Causes | Prescriptions | External remedies
	Acupuncture & moxibustion | Relief tips | Dietary advice

The female external genitalia (also called vulva) include the opening of vagina, labia majora and labia minora (fleshy lips around vagina), clitoris (small organ packed with nerve endings) and the urethra opening. The delicate skin surface can easily be irritated and becomes itching, burning or stinging.

Itching of the external female genitalia is troublesome, usually worsens at night and disturbs sleeping. Women in any age can be affected, and it may come and go for years that impose heavy mental and physical burdens on some women. Doctors will diagnose as pruritus vulvae when the situation is persistent and distressing.

Treatment for itchy vulva should be focused on the underlying causes.

Causes of itchy vulva

Itchy vulva or external vaginal itching is actually a symptom that can occur in many conditions, including irritations, infections, skin conditions, allergies and cancers. Treatment for itchy vulva should be focused on the underlying causes, and so professional advice is critical. Below is a list of the common causes for itchy vulva:

Yeast infection or thrush: an overgrowth of fungi that normally live in the genital region; triggering factors include using antibiotics, birth control pills, corticosteroids, hormonal changes of body, diabetes, sexual intercourses and impaired immune system. Although this is a common cause for itchy vulva, individuals should still consider other possibilities and are not encouraged to use the OTC products for a long period of time, as they are not intended to be used continuously.

Vaginitis: the causes of vaginitis can be bacteria, viruses and sexually transmitted diseases, inflammation or infection of the vagina usually has discharges and odor. It can be difficult to distinguish an itchy vulva from a vaginal itching.

Menopause, pregnancy and breast-feeding: women after menopause or in breast-feeding produce less estrogen, which makes the genital skin becoming thinner and drier, and thus can easily be irritated. Pregnant women tend to have more vaginal secretions, which can cause irritation and itching.

Allergic or contact dermatitis: the vulva area can easily react to any chemical substance that comes into contact. Everyday products such as soap, deodorants, wet wipes, disinfectants, laundry products, creams, douches, synthetic materials and contraceptive products may cause the skin itching and irritated.

Skin conditions: eczema, psoriasis, lichen simplex and lichen sclerosus develop rashes with redness, cracks, thickening and intense itching. Individuals often have the same skin features in other body regions as well.

Urinary or fecal immersion: urinary or fecal materials make the genital area moist and irritated. Poor hygiene practice such as inadequate washing or drying of the area, wiping the bottom in the 'wrong' direction, rubbing too hard by toilet paper can also be the causes.

Parasites: the possible parasites include lice, scabies, and threadworms, each of them live in different sites, but all can cause itching of the genital area.

Skin cancer: cancer of the vulva mainly occurs among old women and is very rare; itching is usually the first sign, and there will be a lump or a sore in the area.

Systemic diseases: this occurs in diseases like blood disorders, diabetes, thyroid problems, kidney or liver diseases.

Stress and anxiety: emotional disturbances affect the nervous system and make the individual likely to scratch, which prone to worsen itchy vulva or cause recurring itching.

Side effects: certain medications cause an adverse effect of itching.

Most of the time, several causes may be combined to cause an itchy vulva, it is difficult to identify the main underlying problem by individual themselves, only doctors are able to give the appropriate diagnosis and treatment, so as to prevent the development of complications or permanent damage. When the itchy vulva is accompanied with following symptoms, you should definitely seek medical care, because it might indicate a serious condition:

Abnormal discharge or bleeding

Pain or burning of the genitals

Sores, blisters or spots on the genitals

Changes in appearance, color, or texture of the vulva

Pain or burning feeling during urination

Found small insects or eggs in pubic hair

Itchiness in other areas of the body

For persistent cases that no cause is found, Chinese medicine can be an alternative to help stop genital itching. Traditional Chinese Medicine (TCM) has a long history of treating women diseases, physicians use a holistic approach to maintain the well-being of women, and the practice is highly sophisticated with unique theories, diagnoses and therapies.

The Governor Vessel, Conception Vessel, Thoroughfare Vessel and Girdling Vessel meridians play important roles in woman's physiology.

Chinese herbal remedies to stop itchy vulva

From a TCM holistic view, the external genitalia are regarded as part of the female reproductive system, and their conditions are closely associated with internal conditions. Through the small branches of meridians and the Thoroughfare Vessel, Conception Vessel and Governor Vessel, the spleen, liver and kidney rule the external genitalia directly or indirectly. The organs support and ensure the external genitalia to stay in proper conditions. Persistent itchy vulva, with or without vaginal discharges, often resulted from both internal and external origins. Firstly, the body is in a disharmony state that makes the external genitalia susceptible to various irritations. External factors such as germs, parasites or injuries will take advantage of the weakness and then trigger an itchy condition. TCM treatment for itchy vulva is based on disharmony patterns of the individuals, and the remedies are aimed to resume the normal functional state of organs and eliminate the local irritations as well.

