At least 90% of women who complain of vaginal or vulvar itching will have yeast as at least a portion of the problem.

Because of this, simply treating these patients with a reliable anti-fungal agent (Monistat, Mycelex, Lotrimin, Diflucan, etc.) without a detailed history, physical and laboratory evaluation, is often expedient and successful. In many settings, this therapeutic approach is particularly useful as it requires no laboratory or physical examination.

For those in whom itching persists, a careful history and physical exam will be useful in determining the cause of the itching.

When available, some tests which may be used in determining the cause of the itching, including vaginal cultures (for strep), wet mount (for yeast, Trichomonas and bacterial vaginosis), vulvoscopy (magnified inspection of the vulva) and directed skin biopsies.

Less common causes of vulvar itching include hypertrophic vulvar dystrophy, lichen sclerosus, HPV, Paget’s disease, VIN, contact dermatitis, psoriasis of the vulva and lice.