One of the lesser-known side effects of changing hormones in pregnancy is vaginal itching.  The vagina, the vulva, or both can itch. The vulva is the external part of the female genitals, including the clitoris, the labia, and the opening of the vagina.  

How does one get the right advice? Here is a comprehensive blog on vaginal itching.

Causes of Vaginal Itching during Pregnancy

Let’s look at the causes, one by one:

‍Cause 1: Bacterial vaginosis

Bacterial vaginosis is a type of vaginal inflammation caused by the overgrowth of bacteria naturally found in the vagina, which upsets the natural balance. BV is a result of an imbalance of “good” and “harmful” bacteria in a vagina. A change in the vaginal bacterial balance causes bacterial vaginosis.It is important to recognize the symptoms early in pregnancy.

The symptoms are:

• Thin, white, grey, or green discharge.
• Unpleasant odour.
• Vaginal itchiness.
• Burning sensation while urinating.

Management: 

Please a see a doctor immediately if your vaginal area has these issues.

• Swelling, itching, or soreness.
• Colour or consistency changes.
• Unpleasant odour and/or discharge.
• Some women find cold compresses helpful.

‍Cause 2: Increase in vaginal discharge

The amount of vaginal discharge and cervical mucus you secrete may increase throughout pregnancy. Hormonal changes causes this as well as the softening of the cervix and vaginal walls. Discharge is designed to protect your vagina from infection, but it can irritate the skin of the vulva, making it red and itchy.

‍Management: 

• Bathe regularly and wear cotton panties.
• Change panties every few hours.
• Do not use any chemicals in that area.
• Add 1 tbspn to a glass of lukewarm water and wash the area.
• Don’t apply hair-removing cream. If you are using a razor, get a new razor for yourself as dull razor can aggravate the skin around your vagina, causing irritation and redness.

Healthy vaginal discharge is usually thin, clear or milky white and shouldn't smell bad. Speak to your midwife or doctor if you are unsure about any increase or change in your vaginal discharge.

‍Cause 3: Vaginal dryness

Hormonal changes may cause vaginal dryness to occur in some people during pregnancy. Anecdotal evidence indicates that those who are breastfeeding when they conceive are more likely to experience this symptom.

Redness, irritation, and pain during sex may also occur.

Low progesterone may also cause vaginal dryness in some pregnant women. Since this hormone is necessary for sustaining pregnancy, talk to your doctor if you have this symptom.

Management: 

• Have a lot of water, stay well-hydrated.
• Avoid chemical products. 
• Apply coconut oil.
• Stress can also cause vaginal dryness. Invest in meditation and yoga.

‍Cause 4: Sensitivity to products

During pregnancy, the vagina becomes engorged with blood, and your skin may feel stretched and more sensitive than usual.

Products that you used comfortably before conceiving may now irritate your skin, causing it to itch and redden.

Products that can cause this to occur include:

• Detergent
• Bubble Bath
• Body Wash
• Soap

‍Management: 

• Use gentle agents for washing your clothes.
• Do not immerse yourself in bubble baths.
• Use mild, oil-based soaps for bathing.
• Apply a cold compress to the vagina, or take cooling baths.
• Take a baking soda bath, mixing 1/4 to 2 cups of baking soda into a tub full of warm (not hot) water.
• Mix baking soda and water to create a paste, and apply it to the itchy skin.
• Apply coconut oil to the itchy skin.

‍Cause 5: Urinary tract infection (UTI)

The uterus sits on top of the bladder. As it expands during pregnancy, greater pressure is placed on the bladder. This can block the expulsion of urine, causing an infection to occur.

For this reason, pregnant women can be at greater risk for getting a UTI.

Bacteria can also cause UTIs, such as group B strep bacteria (GBS). Around 1 in 4 pregnant women test positive for GBS. GBS in adults doesn’t usually show symptoms. Since the GBS bacteria can be harmful to a newborn, your doctor will test you for it during pregnancy.

Symptoms include:

• Frequent and urgent need to urinate
• Abdominal pain
• Vaginal itching and burning
• Blood in urine
• Pain during intercourse

‍Management: 

• Stay hydrated. Have a lot of barley water, too.
• Sugar-free curd can also help. It contains antibacterial, antifungal, and antimicrobial properties that help fight yeast infections. Mix two to three drops of honey with the fresh curd. Apply the mixture into the vagina.
• See a doctor immediately. Do not self-medicate.

‍Cause 6: Cholestasis of pregnancy is a liver condition that causes severe itching late in pregnancy. It’s also known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis.