Generally, women in productive age are likely to present in excess syndromes such as damp-heat accumulation; women after menopause are likely to present in deficient syndromes such as yin deficiency, or blood deficiency. After evaluating the local and whole body situations, and along with the gynecologic and laboratory results of the individuals, TCM physicians will design a treatment plan accordingly.

In order to enhancing a full recovery, physicians may give oral remedies to regulate the dysfunction organs, and apply topical remedies such as wash or suppository on genital region to eliminate the local irritations.

Below are the common disharmony patterns of itchy vulva and the anti-itch remedies.

Damp-heat accumulated in lower burner
The genital area is red and Itchy, and with excessive vaginal discharges that are yellowish and thick in texture, and a foul and fishy smell. Other accompanied symptoms include irritability, poor sleep, chest stuffiness, a bitter taste and slimy sensation in the mouth, low appetite, and yellowish and scanty urine. On examination, the tongue is red and covered by yellow and greasy coating, and the pulse is rolling and rapid. TCM remedy should aim to clear heat, drain dampness, eliminate local irritations and stop itching.
Sample of prescription: modified Gentian Liver-Purging Decoction or
　　　　　　　　　　  Poison Yam Draining Dampness Decoction plus atractylodes rhizome, dictamnus root bark, carpesia grass

Yin deficiency of liver and kidney
The genital area is itchy, dry and burning, that are worse at night. Individuals may also have vaginal discharges (yellow or blood-stained), irritability, hot flashes, dizziness, blurred vision, ear ringing, sweating, mouth dryness, lumbar soreness, warm palms and soles. The tongue is red and little coating, the pulse is thready, rapid and taut. TCM remedy should aim to nourish yin, check virtual fire, and invigorate liver and kidney.
Sample of prescription: modified Rehmannia Pill Plus Anemarrhena and Corktree Bark, plus angelica root, dictamnus root bark, processed fleeceflower root, belvedere fruit

Blood deficiency creating dryness and wind
The genital area is itchy, dry, and even scaly, which feel worse at night. Individuals often accompany with dizziness, blurred vision, heart palpitations, insomnia or dream-disturbed sleep, forgetfulness, sallow complexion, and dry stools. The tongue is pale and the pulse is thready and hesitant. TCM remedy should aim to enrich blood, moist dryness, and stop itching.
Sample of prescription: modified Nourish Blood and Conquer Wind Decoction

Fire accumulated in liver and heart
Itchy vulva that is worst at night, and the results of gynecologic examination is usually normal. Individuals often accompany with restless, chest stuffiness, agitated or anxiety, and insomnia. The tongue is slightly red and covered by yellow and greasy fur, and the pulse is taut, thready and rapid. The remedy should aim to clear liver and resolve stagnation.
Sample of prescription: modified Free and Easy Wanderer Plus

External herbal remedies for itchy vulva

External herbal remedies are important for itchy vulva, and are usually applied in wash, compression, powder or cream forms by TCM physicians. The effective ingredients can direct act on the private part, to clean, deodorize, eliminate harmful irritations, arrest discharges, stop itching, anti-septic, anti-fungal, and promote tissue repairing. Physicians use a wide range of herbs for the remedies, and are prepared according to individual health needs, thus the cause of side effects is infrequent.

Actually, external remedies alone are well enough for mild cases, but for stubborn itchy vulva, it is best to work together with oral remedies, especially for those weak or elderly women.

(I) Washing remedies
	Common cnidium fruit, pricklyash peel, alum, sessile stemona root, sopora root, for 10~15g each. This is suitable for itchy vulva due to infections.
	Common cnidium fruit (30g), sessile stemona root (30g), sopora root (30g), paniculated swallow-wort root (15g), amur corktree bark (20g), and schizonepeta herb or pepper mint (20g, add in the last 5 minutes). This is suitable for itchy vulva in menopause.
	Carpesium (30g), sopora root (15g), clematis root (15g), angelica root (15g), common cnidium fruit (15g), Chinese Stellera root (30g). After decocted, add fresh pig bile juice (10ml) into the herbal solution. This is suitable for itchy vulva due to fungal infection.
	Epimedium, psoralea, common cnidium fruit, red peony root, Chinese rhubarb, schizonepeta herb, and Siberian solomonseal rhizome, for 30g each. This is suitable for itchy vulva in elderly.
	Garden balsam stem (10g), dandelion, purslane herb, Tokyo violet herb, ledebouriella root, pubescent angelica root, and Chinese mugwort leaf, for 5g each; and liquorice root (3g).
	Chinese mugwort leaf (100g), and dictamnus root bark (200g).
	Capillary wormwood herb (30g), dandelion (30g), belvedere fruit (30g), Tokyo violet herb (15g), and borneol (5g, add after decocted).

