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Genital Itching: Causes, Diagnosis, and Treatment

Genital pruritus (vulva/scrotum) has diverse causes spanning infectious, dermatologic, and systemic categories.

Infectious Causes

  • Candidiasis (yeast): curdy discharge, erythema.
  • Bacterial vaginosis: fishy odor, thin discharge.
  • Trichomoniasis: frothy yellow-green discharge.
  • STIs: HSV (vesicles/ulcers), HPV (warts), syphilis (chancre).
  • Pubic lice, scabies.

Dermatologic Causes

  • Contact dermatitis (soaps, latex, fragrances).
  • Lichen sclerosus (white, atrophic, intense itch).
  • Psoriasis, eczema, seborrheic dermatitis.
  • Lichen planus.

Systemic/Hormonal Causes

  • Menopause (atrophic vulvovaginitis).
  • Diabetes (glucosuria → yeast).
  • Thyroid, liver, renal disease, iron deficiency.

Diagnostic Approach

  1. History and exam (speculum if needed).
  2. Tests: wet mount, KOH prep, culture, biopsy if atypical.
  3. Treat specific cause.
  4. General measures: cotton underwear, avoid irritants, moisturize, no scratching.

Persistent itch warrants gynecology or dermatology referral.

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