Genital and Anal Itching – Assessment by a Dermatologist



A specialist in dermatology examines the causes of itching in the genital and anal areas in children and adults and develops an appropriate treatment plan.


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In brief

Itching around the genitals and anus (genital and anal itching, pruritus ani) is a common symptom in both women and men. The most common skin-related causes are eczema – often caused by soap, wet wipes or contact allergy – fungal infection, psoriasis and lichen sclerosus. At Charlottenlund Privathospital, genital and anal itching is assessed by Susanne Birkballe, specialist in dermatology. If needed, swabs, a tissue sample or tests for sexually transmitted infections may be taken, and a treatment and follow-up plan is developed based on the diagnosis. Haemorrhoids and anal fissures are referred to a surgeon.

Your consultation with the dermatologist
1
Consultation
Where is the itching located, how long has it been present, and which products are used for washing and skincare?
2
Examination of the skin
The affected area is examined – and often the rest of the skin, scalp and nails as well, looking for signs of eczema or psoriasis.
3
Tests if needed
A swab for fungal infection, a small tissue sample under local anaesthesia, or testing for sexually transmitted infections.
4
Treatment
The treatment plan is based on the diagnosis – for example topical treatment and skincare advice.
5
Follow-up
The effect of treatment is assessed. Regular follow-up is arranged for lichen sclerosus.

Genitals


  • Eczema caused by soap, intimate washes, fragrance, and panty liners
  • Contact allergy, for example to fragrance or preservatives
  • Fungal infection (candida)
  • Psoriasis
  • Lichen sclerosus and lichen planus
  • Sexually transmitted infections and scabies



Anus


  • Eczema caused by moisture, sweat, and frequent wiping
  • Contact allergy, for example to wet wipes or creams
  • Fungal infection
  • Psoriasis
  • Lichen sclerosus
  • Threadworms—especially in children
  • Haemorrhoids and anal fissures

Around the anus, moisture and small traces of stool on the skin can play an important role. The skin becomes irritated, which causes itching, and scratching then creates further irritation – a vicious cycle.

In the genital area, eczema caused by intimate washes, fragrance and panty liners is common. Psoriasis in this area is often smooth and red without the typical scaling and can therefore be mistaken for fungal infection or eczema.

Anal itching is common: 1–5% of the population experience it, and men are affected around four times as often as women.

1–5 %
of the population experience anal itching. It is one of the most common reasons for seeking medical advice about symptoms in this area and affects men more often than women.
Source: St-Amour and Hahnloser, Schweizer Gastroenterologie 2024

What is lichen sclerosus?

Lichen sclerosus is a chronic inflammatory skin condition that most commonly affects the genital and anal areas. The skin becomes white, thin and fragile and may itch, often most severely at night. Small cracks and bleeding can develop, and over time the skin may tighten and scar.

The condition is most common in women after menopause, but it can occur at any age, including in girls and in men, where it typically affects the foreskin. According to the European guideline, around 1.6% of women have developed lichen sclerosus by the age of 80. The condition is not contagious.

Lichen sclerosus is treated with corticosteroid cream, which reduces itching and inflammation and can help prevent scarring. There is a small increased risk of skin cancer in the affected area – below 5% – and guidelines therefore recommend follow-up after 3 months and then once a year.

A new lump, a sore that does not heal, or an area of skin that changes should always be examined.

When should you see a dermatologist about genital itching?


You should see a doctor if the itching lasts more than a couple of weeks, keeps coming back, or does not improve with antifungal treatment from the pharmacy. You should also seek advice if the skin becomes white or thin, develops cracks, or if sores, lumps, or discharge appear. Many people try several antifungal products before discovering that the cause is eczema, contact allergy, or lichen sclerosus.

Blood from the anus, changes in bowel habits, or weight loss should always be assessed by your GP, as these require a different investigation from skin itching.

