Clinical Overview of Chronic Vulvar and Vaginal Itch: Causes, Diagnosis, and Treatment

Conclusions

• Vulvovaginal itch is common, frequently underrecognized, and can substantially impair sleep, sexual function, and mental health.
• Many cases labeled as candidiasis are not chronic Candida infection, so careful history and examination are essential before repeating antifungal therapy.
• The main causes of chronic vulvovaginal itch fall into infectious, inflammatory, neuropathic, neoplastic, and psychogenic categories.
• Lichen sclerosus, lichen planus, and lichen simplex chronicus are major inflammatory causes of genital itch and should be actively considered.
• Lichen sclerosus is especially important because it causes severe itch, white atrophic scarring, and carries a cancer risk.
• Menopause-related estrogen deficiency and elevated genital pH can worsen vulvovaginal symptoms, and irritant cleansing products can aggravate itch.
• Effective management requires treating the underlying cause, restoring the skin barrier, avoiding irritants, and using low-pH/gentle hygiene measures.
• Superpotent topical corticosteroids remain first-line therapy for many inflammatory genital dermatoses, but some patients need systemic treatment or newer agents.
• Neuropathic and psychogenic components are common enough that therapies such as gabapentin, pregabalin, mirtazapine, and select off-label agents may be useful in refractory cases.
• Biologics and JAK-pathway therapies are emerging as promising options for difficult genital itch conditions, especially psoriasis and lichen-related disease.
• Multidisciplinary care involving dermatology, gynecology, and psychiatry is often necessary for optimal diagnosis and treatment.
• Nonresponders and patients with atypical, persistent, ulcerated, or pigmented lesions should undergo biopsy to exclude serious disease.