Genital Itch

Have you ever had an episode where you had to cross and uncross your legs in public due to the itchy sensation below? Or an episode of urgent need of the bathroom to scratch the itchy genitalia? The symptom may sound trivial, but it can profoundly impact our lives, affecting our daily routine and causing embarrassment when socialising with others.

How common is genital itch?

Genital itch is a common medical symptom that can occur in anybody. It is a non-discriminative symptom, regardless of your educational or socioeconomic background. 

What are the causes of genital itch?

Genital itch symptoms can be broadly categorised into dermatological versus infectious/sexually transmitted disease STD-related causes.

Dermatologically related genital itch:

• Fungal infection: this can occur due to a combination of factors of a hot and humid environment, moist genital region, and low self-immunity.
• Eczema: this is a common inflammatory skin condition secondary to impaired skin barrier compound further with environmental exacerbation.
• Psoriasis: this is an autoimmune skin condition associated with excessive and rapid building up of skin cells.
• Lichen planus/lichen sclerosus: lichen planus and lichen sclerosus are chronic inflammatory skin conditions that are not infectious and commonly affect the genital and mucosal surfaces of the bodies.
• Irritation/contact dermatitis: this can occur when the wrong usage of creams/topicals/wash to the groin region leads to skin irritation and inflammation.

STD-related genital itch:

• Genital warts: fleshy bumps and lumps due to HPV-related infection. Genital warts spread to people via contact/sexual contact. In females, HPV infection can be associated with cervical cancer. In males, certain high-risk strains of HPV infections can be associated with penile and anal cancer. 
• Herpes Simplex Virus infection: the affected area may have blisters and erosions. One can present with systemic symptoms of fever and swelling of lymph node glands. 
• Molluscum contagiosum: molluscum contagiosum manifests as small bumps commonly confused with genital warts. This is due to an infection from poxvirus. Typically, genital molluscum is a sexually transmitted condition, and it is imperative to treat it to prevent further spread of the condition to others.
• Scabies/lice or crabs: these are mite infections that are spread via sexual contact. Intense itch is one of the key symptoms. However, it is generally not life-threatening per se; the high spreading rate and the associated social stigmatisation of the condition warrant urgent treatment and termination of the mites.

Other causes of genital itch:

Some various bacteria or parasites can cause symptoms of itch over the genitalia when the infection is left unattended. This includes chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma Genetalium, Gardnerella bacteria, Trichomonas parasites, etc. These are commonly associated with sexually active people. If you are having trouble with genital itching and you are in a sexual relationship, do discuss it with your doctor and consider further screening for sexually related infections. These bacterial/parasitic-related sexually transmitted infections are treatable, and they do not resolve on their own unless treated with the correct medications.

A genital itch can be an embarrassing symptom to present to your doctor. Nonetheless, the condition is manageable if the right cause is determined and dealt with.

When should I see my doctor?

You are encouraged to see your doctor when your symptoms persist and cause impairment and nuisance to your daily routine. 

Further red flags to note and consider seeing your doctor if you have:

• Rash/growth/lumps and bumps
• Pain
• Blisters
• Unexplained discharge –both watery/serous or pus/yellow cloudy
• Sores/ulcers
• Noticeable crawling insects/mites
• Painful urination
• Vaginal discharge (in females), urethral discharge (in males)
• Painful testicles (in males)
• Fever
• Lower pelvic pain

Although 'itch' is a generally benign symptom, it may be a tell-tale sign of a more serious medical condition that requires treatment. Do see your doctor if the genital itch symptoms are not improving or if you develop any of the red flags discussed above.

What will my doctor do?

As genital discomfort or itch can be a private and embarrassing condition, you are encouraged to see a doctor that you are comfortable with.

Your doctor will obtain a relevant history of your symptoms and relevant social/sexual histories. Your doctor will then physically examine your genitalia region for skin integrity. In females, your doctor may request, with your consent, a vaginal examination. In males, your doctor may request, with your consent, to examine your scrotal and penis region. Depending on individual conditions, your doctor may examine the rest of the body for other relevant body signs associated with your symptoms. Your doctor may also offer various tests in the form of blood, swab, scrape, or even urine tests depending on the working differential diagnosis. 

How can I treat my itchy genitalia?

The treatment and management of itchy genital symptoms depend on the cause. In dermatological causes, your doctor may offer topical medicated cream as a steroid, antifungal, or antibacterial to manage the symptoms. In more severe cases of concern with fungal infections, your doctor may prescribe oral antifungals to manage the symptoms. Lifestyle advice to reduce triggers that irritate dermatological symptoms will be discussed.

If the underlying cause is an untreated infection, you may be offered targeted treatment through oral medication, cream, or even procedures such as cryotherapy or electrocautery. 

Discuss your symptoms with your doctor, allow your doctor to examine your condition, and discuss the treatment options available to manage your genital itch symptoms with your doctor.

What will happen if I do not treat my itchy genitalia?

Although itch can be a completely benign symptom that potentially resolves spontaneously, if the symptom is not addressed appropriately, one may miss or delay diagnosing an underlying medical condition. In the event of dermatological-related itchy genitalia, if the underlying skin condition is not addressed, one may have recurring symptoms in the near future. In the event of infectious-related itchy genitalia, one will have an untreated infection and be at risk of developing complications from the infection and spreading the disease to people around you. 

You don’t have to suffer genital itch alone…

There are effective treatments to manage the itch in the genital region. Understanding the possible differentials and having the courage to seek medical help are paramount steps to take to take control of your health and your overall quality of life.

References:

1. Raef HS, Elmariah SB. Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front Med (Lausanne). 2021 Apr 7;8:649402. 
2. Krishnan A, Kar S. Scrotal Dermatitis - Can we Consider it as a Separate Entity? Oman Med J. 2013 Sep;28(5):302-5. 
3. Savas JA, Pichardo RO. Female genital itch. Dermatol Clin. (2018) 36:225–43. 
4. Fischer GO. The commonest causes of symptomatic vulvar disease: a dermatologist's perspective. Australas J Dermatol. (1996) 37:12–8. 
5. Connor CJ, Eppsteiner EE. Vulvar contact dermatitis. Proc Obstet Gynecol. (2014) 4:1–14. 
6. Gopinath H, Karthikeyan K. Genital scabies: Haven of an unwelcome guest. Indian J Sex Transm Dis AIDS. 2020 Jan-Jun;41(1):10-16. 
7. Thorstensen KA, Birenbaum DL. Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus. J Midwifery Womens Health. 2012 May-Jun;57(3):260-75. 
8. Swamiappan M. Anogenital Pruritus - An Overview. J Clin Diagn Res. 2016 Apr;10(4):WE01-3.