Itchy bottom,
called pruritus vulvae,

caused by skin allergy & irritations...
herpes + other infections...
and vorious cancers.

Itchy bottom,called pruritus vulvae,caused by skin allergy,herpes infection,herpes type 2,herpes type 1,and cancer.

Causes of itchy bottom ,pruritus vulvae:

A.Dermatological,skin causes;

1.Simple irritation from agent like
-condom and lubricants
-feminine hygiene
-anti fungal overuse,

2.Any irritation when long enough causes dermatitis, a skin inflammation.

3.Irritation and dermatitis ,ie. 1 + 2 above,cause vicious Scratch-Itch Cycle.When prolonged and severe --> it cause a simple skin thickening,medically called LSC,lichen Simplex Chronicus,.

4.true allergic or contact dermatitis
-this is possible ,but uncommon

-this is rarely severe

-because of dry and thinning skin

7. Generalized medical conditions
-are those that cause skin dryness

B.Infective causes

1.Genital herpes
-especially herpes simplex virus type 2,HSV-2
-but now HSV-1, is also common
-it present with crops of minutes vesicles,that eventually ulcerate ,and fissures,leading to pain and intense itch.

2.thrush due to candida infection
-it cause itch and likely vaginal discharge

3. Bacterial vaginosis
-here the itch is mild

4.Crabs/pubic lice/Pthirus pubis,
-the infestation is localized,
-but itch is intense,starting few weeks after sex with infested person
-on examination show presence of lice and telltale nits,egg cases

5.Scabies/Sarcoptes scabiei
-itch is intense, + involvement of other body parts
-condition is usually generalized

C.Not to be missed causes:

1.lichen sclerosus ,LS
- this is an auto immune disease,
- in MALE;it affect glands penis,foreskin.This is called BXO,Ballanitis Xerotica Obliterants
-in FEMALE; it affect vulva,causing itch,bleeding,discomfort with sexual intercourse ,however ,the condition is readily treated by potent steroids using lacal application,eg pimecrolimus, tacrolimus
-please note that,by not treating such cases,it may end up as squamous carcinoma of vulva.The malignancy risk is 3 to 4 %
- such cases normally need annual monitoring

2.Vulval intraepithelial neoplasia,VIN
-when there is localised mild persistent itch,and if there are no causes apparent,vulvoscopy examination is necessary to exclude VIN

3. Cancer of vulva
-may present with ulceration but is painless,no itch
-or as induration
-in both cases , histological examination is required.

Tips on prevention:

1. The cornerstone is behavior change all mean decrease irritation to vulval skin
-stop all soap,cream,unguent
-use bland moisturizer only eg,sorbolene,aquous cream,to wash vulva

3.use cold pack to ease itch

4.use hydrocortisone 15 to decrease itch irritation and erythema

5.wear only cotton underwear
-no nylon panty hose
-no tight trouser,
-no G-string

6.oral antihistamine
-if itch is severe or in night use

7.Low dose tricyclic antidepressant
-rarely used, except in long standing cases

8.Regular review
-if not improving,reconsider initial diagnosis

9. Resources materials for education----internet,hand out,books, journal,articles

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