Vaginal Itching

WHEN TO SEE YOUR DOCTOR

* Itching persists more than three days, doesn't respond to home remedies or is getting progressively worse.

What Your Symptom Is Telling You

Unless you spend your summers at a nudist camp, your private parts are often covered in three or four layers of material—perhaps a pantiliner, panties, a pair of snug-fitting pantyhose and your coolest Calvin Kleins.

So what is that warm, moist part of you doing under all those layers?

It's itching! And it's driving you nuts.

Vaginal itching can come from something as simple as trapping bacteria for too long under too many layers of too-tight clothes. All that warmth and moisture provide perfect conditions for incubating infections.

In fact, itching can be the unwelcome calling card of a wide variety of infections, ranging from bacterial vaginitis to yeast (also called Candida albicans or monilia) and trichomoniasis.

The itching can also signal an allergy to a chemical in soap, deodorant or dye, or may simply be a sign of thinning vaginal tissues in women approaching menopause.

Symptom Relief

Let's take a soothing look at how to banish that infernal itching.

Sitz in some salt. Several forms of vaginitis will often respond to a simple home remedy—the saline sitz bath. Here's the recipe from Gideon Panter, M.D., a gynecologist in New York City.

Dissolve a half-cup table salt in a shallow tub of warm water. In the tub, insert your finger into your vagina to let the warm salt water in, then remove your finger and relax for 10 to 15 minutes. Two or three consecutive nights of sitz baths should ease the itch, if yours is home treatable, Dr. Panter says.

Abstain for the duration. Don't have sexual intercourse until your itching has cleared up, Dr. Panter says. If the organism that set up its itchy housekeeping in your vagina was transmitted by your partner, there's no sense in re-exposing yourself to trouble. Take a few days to show love in other ways, he suggests.

Consider the condom. Condoms provide wonderful protection against both unwanted pregnancy and sexually transmitted disease. If condom use always seems to be followed by a bout of vaginal itching, however, it's possible that an allergy to the condom's latex rubber, powder coating or lubricant could be the problem.

Try this simple home patch test from Bruce Katz, M.D., a dermatologist and assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons in New York City. Tape an inner-side piece cut from a fresh condom to one arm, and an outer-side piece to the other arm. Leave both pieces in place for 48 hours, and keep the areas dry. If both arms react, you're allergic to the rubber. If only the arm with the inside of the condom taped to it gets itchy or rashy, you're allergic to the powder. If only the arm with the outside piece reacts, you're allergic to the lubricant.

Does this mean you should avoid using condoms? Absolutely not, says Dr. Katz. Their role in reducing infection risk is too critical. Instead, have your partner use two—lambskin over latex if you are allergic to rubber, or reverse the order if the powder is the problem. Why not just switch to lambskin? Lambskin on its own can't protect against some organisms, including the virus that causes AIDS. Dr. Katz says a nonlatex condom should be on the market shortly, which will solve the problem entirely.

Ask your doctor. You'll need your doctor's help to determine which type of infection is causing your itching. If you've been diagnosed with yeast infections in the past, and are very familiar with the specific symptoms, call your doctor for a prescription, recommends R. Don Gambrell, Jr., M.D., clinical professor of endocrinology and obstetrics and gynecology at the Medical College of Georgia Hospital and Clinics in Augusta. Your doctor will prescribe antifungal medications such as Vagistat, Nystatin or Monistat.

Trichomoniasis is treated with the prescription antibiotic Flagyl. Bacterial infections call for antibacterial agents—either sulfa drugs or, if you're allergic to sulfa, with Betadine antiseptic, an over-the-counter product, says Dr. Gambrell.

"And be sure to have your doctor test you for the human papilloma virus (HPV)," recommends Jessica L. Thomasson, M.D., a gynecologist at Columbia Medical Center in Milwaukee. This virus, which causes genital warts, is an important and frequently overlooked cause of vaginal itching, she says.

