes painful symptom that often occurs due to irritating substances, infections, or menopause. However, pruritus vulvae means the itch is persistent and causes distress. Scaly, thick, whitish patches on the vulva. Foreign bodies may cause nonspecific vaginitis, often with a scant bloody discharge. A common contributing factor in girls aged 2 to 6 years is poor perineal hygiene (eg, wiping from back to front after bowel movements, not washing their hands after bowel movements). Others can be treated with steroid creams or lotions. Pruritus vulvae; Itching - vaginal area; Vulvar itching. Biopsy is seldom indicated. Editorial team. Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning. Vaginitis is also a common cause in women of reproductive age; it is usually infectious. follows rigorous standards of quality and accountability. Pruritus, vulvovaginal erythema, vaginal odor, sometimes dysuria, no discharge, Vaginal discharge, usually with a foul odor and vaginal spotting, Clinical evaluation (may require a topical anesthetic or procedural sedation), Infections (eg, candidal, pinworm, streptococcal, staphylococcal), Pruritus and vaginal discharge with vulvar erythema and swelling, often with dysuria, Worsening of pruritus at night (suggesting pinworm infection), Significant erythema and vulvar edema with discharge (suggesting streptococcal or staphylococcal infection), Microscopic examination of vaginal secretions for yeast and hyphae and culture to confirm, Examination of vulva and anus for pinworms, Vulvovaginal soreness, bloody or malodorous vaginal discharge, Often, vague and nonspecific medical complaints (eg, fatigue, abdominal pain) or behavior changes (eg, temper tantrums), Cultures or PCR for sexually transmitted diseases, Measures to ensure the child’s safety and a report to state authorities if abuse is suspected, Malodorous (fishy), thin, gray vaginal discharge with pruritus and irritation, Clue cells seen during microscopic examination, Vulvar and vaginal irritation, edema, pruritus, Discharge that resembles cottage cheese and adheres to the vaginal wall, Sometimes worsening of symptoms after intercourse and before menses, Sometimes recent antibiotic use or history of diabetes, Yeast or hyphae identified on a wet mount or KOH preparation, Yellow-green, frothy vaginal discharge, often with a fishy odor, Often soreness, erythema, and edema of the vulva and vagina, Sometimes punctate, red “strawberry” spots on the vaginal walls or cervix, Mild cervical motion tenderness often detected during bimanual examination, Motile, pear-shaped flagellated organisms seen during microscopic examination, Rapid diagnostic assay for Trichomonas, if available, Foreign bodies (often a forgotten tampon), Extremely malodorous, often profuse vaginal discharge, often with vaginal erythema, dysuria, and sometimes dyspareunia, Cervical motion and/or adnexal tenderness, Dyspareunia, scant discharge, thin and dry vaginal tissue, Increased number of neutrophils, parabasal cells, and cocci and decreased number of bacilli seen during microscopic examination, Vaginal cancer, cervical cancer, or endometrial cancer, Gradual onset of pain, a watery or bloody vaginal discharge (which precedes bleeding), abnormal vaginal bleeding (eg, postmenopausal bleeding, premenopausal recurrent metrorrhagia), Often no other symptoms until the cancer is advanced, Pelvic ultrasonography or sometimes MRI or CT, Chemical vulvitis due to irritation from urine or feces, Risk factors (eg, incontinence, restriction to bed rest), Vulvovaginal erythema, edema, pruritus (often intense), vaginal discharge, History of recent use of hygiene sprays or perfume, bath water additives, topical treatment for candidal infections, fabric softeners, bleaches, or laundry soaps, Inflammatory (eg, pelvic radiation, oophorectomy, chemotherapy)‡, Purulent vaginal discharge, dyspareunia, dysuria, irritation, Sometimes pruritus, erythema, burning pain, mild bleeding, Diagnosis of exclusion based on history and risk factors, Granulocytes and parabasal cells seen during microscopic examination, Enteric fistulas (complication of delivery, pelvic tumors, pelvic surgery, or inflammatory bowel disease), Malodorous vaginal discharge with passage of feces from vagina, Direct visualization or palpation of the fistula in the lower part of the vagina, Skin disorders (eg, psoriasis, lichen sclerosus, tinea versicolor), Characteristic genital and extragenital skin findings. What is the vulva?. If no foreign body is present and children have trichomonal vaginitis, sexual abuse is likely. Vaginal itching can be due to bacterial or yeast infections, eczema, or using harsh soaps and body washes that irritate the delicate skin around the vulva. Philadelphia, PA: Elsevier; 2018:chap 33. 