March 2006
Unexplained Itches and Odors:
Sources and Treatment of Non-Infectious Odors and Itch

By Elizabeth Gunther Stewart, M.D.

Cindy prided herself on her high standards for everything- these included her flawless appearance, great shape achieved by diet and exercise, and meticulous self-care. Her beauty ritual included a trip to the gym every day before work. She wore a mini-pad to prevent any wetness, bikini briefs laundered with bleach and fabric softener, then spandex shorts. After a 45-minute workout on the machines, she had a long, hot shower with a spa-cleansing product, then a wipe-down with an aloe based herbal product. Then another mini-pad fitted to a thong, panty hose and a pants suit that fit her every curve. Problem was, she was starting to itch. A three-day anti-yeast treatment did absolutely nothing; she started taking really hot baths that felt great, but soon after the itching returned.

At some point almost every woman experiences itching and/or odor. A recent survey conducted by the Vagisil Women's Health Center revealed that one out of every two women aged 18-44 says they experience vaginal itching (43 percent across all age groups 18 and over). More than half of the women surveyed (57 percent) who say they experience itching will try to self-treat the problem before going to the doctor for help.

Most women will immediately attribute the itch to a yeast infection, or assume that any odor present is representative of infection. While odor and itching accompanied by discharge and irritation can represent infection, much of the time odor and itching have nothing to do with infection and come from a host of harmless sources. Look for the answers to Cindy’s problems as you read on.

ITCHING

What else itches besides yeast? The simplest reason is tight clothing layers that trap moisture. Since we perspire freely in the vulvar area, it doesn’t take long before this moisture, along with residues of soap, bleach and fabric softener in the clothes compounds with friction to cause irritation and itching.

In another effort to be clean, we wash with the hottest water we can stand, scrubbing with drying soaps and abrasive sponges or loofahs. Pilar was taught to scrub with soap and water after every urination; at the age of 41, her skin started to protest!

Personal care products are another possible culprit. People can have various allergies, even to natural substances, such as aloe or lanolin. A personal care product that works for one person can trigger an allergic reaction in another. Even pure soap can be drying and caustic to the skin.

There are a number of skin disorders that lead to itching of the vulvar skin, such as eczema and psoriasis. With menopause, low estrogen can lead to dryness and itching. Other possibilities include pinworms, pre-cancer and cancer, warts and vaginal infections.

WHAT TO DO ABOUT ITCHING

1. Lighten up! Skip the panty liner; change your underwear frequently if you are wet.
   
2. Avoid pantyhose and tight underwear. Strip down when you are at home and wear no underwear. Sleep without it, too.
   
3. Identify possible irritants, from the type of laundry detergent you're using to any personal care products, and eliminate the offending substance or substances. Use mild, fragrance-free soap.
   
4. Over-the-counter products such as Vagisil® Maximum Strength Anti-Itch Crème can relieve itching and burning and sooth skin. Vagisil also offers Maximum Strength Anti-Itch Medicated Wipes for convenient, on-the-go relief. However, if itching persists or worsens, it’s imperative that you see your doctor.
   
5. If your skin itches due to allergies, try Maximum Strength Gynecort® Anti-Itch Crème, which contains 1 percent hydrocortisone acetate.
   
6. If estrogen is low, some estrogen cream can provide safe relief.
   
7. Avoid very hot showers and baths. Hot water can make skin dry, and itchy.

ODOR

The recent survey by the Vagisil Women's Health Center reveals that almost one in four women aged 18 years and older (23 percent) report that they are "very conscious" of their vaginal or external vaginal odor. I have found that a lot of women worry that odor implies poor personal hygiene, but inadequate washing is almost never the case. Some scent is to be expected from almost all activity in the vulva and vagina. The vulvar area is supplied with many sweat glands and sweat causes odor. Normal secretions from the vagina may smell faintly like sour milk. Any secretion or menstrual flow that stays on a pad or underwear is exposed to bacteria normally present, producing an odor. And every woman has her own unique scent. Most women are especially sensitive to this scent, which may not be detected by others.

Other possible causes of odor include urine leakage, a forgotten tampon and some medications and vitamins that produce odor in the urine. Food substances, such as garlic come out through perspiration and urine.

WHAT TO DO ABOUT ODOR

1. If odor is accompanied by irritating discharge, a check with your doctor is important to rule out infection.
   
2. If you think that perspiration is the culprit, wash with antibacterial soap daily.
   
3. Wear underwear made of fabric designed to wick away moisture and sports clothing purchased from a sporting goods store.
   
4. You can use a non-talc based deodorant powder, such as Vagisil® Anti-Itch Powder, which is cornstarch-based. Sprinkle it into your panties or apply directly to the skin, any where you perspire (including under the breasts and inside thighs).
   
5. If you are a woman with curves that trap moisture under them, you can use strips of old sheeting or handkerchiefs placed between the skin folds to help absorb sweat.
   
6. Losing weight can make a huge difference. Susan joined a gym and lost 25 pounds, as well as the moisture trapping skin folds. Goodbye odor!
   
7. Think if you are taking a new vitamin or medication that could cause the odor and hold off for a few days if possible.
   
8. Make sure you removed the last tampon you inserted. Fredricka was so embarrassed, but this was the cause of her problem.
   
9. Correct any urinary leakage. Make sure you do not have a urinary tract infection and learn how to do Kegel (pelvic floor) exercises. A urogynecologist can help if these are not enough.
   
10. If you checked out well with your doctor and tried all the simple measures, consider that this may be your individual thing. You can use a plastic squeeze bottle to rinse after urination and carry extra underwear for a freshening change.
    
11. Douching is not helpful and can lead to pelvic infection.

Helpful web sites:

www.thevbook.com
www.nlm.nih.gov/medlineplus/ency/article/003217.htm
www.obgyn.uihc.uiowa.edu/patinfo/vulvar/lichensimplex.htm
www.goaskalice.columbia.edu/2265.htm
www.kegel-exercises.com