Genital itching is a vexing but common problem in women. Female genital itchiness occurs with conditions that affect the vagina, vulva or both. It's only human to scratch an itch, particularly if the itchiness is intense or persistent. Therefore, spotting associated with genital itchiness is often due to minor bleeding caused by scratching. The spotting might also come from light bleeding from the cervix or vagina.
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Infections are a leading cause of female genital itchiness, which might be accompanied by spotting.
The Centers for Disease Control and Prevention reports that an estimated 75 percent of women experience at least one genital yeast infection, also known as vulvovaginal candidiasis. This infection inflames the vaginal and vulvar tissues causing soreness, burning and itchiness. Spotting may occur due to scratching the vulva or from vaginal bleeding in the case of a severe infection. Thick white vaginal discharge also characterizes this infection.
Bacterial vaginosis (BV) is a very common condition characterized by an imbalance in the normal bacteria in the vagina that allows harmful bacteria to flourish. Many women with BV experience no symptoms but those who do might experience a thin vaginal discharge with a fishy odor, burning with urination, and burning, pain or itchiness in or around the vagina. Spotting might occur due to scratching or inflammation of the cervix.
Trichomoniasis, commonly known as trich (pronouned like trick), is the most common curable sexually transmitted infection in the US, according to CDC. Only about 30 percent of people with this infection develop symptoms but women who experience symptoms might notice a change in their vaginal discharge, unusual genital odor, and vulvovaginal burning, itchiness and/or soreness. As with BV, spotting can occur due to scratching or cervical inflammation.
With contact dermatitis, direct exposure to an aggravating chemical inflames the involved area leading to a red, itchy rash. The vulvar skin is vulnerable to this skin condition due to exposure to any of several chemicals found in soaps, feminine hygiene products, underwear dyes, lubricants and spermicides, among others. In most cases, contact dermatitis is due to an irritant reaction but is sometimes caused by an allergic reaction. Spotting might occur due to vulvar scratching or a crack in the skin, which can develop with persistent contact dermatitis.
Lichen Sclerosus and Lichen Planus
Two skin disorders called lichen sclerosus (LS) and lichen planus (LP) commonly affect the vulvar skin and cause intense itchiness. LS is a chronic inflammatory condition that primarily affects postmenopausal women. The cause is incompletely understood. The affected skin is fragile and easily bleeds, which is often noticed as spotting.
LP is less common than LS. It also affects women more frequently than men although not as disproportionately as LS. LP is an autoimmune disorder. The most common form of LP causes erosions and ulcerations that itch and easily bleed. In contrast to LS, 70 percent of women with vulvar LP have vaginal involvement, as noted in a February 2008 American Family Physician article.
A number of other conditions can potentially cause vulvovaginal itchiness and spotting. Many of these conditions cause additional symptoms. Examples include:
- Genital warts
- Genital herpes
- Atrophic vaginitis in postmenopausal women
- Vulvar psoriasis
- Vulvar cancer
Next Steps, Warnings and Precautions
If you've had a vaginal yeast infection in the past and recognize the symptoms, it's usually safe to try a course of treatment with an over-the-counter antifungal medicine. For other situations, it's best to visit your healthcare provider for an accurate diagnosis and the best treatment options. Contact your doctor right away if you think you might have been exposed to a sexually transmitted disease, are pregnant or experience any warning signs or symptoms, including:
- Fever and/or chills
- Abdominal pain
- Vaginal discharge the resembles urine or feces
- Merck Manual Professional Version: Vaginal Itching and Discharge
- Centers for Disease Control and Prevention: 2015 Sexually Transmitted Diseases Treatment Guidelines -- Diseases Characterized by Vaginal Discharge
- Differential Diagnosis of Common Complaints, 6th Edition; By Andrew B. Symons and Robert H. Seller
- Journal of Clinical Outcomes Management: Vulvar Dermatoses: A Practical Approach to Evaluation and Management
- American Family Physician: Diagnosis of Vaginitis
- BioMed Research International: Pruritus in Female Patients
- Centers for Disease Control and Prevention: Vaginal Candidiasis
- Centers for Disease Control and Prevention: Trichomoniasis
- American Family Physician: Non-Neoplastic Epithelial Disorders of the Vulva