Get help for menopause symptoms. If you're approaching menopause, ask your doctor about treatments for itching caused by changes that are taking place in the vagina. Hormone replacement therapy is an option, but you should also ask about prescription hormonal creams for the vagina.

Bag the douche and powder. Douching not only won't help to relieve itching or vaginitis, it may be dangerous, says David Eschenbach, M.D., professor and chief of the Division of Gynecology at the University of Washington School of Medicine in Seattle. Douching may drive infectious material up through the cervix and cause pelvic inflammatory disease, he says.

The use of talcum powder or cornstarch is questionable, too, Dr. Eschenbach says. Over time, the tiny particles may collect near the ovaries and increase ovarian cancer risk.

Defeating the Yeast Beast

Fortunately for women who suffer from recurrent yeast infections, these infections respond well to treatment. And there's plenty of prevention available, too.

Cut down on sugar. Sugar feeds yeast, so cut back on high-sugar foods, advises Marjorie Crandall, Ph.D., a microbiologist, candida researcher, and founder of Yeast Consulting Services in Torrance, California.

See what C can do. Take 500 milligrams of vitamin C twice a day, recommends Eva Arkin, M.D., chief of gynecology at Scottish Rite Hospital and obstetrician and gynecologist with Atlanta Women's Specialists. Vitamin C increases the acidity of the vagina, creating a yeast-unfriendly environment, she says.

Blow it away. After a shower or bath, blow-dry the vaginal area, Dr. Arkin suggests. Yeast needs moisture to survive. Set your blow dryer on cool, and position the dryer six to eight inches from the vaginal area.

Try another sort of sitz. Another type of sitz bath works well to fend off yeast infections, says Dr. Arkin. Once a month after your menstrual cycle, add three tablespoons of boric acid to six inches of water in a pan large enough to sit in. While you're roosting in your roaster for five to ten minutes, the yeast is in retreat.

Lay on the lactobacillus. A cup-a-day habit of yogurt with active Lactobacillus acidophilus cultures will reduce your likelihood of yeast infections, a study from Long Island Jewish Medical Center shows. Health food stores are your best bet for "live" natural yogurt. (You eat the yogurt, by the way; you don't douche with it.) Lactobacillus is also available in powder and capsule forms at health food stores.

Take the scratch test. If your yeast infections persist, you may be allergic to Candida, and allergy shots of Candida extract can help prevent further problems. Ask your doctor to refer you to a board-certified allergist for skin testing, Dr. Crandall recommends.

Yank yeast from your diet. If you test positive, Dr. Crandall suggests avoiding allergic reactions to Candida by avoiding foods and beverages containing yeast and molds, at least until you have received the allergy shots for about six months. Look out for the following yeast and mold troublemakers: bread, pizza, English muffins, bagels, croissants, raised doughnuts, beer, wine, liquor, apple cider, moldy cheeses, cider or wine vinegar, pickles, grapes, berries, cantaloupe, fruit juices, brown sugar, sprouts, mushrooms, yeast extract, vitamins derived from yeast, smoked meats and fish and leftovers.

Prime your prescription. If you know you get frequent yeast infections, then ask for anti-yeast medication whenever your doctor puts you on antibiotics, Dr. Crandall suggests. (Antibiotics taken for other infections kill off both friendly and unfriendly bacteria in the vagina, clearing the way for an overgrowth of yeast.)

Plan your prevention. Any vaginal irritation can pave the way for yeast infection, says Dr. Crandall. That's why it helps to avoid any vagina/chemical contact, including perfumes, colored toilet paper, dyed underpants, deodorants and commercial sexual lubricants. Dr. Crandall recommends unscented mineral oil or vegetable oil as a nonirritating lubricant alternative. (These cannot be used with condoms or a diaphragm, however.)

To prevent yeast flare-ups, she suggests laundering your clothes with unscented detergent, avoiding fabric softeners and wearing loose-fitting cotton clothing, white cotton underwear and no pantyhose.