ICP temporarily lowers liver function in some pregnant women. This causes bile to build up in your liver and bloodstream.Bile is a substance made by your liver and stored in your gallbladder. Your liver helps break down fats during digestion. Increased levels of estrogen and progesterone during pregnancy affect your liver's ability to transport bile.

Cholestasis of pregnancy causes extreme itchiness on the palms of the hands and soles of the feet. The itching may start to affect the entire body, including the vaginal area. Rashes and redness don’t occur with this condition. 

What are the risk factors for cholestasis of pregnancy?

You’re at higher risk for developing cholestasis of pregnancy if you:

• Have a family member with the condition.
• Had ICP before.
• Are pregnant with twins, triplets or more.
• Have a history of liver disease or hepatitis C.
• Have a history of liver damage.
• Have a genetic condition that affects how your body makes and uses bile.

Management:

Your doctor will do a simple blood test  and physical examination to check. The level of bile acids in your bloodstream tested using a serum bile acid test will confirm the diagnosis. 

Medication will be started immediately. Along with that, your doctor will:

• Give anti-itch medicine (don’t pick any on your own!)  
• Recommend that you wear soft and loose-fitting clothing.
• Rest in a cool room.

If you have crossed Week 37, the doctor may also suggest getting the baby out if your symptoms are not lessening.

‍Cause 7: Sexually Transmitted Infections (STIs)

STIs, such as genital herpes, HPV, and trichomoniasis, may all have vaginal itching as an early symptom.

You can become pregnant while you have an STI or get one during pregnancy. Since STIs may not show symptoms, it’s important to let your doctor know if you think you may have one contracted one.

If an STI does show symptoms, you may have:

• Rash
• Burning sensation
• Warts
• Fever
• Vaginal discharge
• Flu-like symptoms

STIs can adversely affect you and your baby, but you can get treated while you’re pregnant, eliminating those risks.

‍Management: 

STDs, such as chlamydia, gonorrhea, syphilis, and trichomoniasis can all be treated and cured with antibiotics that are safe to take during pregnancy. Viral STDs, including genital herpes, hepatitis B, and HIV cannot be cured.

Keeping your vaginal area healthy with Yoni Dhupan

YONI DHUPAN means steaming or fumigation of the vagina with medicated smoke. Doing this helps in balancing the secretions of the vagina and removing bacteria from it. It also helps in improving blood circulation. When warm, medicated smoke surrounds that area, it gives it a good, gentle cleaning. You can do it yourself at home.

It’s done on a special toilet-style stool, or even a chair with openings, by sitting over the steaming (often ceramic or copper) pot of herbs. Yoni steam seats and steam gowns are also available in the market.

Where exactly in the body is Yoni Dhupan done?

The area you have to target is called ‘Bhaya Yoni’ or the outer surface of the vagina. It should be done for 3 to 5 minutes.

When should a pregnant woman do Yoni Dhupan?

Yoni dhupan can be both a treatment for some irritants and also just a preventive, good habit to keep the pregnancy healthy.

As per Ayurveda, the following conditions are indicators for this therapy (do consult a Vaid for the right herbs if you wish to do Yoni Dhupan)

• Shweta Pradara (leucorrhea/ abnormal white discharge)  
• Yoni Kandu (itching of the vagina)
• Apara Sanga (retention of placenta)
• Garbha Sanga  (delayed labour)
• Sutika Paricharya (postpartum regimen for healing)

Which herbs should be put in the Dhupan?

Here is a recommended list. Please consult with a vaidya before using them:

• Kushta ( Saussure acostus )
• Agaru ( Aquilaria agallocha )
• Guggul (Comiphera mukul )
• Vacha ( Acorus calamus )
• Vidang (Embelia Ribes)
• Nimba Patra (Azadirachta Indica ) 

These herbs mentioned should be used per the vaidya’s advice depending on the type of infection if any. 

One can use dried neem leaves for ‘preventive’ dhupan. That is, the dhupan you can do just for hygiene.

What is the right procedure for Yoni Dhupan?

• Empty your bladder and sit on the Dhupan seat.
• Place the dhupan dravyas in a bowl, light them till smoke emerges. 
• The smoke coming from the dhupan herbs must reach up to the expected genitalia for fumigation.
• If you wish to use a pipe to target the areas (Nadi Dhupan), that is also fine.
• Make sure that you watch the temperature. The smoke should feel warm against the skin but shouldn’t feel hot. If hot, it could lead to minor burns.