Application: soak the herbs in water for 20 minutes, then decoct the herbs to make a 2000ml of solution, pour the hot solution in a basin, let the private part steam over it, when the solution cools, soak in it for 20 minutes. Do this in the morning and at night, 10 times are as one course of treatment.

An herbal prescription for cool compression

(III) Herbal creams This is for itchy vulva that has broken skin and is not suitable for steaming and washing methods, or for the private region with eczema changes.
	Clam shell (3g) and borneol (0.3g), grind into fine powder, mix with a few Vaseline to make into herbal cream.
	Wintergreen, epimedium and palmleaf raspberry fruit, prepare in equal amount, grind into fine powder, mix with a few Vaseline to make into herbal cream.
	Natural indigo (6g), calcined gypsum (12g), talc (12g), amur corktree bark (6g), gallnet of Chinese sumac (6g), and Vaseline (100g). Grind the herbs into fine powder, and mix with Vaseline to make into herbal cream.

Apply a thin layer of cream to the affected area, and gently rub over it, for 5~6 times a day.

Acupuncture and moxibustion therapies to stop itchy vulva

Acupuncture and moxibustion therapies promote self-regulation of the body, and enhance the overall healing power, so as to speed the recovery. Physicians stimulate on selected body points and apply with special techniques to calm down the body and stop itching. The methods are simple and unlikely to have side effects. Below are the acupuncture and moxibustion protocols for vulvar itching.

Acupuncture and moxibustion protocol (I)
Point selection for damp-heat type: li gou (Lr 5), qu quan (Lr 8), yin lian (Lr 11), & qu gu (Cv 2); apply with reducing techniques;
Point selection of yin deficiency type: li gou (Lr 5), zhong ji (Cv 3), xue hai (Sp 10), & san yin jiao (Sp 6); apply with reducing techniques.

Methods: after cleaned and sterilized the region, rapid insert the needles. For Lr 5, the needle is punctured upward and in an oblique angle for 6.6cm deep, stimulated with lifting and thrusting, twirling and rotating techniques to achieve a needling sensation that radiates along the inner side of the upper leg. For Lr 8, the need is punctured in right angle for 3.3~5cm deep, stimulated with lifting and thrusting techniques. For Lr 11, the needle is punctured either with a right angle or slight upward direction for 1.65~5cm deep, stimulated with twirling and rotating techniques. For Cv 2, the needle is punctured in a right angle, stimulated with gentle twirling and rotating techniques. For Cv 3, the needle is punctured downward and an slight oblique angle for 3.3~5cm deep, stimulated with lifting and thrusting, twirling and rotating techniques. For Sp 10 and Sp 6, the needles are punctured in a right angle, stimulated with lifting and thrusting, twirling and rotating techniques.

Moxa warming on zhong ji (Cv 3), qi hai shu (Bl 24), yin lian (Lr 11), xue hai (Sp 10), and qu gu (Cv 2); warm the places for 3~5 moxa cones , or with moxa sticks for 5 minutes. Do this every two days, 10~15 times are as one course of treatment.

Acupuncture protocol (II)
Major acupuncture points: zhong ji (Cv 3), xia liao (Bl 34), and san yin jiao (Sp 6);
Assistant points are added according to individual conditions:
Damp-heat: yin ling quan (Sp 9)
Yin deficiency: zhao hai (Ki 6)
Severe itching: qu gu (Cv 2), and da dun (Lr 1)
Irritability and poor sleep: shen men (Ht 7), and jian shi (Pc 5)

After inserted the needles, retain for 20 minutes. Do this every day or every two days.

