Why is it itching down there?
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Created
13 February 2025
Updated
18 March 2025
Here's how Prof. Graziottin answers this question from her patients:
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Listen to the TIMING of the itching. If itching peaks at night, we have two major causes:
- First, bowel parasites, they could be in play because they migrate through the anus in the perineum at night to deposit their eggs. They are more frequent in children and adolescents, with rare cases in adult and elderly women. But the search of parasites is key in the feces to confirm the diagnosis. The search of the parasites in the feces will confirm the diagnosis. Clinical examination, a vaginal swab with the exam of the secretion at the microscope in the office or a culture test can confirm the diagnosis.
- The most frequent etiology of itching at night with increasing age is the so-called vulvar lichen sclerosus. It is present also in children and adolescents, but it increases in prevalence with increasing age.
- It is an autoimmune disease, what does it mean? Our immune system attacks the vulvar tissues in all their components, with progressive thinning and whitening of the vulvar skin, fusion of the labia, destruction of the tissue, and damage to the nerve terminals, the nerve endings. This is responsible for the itching feelings.
A very careful examination is key, even with a biopsy if indicated, and then appropriate treatment with cortisol and testosterone is key.
When the itching is also frequent during the day, think about the Candida infection and important to an aberrant response of our immune system, abnormal response, to the candida antigens. Because this causes itching, and again, we need a clinical examination of the vaginal swab with the exam of the suppression at the microscope of the office and a culture that can confirm if really a candida infection is in play in causing this itching day and also at night.
The predisposing factors include:
- First, an inappropriate diet rich in sugar: That's why we strongly recommend a sugar-free or almost-free diet. Why that? Because sugar gives a lot of energy to the candida and she will aggress us with much more intensity. But also because sugar causes gut, vaginal and vulvar dysbiosis.
- Second, we may have hyperactivity of the pelvic floor, too tight on the pelvic floor, and this predisposes to microabrasion that increases the probability of the aberrant immune reaction to candida antigen.
- And then, vulvar and vaginal dysbiosis worsens the infection and predisposes to recurrences, in spite, very important, of both oral and topical antimycotic treatment.
Lifestyles, with appropriate diet and daily aerobic outdoor activity, such as brisk outdoor walking in the morning, also to go to work, can optimize the circadian biorhythms, may optimize the glycemic control and reduce the shift from spora to ifa, the active form of Candida infection. Normalization of the pelvic floor muscles tonus, with appropriate hands-on physiotherapy, is key to reducing the “biomechanical” contributor of vulvar/vestibular micro-abrasions, the tiny cutting, like women say, which amplifies the Candida symptoms through an aberrant immune response in predisposed subjects; probiotic may help in synergy with antimycotics.
BMI-24.55
