Infectious causes
Candidiasis, or thrush, causes itching, burning and thick, curd-like discharge without a strong odor, often before menstruation or after a course of antibiotics. Bacterial vaginosis is not inflammation, but an imbalance of microflora: the main symptom is not itching, but grayish liquid discharge with a fishy odor, but discomfort also occurs. Trichomoniasis is sexually transmitted and is manifested by foamy yellowish-green discharge and a severe burning sensation. Less commonly, itching is caused by herpes infection with blisters and painful ulcers, as well as genital warts.
- Candidiasis (thrush)
- Bacterial vaginosis
- Trichomoniasis
- Genital herpes
- Human papillomavirus and condyloma
- Nonspecific vaginitis
Non-infectious causes
Contact dermatitis is very common: a reaction to scented pads, intimate gels, soap, washing powder, lubricants and synthetic underwear. Irritation is increased by excessive hygiene and douching, which washes away the protective flora. In menopause and during long-term breastfeeding, a decrease in estrogen leads to thinning and dryness of the mucous membrane, hence itching, burning and pain with intimacy. A separate group is skin diseases of the vulva, including lichen sclerosus, which causes white patches and thickening of the skin. Itching can also be one of the first signs of poorly controlled diabetes.
- Allergies to hygiene products and linen
- Douching and aggressive washing
- Estrogen deficiency in menopause
- Lichen sclerosus and vulvar eczema
- Diabetes mellitus with high glucose levels
- Stress and scratching complete the circle of itching
What does the discharge suggest?
The nature of the discharge helps to navigate even before the tests, although the final answer is given by a smear. White, thick, cheesy discharge with a sour odor is typical of candidiasis. Homogeneous grayish with the smell of stale fish, which intensifies after intimacy, is characteristic of bacterial vaginosis. Foamy yellowish-green ones indicate trichomoniasis. Scanty discharge with dryness and burning with a normal smear occurs when the mucous membrane is thinning. The complete absence of discharge with severe itching most often indicates an allergic reaction or skin disease of the vulva.
- Curdled whites - candidiasis
- Gray with a fishy odor - bacterial vaginosis
- Foamy greenish - trichomoniasis
- Dryness without discharge - atrophy or allergy
- Bloody discharge is a reason for urgent examination
What tests are needed
They start with an examination: the doctor assesses the condition of the skin of the vulva, mucous membrane and the nature of the discharge. The basic analysis is a flora smear that shows inflammation, leukocytes, fungi and key cells. To accurately identify pathogens, PCR studies and comprehensive microflora panels are used. If there are repeated episodes of thrush, your blood glucose will be checked to rule out diabetes. If the smear is clean, but the itching persists, a skin or allergic cause is looked for and referred to a dermatologist; For persistent changes in the skin of the vulva, a biopsy may be required.
- Examination by a gynecologist
- Flora smear
- PCR for candida, trichomonas and other infections
- Comprehensive study of vaginal microflora
- Blood glucose and glycated hemoglobin
- Consultation with a dermatologist and biopsy for skin changes
Treatment and care
Treatment is prescribed based on the results of the examination: for candidiasis - antifungal drugs locally or orally, for bacterial vaginosis and trichomoniasis - antibacterial agents of certain groups, and for trichomoniasis the partner is also treated. With thinning of the mucosa, local estrogen preparations and moisturizers help. At the same time, irritants are removed: scented pads and gels, panty liners for the whole day, tight synthetic underwear. Douching does not cure, but aggravates the problem. Wash the external genitalia with fairly warm water or a mild, fragrance-free cleanser once or twice a day.
- Antifungal drugs for candidiasis
- Antibacterial therapy for vaginosis and trichomoniasis
- Local estrogens for dry mucous membranes
- Avoiding douching and scented products
- Cotton underwear, change pads every 3-4 hours
- Treatment of a partner for sexually transmitted infections
- Controlling blood sugar in diabetes