Common acupuncture points for itchy vulva

Common acupuncture points for itchy vulva

Relief tips for itchy vulva

Like itching in other regions, good personal habits are very important, which can protect the genital region, promote healing as well as avoid unnecessary irritations to cause further damages. For whatever the causes, some measures are very helpful to alleviate the discomfort:

	Avoid scratching and rubbing: scratching or rubbing makes the region itchier, and increases the risk of complications like skin thickening, breaking, bleeding, and infection. Trim the fingernails regularly, and consider wearing cotton gloves at night to prevent scratching during sleep.
	Stay dry and cool: wear loose cotton underwear, try not to wear synthetic fabrics and tight-fitting clothing too often. At home or during sleep, take off the underwear can be more comfortable.
	Proper cleaning: wash the genital region gently, and rinse off soap, shampoo, or similar body washes completely. Scrubbing vigorously can worsen the symptoms, so does over-washing.
	Gentle care: choose soft, non-colored and unscented toilet paper. Wipe from front to back after using the bathroom, this can avoid contaminating the external genitalia.
	Avoid potential irritants: be careful to choose the feminine products, lubricants, or creams, as they may contain chemicals that cause sensitivity, pay attention to any sign of irritations or aggravations when using them.
	Proper rest: avoid activities like intercourse, cycling, swimming and riding horse until the symptoms subside.
	Healthy diet: eat adequate amount of fruits and vegetables, yogurt and whole grains, that contain essential nutrients to help speed the recovery. Individual should also drink plenty of water.

When bathing, be sure to rinse the soaps or chemical cleansers off thoroughly.

TCM dietary advice for itchy vulva

Eating healthy has a positive impact on the skin, since many skin problems are a reflection of internal changing of the body. A well-planned diet ensures the body to absorb essential nutrients and to remove toxins effectively, that facilitate the skin condition to heal. From a TCM perspective, itchy vulva is roughly divided into dry and damp types. The dry type is associated with under-nourishment, while the damp type is associated with damp-heat irritating the local region. TCM physicians are highly recommended their patients to abstain from smoking, alcohol, tea, coffee, seafood and spicy food, because they are definitely not favor the healing processes of the skin and membrane. Deep fried, greasy and sweet food tend to induce excess secretions, so they should be avoided by the damp type individuals, however, foods like Chinese yam, coix seed, mung bean, celery, chrysanthemum, three-colored amaranth, wax gourd, watermelon, rice bean, water chestnut, and laver can help reduce the inflammatory reactions, and thus are beneficial for them. For the dry type individuals, yin nourishing food help lessen the dryness of the genitalia, the beneficial ingredients include daily products, soymilk, egg, fishes, Chinese yam, lotus seed, red dates, lily bulb, longan pulp, apple, pear, banana, peach, sesame, glutinous rice, mushrooms, honey, and nuts.

A nourishing soup with carrot, corn, white fungus and pork ribs.	Kelp and mung bean porridge

Simple healthy recipes for itchy vulva:

Kelp and mung bean congee
Prepare kelp (30g), mung bean (30g), rice (100g) and sugar (20g). Cook the ingredients with 1500ml of water, bring to a boil quickly, then simmer under low heat, when the liquid turns thick, turn off the heat. Serve warm in the morning and evening. This helps clear heat, detoxify and induce urination, which are beneficial to damp type itchiness.

Coix seed and red date congee
Prepare coix seed (30g), red dates (10 pieces) and rice (50g). Cook the ingredients with 1500ml of water, bring to a boil quickly, then simmer under low heat, when the liquid turns thick, turn off the heat. Serve warm in the morning and evening. This helps clear heat, and regulate vaginal secretion which are beneficial to damp type itchiness.

Fleeceflower root, mulberry and sesame congee
Prepare fleeceflower root (30g), mulberry fruit (10g), black sesame powder (10g) and rice (50g). Boil the fleeceflower root and mulberry fruit to make a 200ml of herbal solution first, then use the solution, and other two ingredients to cook as congee. This helps enrich blood and nourish yin, which are beneficial to those with dry type itchiness.

Three-nut drink
Prepare gingko nut (10 pieces, peeled), coix seed (50g) and wax gourd kernel (50g, peeled). Boil the ingredients with 750ml of water, turn off the heat when the liquid remains 200ml, serve hot, and drink daily. This drink helps arrest genital secretion and remove odor, and eliminate irritations of the private part, which are beneficial to damp type itchiness.

Turtle fish and glabrous greenbrier rhizome stew
Prepare one soft-shelled turtle fish (about 450g), fresh glabrous greenbrier rhizome (250g), and fresh ginger 3 pieces. Chop the fish into big pieces, remove the outer membrane, head and paws, blanch in boiling water and drain, marinate with rice wine, and soy sauce; chop the herb and boil with 1500ml of water to make a solution; heat up about one tablespoon vegetable oil in a pot, add in the ginger to stir a while, then add in the fish pieces and keep stirring for one more minute, pour in the solution, bring to a boil and turn to low heat to simmer for 2 hours, season to taste. Serve warm, drink the soup and eat the meat. This is suitable for all itchy vulva conditions.

The above self-help remedies are not enough for serious itchy vulva. Seeing your doctor is the best option to secure a better management.