How to stop vaginal itching after birth

Most postnatal vaginal itching comes from a short list: thrush, bacterial vaginosis, or plain irritation from low oestrogen, pads and friction. Plain water, cotton underwear and fewer products fix a good share of it. Discharge that has changed colour or smell needs a doctor.

Why it itches after birth

Oestrogen drops steeply once the placenta is delivered, and it stays low for as long as you are breastfeeding. That thins the vulval tissue, reduces natural lubrication, and leaves skin that used to tolerate anything suddenly reacting to everything.

The NHS describes this postnatal dryness as a common cause of soreness and itching. It is treatable.

Several other things pile on at the same time. Stitches healing, weeks of heavy maternity pads, lochia, broken sleep, and in this climate a fold of skin that is damp from morning to night.

Is it thrush, bacterial vaginosis, or irritation?

These get confused constantly, and the treatments are different.

The Centers for Disease Control and Prevention lists bacterial vaginosis among the most common vaginal infections, and it needs antibiotics rather than an antifungal. Trichomoniasis, which is sexually transmitted, can look similar and also needs a prescription.

A swab takes a minute at the polyclinic and removes the guesswork. Worth it for a first episode.

What helps at home

• Plain warm water on the vulva, once or twice a day, and nothing inside
• Cotton underwear, changed if it becomes damp during the day
• Loose bottoms rather than leggings or shapewear, particularly in the first weeks
• Pat dry, properly, including the folds, before dressing
• Change pads often, every few hours while bleeding, rather than waiting until they are full
• A cool compress for ten minutes when the itch is at its worst
• A water-based lubricant during sex, since low oestrogen reduces natural lubrication

A plain emollient, the sort prescribed for eczema, can be used on the vulva as both a moisturiser and a soap substitute. Ask the pharmacist at Guardian, Watsons or Unity for an unfragranced one.

If stitches or general soreness are part of the picture, our guide to postpartum pain covers what else helps.

What to stop doing

Douching is the big one. The American College of Obstetricians and Gynecologists advises against it, because rinsing out the vagina disturbs the bacteria that keep the environment stable, and bacterial vaginosis becomes more likely rather than less.

Also worth dropping: fragranced washes, scented pads and liners, bubble bath, wet wipes, talc, and anything marketed as whitening or tightening. The American Academy of Dermatology treats fragrance as one of the most common causes of contact dermatitis, and vulval skin is thinner than the skin on your arm.

Shaving the whole area every few days can keep the skin inflamed. Trim instead while it settles.

Our piece on intimate area care during pregnancy covers the same ground for the months before delivery, and our guides to underarm problems and choosing a deodorant for pregnancy deal with the same fragrance and friction questions elsewhere on the body.

Heat, pads and this climate

Singapore makes the damp-fold problem worse than it would be elsewhere. Humidity sits high all year, sweat does not evaporate, and a panty liner worn daily out of habit turns into a warm plastic layer against skin that is already dry and thin.

Practical adjustments that help here:

• Skip the daily liner unless you actually need one
• Change out of swimwear and gym clothes immediately rather than on the way home
• Shower in the evening as well as the morning, since the walk home is the sweaty part
• Choose breathable pads, and change them more often than the packet suggests
• Point the bedroom air-conditioning away from you rather than sleeping in a cold draught, which dries skin further

Confinement practice sometimes includes herbal washes or sitz baths for the perineum. Warm plain water is safe and soothing. Herbal mixtures on healing stitches are worth asking your doctor about first, because a stinging wash on broken skin is not helping anything.

Pregnancy and breastfeeding change the treatment

Thrush is more common in pregnancy, and some oral antifungal tablets are avoided then, so treatment is usually a pessary or cream prescribed after an assessment. Do not use a leftover tablet from before you were pregnant.

Bacterial vaginosis that causes symptoms in pregnancy is usually treated rather than watched, so mention a change in discharge at your antenatal visit even if it is not bothering you much. The same goes for any itch you have been quietly managing for weeks.

While breastfeeding, the dryness may persist until your periods return. A prescribed topical oestrogen is sometimes used for exactly this, and it is a reasonable thing to ask about rather than enduring.

When to see a doctor

• A first episode, so you find out what it actually is
• Discharge that is grey, green, frothy, bloodstained or smells strongly
• Itching with fever, pelvic pain, or pain when passing urine
• Symptoms that return within a month of treatment, or more than four times a year
• Any itch during pregnancy, before you treat it yourself
• Sores, ulcers, blisters or a lump
• Itching that has gone on for weeks with no discharge at all, since a skin condition such as lichen sclerosus needs a diagnosis

Your polyclinic handles most of this, and KK Women's and Children's Hospital runs the specialist services if a referral is needed. Postnatal review at around six weeks is a natural moment to raise it, and the doctor you ask has heard the question several times already that morning.