I keep treating thrush but the itching returns. Why?

Because it is often not thrush. Persistent vulval itching that does not respond to antifungal treatment is more likely to be lichen sclerosus, eczema, contact dermatitis from washes and wipes, or vulval atrophy after the menopause. Each needs different treatment.

What is lichen sclerosus?

A chronic inflammatory skin condition of the vulva causing itching, whitening and thinning of the skin. Over time it can change the vulval architecture. It is common, frequently missed for years, and responds well to a potent topical steroid used correctly.

Are strong steroid creams safe to use there?

Used as directed, yes, and undertreating is the more common problem. Lichen sclerosus needs a potent steroid, applied in a specific way and then reduced to a maintenance regimen. Fear of steroids leads to years of unnecessary symptoms.

Will I need a biopsy?

Not usually. The diagnosis is generally made on appearance. A biopsy is arranged where the appearance is atypical, where treatment does not work as expected, or where there is any area of concern that needs to be identified rather than assumed.

Is lichen sclerosus linked to cancer?

There is a small long-term increase in the risk of vulval cancer, which is why the condition is monitored rather than treated once and forgotten. Well-controlled lichen sclerosus with periodic review is the aim, and treatment appears to reduce that risk.

What should I stop using?

Soaps, shower gels, feminine washes, wipes and douches, all of which commonly worsen vulval skin conditions. Plain emollient as a soap substitute is usually better. Bring whatever you have been using, as the cause is sometimes in the bag.

Consultant gynaecology · Central London EC1

Vulval Itching and Skin Conditions

Persistent itching, soreness or changes in the vulval skin, assessed properly rather than treated as thrush again.

Vulval itching that does not settle with antifungal treatment is usually not thrush. Lichen sclerosus is common, frequently missed for years, and needs a specific treatment that works well once started.

Consultant-led · Examination and diagnosis · From £200

What to expect

A diagnosis, not another antifungal

Careful examination

Vulval skin conditions are diagnosed by looking. Changes in colour, texture and architecture are what distinguish them, and that takes an unhurried examination.

Lichen sclerosus

Causes itching, whitening and thinning of the skin, and can gradually change the vulval anatomy. It responds well to a potent topical steroid, used correctly and long term.

The alternatives

Eczema, lichen planus, contact dermatitis from washes and wipes, and vulval atrophy after the menopause all present similarly and are managed differently.

When a biopsy is needed

Where the appearance is atypical or treatment does not work as expected, a biopsy is arranged rather than the diagnosis being assumed.

What to stop using

Soaps, washes, wipes and antifungal creams frequently make vulval skin conditions worse. Practical advice on what to remove first.

Long-term review

Lichen sclerosus needs monitoring, both to keep it controlled and because a small long-term risk means the skin should be checked periodically.

Fees

Published fees

Gynaecology Consultation
Full consultant consultation

£200

Consultation + Pelvic Ultrasound
Same-day scan and results

£300

Complete Well Woman Check
Consultation, ultrasound and cervical screening

£380

All services and fees →

If anything needs adding on the day

If a test is needed during your appointment it is £80 — cervical cytology, chlamydia and gonorrhoea, a urine culture, or a high vaginal swab. The full seven-infection STI panel is £220.

Nothing is added without being discussed with you first, and it is decided in the room rather than chosen at booking, so you are not paying for a test before anyone knows whether you need it. See every fee.

Book an assessment

Same-day appointments at 1-5 Portpool Lane. Bring the creams you have already tried, prescribed or bought, as that history often points to the diagnosis.