33 Vaginal Discharge and Itching Vaginal discharge, which may be accompanied by vulvar itching or burning, is one of the most common problems seen in the physician’s office. Oral antihistamines lessen pruritus and cause drowsiness, helping patients sleep. You have a sudden change in the amount, color, odor, or consistency of discharge. Avoid douching. This may mean that you have a urinary tract infection. This site complies with the HONcode standard for trustworthy health information:   Symptoms may also include irritation, burning, erythema, and sometimes dysuria and dyspareunia. Philadelphia, PA: Elsevier; 2017:chap 23. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. Davidson's Principles and Practice of Medicine. Last full review/revision Mar 2020| Content last modified Mar 2020, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Some Causes of Vaginal Pruritus and Discharge, Musculoskeletal and Connective Tissue Disorders, National Institute of Child Health and Human Development (NICHD) Protocol. Avoid soap and just rinse with water to clean yourself. Vaginitis is the most common gynecologic diagnosis in the primary care setting. Schrager SB, Paladine HL, Cadwallader K. Gynecology. Persistent vaginal itching that doesn't improve could be a sign of vulvar cancer. Glands in the cervix and the walls of the vagina normally produce clear mucus. In children, a common cause is vaginitis, usually due to infection with gastrointestinal (GI) tract flora (nonspecific vulvovaginitis). Gardella C, Eckert LO, Lentz GM. Check if your vaginal discharge is normal. Allow more air to reach your genital area. You have blisters or other sores on your vagina or vulva. Itching related to menopause can be treated with oestrogen cream or tablet. Sexually transmitted disease ( STDs ). Normally in women of reproductive age, Lactobacillus species is the predominant constituent of normal vaginal flora. This is very common among women of childbearing age. Vaginal or vulvar itch (pruritus vulvae) can be both distressing and embarrassing, and more so if it is accompanied by burning, discharge or odor, as is quite often the case.Determining the cause of an itchy vagina is important so as to be able to initiate proper treatment in order to relieve the symptoms and ultimately lead to complete resolution of the condition. U.S. Department of Health and Human Services, Clear, cloudy, bloody, white, yellow, or green. Vaginal yeast infection, caused by a fungus. Duplication for commercial use must be authorized in writing by ADAM Health Solutions. Symptoms of vulvar itching (or pruritus vulvae) include itching, stinging, or … Any specific cause of the itching or discharge is treated. You have symptoms that get worse or last longer than 1 week despite home care measures. Vaginal itching (pruritus), discharge, or both result from infectious or noninfectious inflammation of the vaginal mucosa (vaginitis), often with inflammation of the vulva (vulvovaginitis). The slide is examined using a microscope; KOH dissolves most cellular material except yeast hyphae, making identification easier. Some vaginal itching may require steroid creams or specially medicated lotions. The most common causes of vaginal itching and discharge vary by patient age (see table Some Causes of Vaginal Pruritus and Discharge). These include: Dermatological conditions. In postmenopausal women, a marked decrease in estrogen causes vaginal thinning (atrophic vaginitis), increasing vulnerability to infection and inflammation. This may cause a foul odor. Sexually transmitted infections. Many women feel cleaner when they douche, but it may actually worsen symptoms because it removes healthy bacteria that line the vagina. It is a symptom which is common to many conditions. Wearing loose-fitting clothes and not wearing panty hose. Vaginal itching is a symptom that may signify something is occurring with your vagina.Signs and symptoms of itching can involve the vagina or the genital area called the vulva. A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). Call 911 for all medical emergencies. In children, a vaginal discharge suggests a foreign body in the vagina. Vaginal symptoms related to itching and/or discharge are often nonspecific. The vulva should be kept as clean as possible. In atrophic vaginitis, inflammation often results in an abnormal discharge, which is scant and may be watery and thin or thick and yellowish. Wash thoroughly before and after using the bathroom. Contact irritant or allergic reactions cause significant irritation and inflammation with comparatively minimal discharge. Learn more about our commitment to Global Medical Knowledge. Besides itching, other symptoms that come with bacterial vaginosis are inflammation, burning, discharge, and a fishy-smelling odor. Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Intermittent use of ice packs or warm sitz baths (with or without baking soda) may reduce soreness and pruritus. Vulvar itching that gets worse at night has many possible causes. If they have unexplained vaginal discharge, cervicitis, which may be due to a sexually transmitted disease, should be considered. 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