There is an identifiable cause for pruritus vulvae in most women.

• Confirm that the woman is experiencing vulval itch, not vulval pain (which is outside the scope of this topic).
• Take a careful history — this may find an underlying cause for the vulval itch. Ask about:
• Duration and timing of symptoms
• How long have symptoms been present? — Acute itch is generally due to infection or acute contact dermatitis.
• Is the itch worse at night? — Nocturnal vulval itching may indicate lichen sclerosus, lichen simplex, or threadworm infestation (particularly if combined with peri-anal itch).
• Associated symptoms
• Is the itch confined to the vulval area? — Itch elsewhere may indicate a more generalized problem, including scabies.
• Is there vaginal discharge? — Discharge may indicate infection, such as candidiasis, bacterial vaginosis, or trichomoniasis.
• Hygiene practices
• Could hygiene practices be causing symptoms? — The use of creams, perfumes, deodorants; sanitary wear containing bleach; douches; soaps; wipes (baby or hygiene); moist toilet tissues; or simply excessive washing may result in vulval irritation or even contact dermatitis.
• Use of topical vulval preparations
• Could self-administered treatments be causing or aggravating symptoms? — Some women may develop irritation secondary to use of antifungal creams for presumed candidiasis, hormone replacement therapy creams, or pessaries.
• What contraception is being used? — Some women are allergic to spermicides, or the latex in condoms and diaphragms.
• Other conditions
• Is the woman known to have a generalized skin disorder that can affect the vulval area, such as dermatitis or psoriasis?
• Does the woman have a personal or family history of atopic conditions (for example hay fever, asthma, eczema)?
• Does the woman have diabetes mellitus? — Diabetes increases the risk of candidal infection.
• Does the woman have a systemic illness that could cause itch, such as renal or hepatic impairment, or anaemia?
• Is the woman menopausal? — Atrophic vaginitis may be the cause of the symptoms.
• Is the woman breastfeeding? — Breastfeeding can result in lowered oestrogen levels and consequent vulval symptoms.
• Does the woman have faecal or urinary incontinence? — These can damage the vulval skin either directly or indirectly by the use of sanitary products or over washing.
• Assess the severity of symptoms and the impact this is having on the woman — in particular enquire into psychosexual problems, low mood, loss of sleep pattern, and feelings of anxiety.
• Examine:
• The anogenital region  — examination findings may indicate an underlying cause, such as signs of candidiasis, dermatitis, psoriasis, atrophic vaginitis, lichen sclerosus, or lichen planus.
• The mouth — examination may find signs of lichen planus.
• The skin —  examine for signs of psoriasis (for example on scalp, elbows, knees, and nails), and eczema (which may be seen on any area of the skin).
• For a discussion of the possible causes of pruritus vulvae, and their differentiating features, see Causes.