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At least 90% of all women who complain of vaginal or vulvar itching will
have yeast as at least a portion of the problem.
Because of this, simply treating these patients with a reliable
anti-fungal agent (Monistat,
Mycelex,
Lotrimin,
Diflucan, etc.) without a detailed
history,
physical
and laboratory evaluation, is often expedient
and successful. In many settings, this therapeutic approach is particularly
useful as it requires no laboratory or physical examination.
For those in whom itching persists, a careful history and physical exam
will usually be needed to determine the cause of the itching.
When available, some tests which may be used in determining the cause of
the itching, including vaginal cultures (for strep), wet
mount (for yeast,
Trichomonas and
bacterial vaginosis), vulvoscopy (magnified
inspection of the vulva) and directed skin biopsies.
Less common causes of vulvar itching include hypertrophic vulvar dystrophy, lichen sclerosis, HPV, Paget's disease, VIN, contact dermatitis, psoriasis of the vulva and lice.
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