Intimate itching in pregnancy: causes and remedies

When expecting a baby, hormonal changes can also affect the vaginal microenvironment, favoring the appearance of itching and infections.

The skin during pregnancy can undergo various alterations, for example stretch marks on the breasts, an increase in pigmentation (which on the face is manifested by the so-called pregnancy mask, while on the belly with the linea alba), or the appearance of dilated capillaries especially on the legs, due to alterations in the superficial circulation of the blood. In addition, even absolutely physiological conditions such as pregnancy can be accompanied by the onset of widespread skin itching, mainly due to the hormonal changes that characterize it.

The problem affects about 20% of expectant mothers, especially in the arms, chest, abdomen and legs. To cause this annoying itching can be, for example, cholestasis gravidarum, a pathology that does not represent a danger for the future mother, but which can compromise fetal health. It is therefore always advisable to consult the gynecologist in case of itching, which can involve a large part of the body (in particular the soles of hands and feet, arms and legs at the level of the thighs), but generally disappears a few days after delivery. In some cases it can be so intense that it causes scratching, causing lesions on the skin, while it is rare for rashes similar to urticaria to appear.

In pregnant women, itching can also be triggered by the tendency to have dry skindue to the hormonal changes typical of this period that make the tissues less elastic. In this case the itchy sensation can also extend to the trunk and to alleviate it it is useful to apply moisturizing and emollient creams or refreshing powders based on mentholated talc on the skin.

During gestation, but not only, women can also experience itching in the genital area. It is, in fact, a particularly delicate area that, although equipped with a natural defense system, is exposed to numerous potential factors that can alter its balance and give rise to irritation and vaginal infections.

Each phase of life presents its own critical issues, very often associated with the hormonal structure that characterizes them.

One of the most frequent consequences of the hormonal storm that accompanies gestation, for example, is the appearance of intimate itching. The tingling and irritation sensation is in fact very common, especially during the first weeks or in the last trimester ofgreed. The symptom can occur externally and affect only the vulva, or also involve the vagina and, if very intense, can be painful.

Whitish and odorless vaginal discharge, although abundant, are part of the normal picture and are called leucorrhoea gravidarum. What should induce the woman to promptly contact her gynecologist are instead abnormal leaks, for example grayish, yellow-green or reddish, creamy consistency and bad smell.

Vaginal pH

The acidity of vaginal pH is the most powerful means of self-defense of the microflora because it prevents the proliferation of pathogenic bacteria or fungi.

The maintenance of the pH around values of 4-4.5 is allowed by lactobacilli, non-pathogenic bacteria that populate the vagina and that play the important role of transforming glycogen, ie the sugar present in the mucous membranes, into lactic acid, which in turn allows to maintain the acidic pH.

Lactobacilli also produce hydrogen peroxide, i.e. hydrogen peroxide, which has a toxic action on bacterial cells.

Since glycogen levels depend on the amount of estrogen and progesterone circulating, vaginal pH varies as a result of changes in hormone levels typical of women’s lives (e.g. during pregnancy and menopause).

Until puberty, the absence of lactobacilli makes the environment neutral and therefore devoid of self-defense systems, with greater risk of developing infections. In childbearing age the abundant presence of estrogen increases the volume of mucous membranes, rich in glycogen, and the large amount of lactobacilli present in the vagina protect the vaginal environment by keeping the pH around 4. With the menstrual cycle, however, acidity tends to decrease: for this reason, in the days following the end of menstruation you are at greater risk of developing infections.

Finally, during gestation, the level of estrogen is maximum and increases the volume of the vaginal mucosa, as well as the amount of glycogen and lactobacilli. The vaginal pH becomes even more acidic, reaching values around 3.5. If on the one hand this acidity is protective, on the other hand the high levels of sugars are ideal for the multiplication ofsome microorganisms such as Candida, which although not dangerous during gestation, can cause discomfort such as itching and sometimes burning during sexual intercourse.

An acidic pH in pregnancy is in any case of fundamental importance: values above 4.5 are associated with bacterial vaginosis, a condition that requires immediate consultation of the gynecologist as it can increase the risk of pelvic inflammatory disease and in pregnancy of abortion and premature birth.

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Causes of intimate itching

Intimate itching in pregnancy can have various causes. In general, the future mother is more sensitive not only to smells and tastes, but also to the level of skin and mucous membranes and it may happen that contact with chemicals, intimate cleansers or clothing causes irritation and allergic manifestations.

At this stage it is therefore advisable to pay attention to the use of aggressive soaps, detergents or fabric softeners for washing underwear, even if before pregnancy the same products did not cause any discomfort.

The appearance of intimate itching can also be an indicator of some infections typical of pregnancy, such as candidiasis, but it can also be due to the greater production of vaginal secretions or only irritation. In the case of candida vaginitis, intimate itching is caused by the excessive proliferation of a fungus, Candida albicans, which normally resides in the intestine, in the oral cavity and in the vaginal mucous membranes.

Quando, per motivi legati a un’alterazione della microflora dell’ambiente vaginale, si creano le condizioni per la sua iperproliferazione, il germe prende il sopravvento e si innesca il processo infettivo, tipicamente accompagnato da secrezioni di densità simile a quella del latte cagliato o della ricotta, che possono essere facilmente distinte dalle perdite biancastre maleodoranti e biancastre causate dall’eccessiva moltiplicazione di un altro microrganismo, la Gardnerella vaginalis, responsabile della vaginosi batterica.

Oltre all’aspetto, la principale differenza fra le secrezioni vaginali tipiche delle due infezioni è la presenza, solo nel caso della vaginosi batterica, di un forte e cattivo odore, simile a quello del pesce avariato, del tutto assente invece in caso di candidosi.

Prurito vaginale intenso, bruciore e gonfiore dei genitali esterni, dolore alla minzione e durante i rapporti sessuali sono altri sintomi caratteristici della candidosi, che è favorita dall’uso di terapie antibiotiche, da una dieta che preveda il consumo eccessivo di cibi ricchi di zuccheri, dallo stress, dal diabete mellito e da disturbi che possono indebolire le difese immunitarie.

In caso di vaginosi batterica i sintomi infiammatori sono invece del tutto assenti, o solo sfumati.

Esiste inoltre un’altra forma di vaginite infettiva che, come la candida, può causare un forte prurito intimo. Si tratta della tricomoniasi, un’infezione a trasmissione sessuale causata da un parassita, il Trichomonas vaginalis. Sia la vaginosi batterica sia la tricomoniasi, se contratte in gravidanza, possono essere pericolose perché aumentano il rischio di una rottura prematura delle membrane e parto anticipato.

Candidiasis is not dangerous for pregnant women, but it is advisable to consult the gynecologist to treat it (also subjecting the partner to the appropriate treatment) before the birth of the child as it could be transmitted to the newborn in case of natural delivery and give rise to thrush, a non-serious infection of the oral cavity frequent in neonatal age.

In summary, here are the symptoms that characterize and differentiate these three vaginal infections:

Appearance of secretions Smell of secretions Inflammatory symptoms
Candidiasis Whitish, granular secretions, similar to ricotta and tend to be abundant Absent Itching, burning and redness
Bacterial vaginosis Milky and homogeneous greyish-white secretions, more or less abundant Unpleasant smell, resembling that of spoiled fish Absent
Trichomoniasis Greenish-yellow secretions, foamy Unpleasant, stale, mold-like odor Very intense pain and itching

Another cause of intimate itching in pregnancy is represented by genital herpes, due to the Herpes Simplex virus type 2 (which belongs to the same family as the one that causes herpes on the lips). It is a sexually transmitted virus (such as those that cause chlamydia and gonorrhea) which, once contracted, is not eliminated, but remains silent in the body, and can reactivate at any time causing inflammation, burning and pain when urinating. If viral reactivation occurs near the end of pregnancy, a cesarean section will be scheduled to prevent the fetus from coming into contact with the virus during passage into the birth canal.

During pregnancy, the risk of developing a urinary tract infection is also higher than normal. Cystitis (an inflammation of the bladder) does not always give signs of its presence, but when it becomes symptomatic it also causes itching at the level of the external genitalia, as well as difficulty urinating, abdominal pain, need to urinate frequently and burning during urination, as a result of the inflammatory state, and in some cases even fever.

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Therapies

Since this is a particularly delicate period in the life of a woman, during pregnancy, as well as breastfeeding, it is always advisable to contact the general practitioner or specialist, who can identify the cause of the itching during the visit based on clinical signs or evaluate the prescription of a vaginal swab or other analyzes, to identify the microorganism responsible for the discomfort.

In pregnancy, the treatment, depending on the case, may be based on antibiotics or antifungals. In the case of candida infections, for example, it is necessary to take, after consulting the gynecologist, topical antifungals, and not oral, which are not recommended during pregnancy.

Along with the treatments used to eliminate the cause of itching, it is recommended to take a specific product to rebalance and optimize the vaginal ecosystem and for the prevention of itching. Today there is also the possibility of administering probiotics directly vaginally: in this way the passage through the digestive system is avoided, obtaining a higher concentration and a faster colonization of the vaginal environment. The defense capabilities of the vaginal ecosystem increase in a short time, thus also reducing the risk of easy relapses.

To get relief from the sensation of itching, you can also resort to natural remedies, such as creams based on chamomile or oats, with soothing and antipruritic properties. For the same purpose, almond oil is also useful, soothing and nourishing. In pregnancy, vitamin C tablets for local use are very suitable to normalize the pH.

Taking care of the vaginal environment

The variations in vaginal pH typical of sweet expectation induce a greater production of secretions that can cause itching. And this could lead to too frequent and aggressive hygiene. On the contrary, it is necessary to use caution so as not to irritate the mucous membranes and not to compromise the balance of the protective microflora. Therefore, use only a couple of times a day a quality product specific for intimate hygiene at physiological pH, with soothing components that relieve itching, irritation and erythema, avoiding the use of internal vaginal douches and intimate deodorants.

It is also important to maintain the right balance in the vaginal bacterial flora: a reduction in “good” bacteria leads to a lowering of the defenses with a greater risk of infections. Since excessive humidity and heat create an environment suitable for the development of harmful microorganisms, it is best to avoid anything that could favor these conditions. For example, with regard to clothing, it is preferable to avoid synthetic clothing in contact with private parts and / or tight trousers. For the same reason, it is advisable to limit the use of panty liners to a minimum.

For linen, it is better to prefer those made of breathable material, such as cotton or natural fibers. Finally, it is advisable to change sanitary pads often (both internal and external), do not use colored or scented toilet paper and use only your own personal towel.

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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