If you have itching in several areas of your body, it may be an itchy rash with another cause. If you also have eczema elsewhere, for example on your hands, contact dermatitis may be part of the explanation.


How does a dermatologist examine genital and anal itching?


The examination begins with a discussion about where the itching is, how long it has lasted, and which products you use for washing, skincare, and hygiene—including wet wipes, creams, and products from the pharmacy. The area is then examined, and often the rest of the skin, scalp, and nails too, since signs of eczema or psoriasis elsewhere may point to the cause.

At Charlottenlund Privathospital, the examination is carried out by Susanne Birkballe, a specialist in dermatology. If needed, a swab is taken to test for fungus, or a small tissue sample (biopsy) is taken under local anaesthetic. Biopsy results are available after 5–10 working days. If a sexually transmitted infection is suspected, you can be tested during the same visit. If contact allergy is suspected, a patch test can identify the substance your skin reacts to.

How is genital and anal itching treated?



Treatment depends on the underlying cause. Eczema and psoriasis are treated with creams or ointments, fungal infections with antifungal medication, and lichen sclerosus with a treatment plan and regular follow-up.

In contact allergy, the most important measure is avoiding the substance that causes the reaction. The dermatologist can start both topical and oral treatment when needed.

If the itching is caused by scabies, everyone in the household should be treated at the same time.

Haemorrhoids and anal fissures are treated within surgery, and patients are therefore referred to a surgeon. Determining whether the itching originates from the skin or from the anus itself is part of the assessment.

What can you do yourself to relieve the itching?



Gentle skincare is an important part of treatment regardless of the cause. The aim is to remove anything that irritates the skin and protect it from moisture:

  • Use water or an unperfumed emollient instead of soap and intimate washes
  • Avoid wet wipes, panty liners and fragranced products
  • Pat the skin dry rather than rubbing it
  • Wear loose-fitting cotton underwear
  • Around the anus: use soft toilet paper moistened with water and apply a thin layer of emollient cream as protection
  • Try to scratch as little as possible – itching and scratching reinforce one another

If these measures do not help within a couple of weeks, the skin should be examined.

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Itching in children

In children, threadworms are the most common cause of anal itching, particularly in the evening and at night. Threadworms spread easily within families and can be detected using an adhesive tape test applied to the skin around the anus in the morning.

In girls, genital itching can be caused by irritation from soap and bubble bath, but it may also be caused by lichen sclerosus, which can easily be mistaken for a fungal infection.

The dermatologist sees children of all ages. If the child also has eczema elsewhere on the body, childhood eczema may be involved.

Referral and payment

Many private health insurance policies cover examination by a dermatologist, but insurers typically require a referral from the patient’s GP and prior approval. Self-paying patients do not need a referral. Prices are available in the price list. Consultations take place at the main hospital in Charlottenlund.

Frequently asked questions

  • What can cause genital itching?

    The most common causes are eczema from soap, intimate washes and perfume, contact allergies, fungal infections, psoriasis and lichen sclerosus. Less commonly, itching is caused by a sexually transmitted infection or scabies.

  • What can cause anal itching?

    Itching around the anus is most often caused by eczema due to moisture and irritation, contact allergies to products such as wet wipes, fungal infections or psoriasis. Threadworms are a common cause in children. Haemorrhoids and anal fissures can also cause itching.

  • What is lichen sclerosus?

    Lichen sclerosus is a chronic skin condition that most often affects the genitals and anus. The skin becomes white, thin, and itchy. The condition is treated with corticosteroid cream and requires regular check-ups because of a slightly increased risk of skin cancer in the affected area.

  • When should you see a doctor about genital itching?

    You should see a doctor if the itching lasts more than a couple of weeks, keeps coming back, or does not improve with antifungal treatment. White or thin skin, cracks, sores, and lumps should always be examined.

  • Can a dermatologist test for sexually transmitted infections?

    Yes. At Charlottenlund Privathospital, the dermatologist can test for sexually transmitted infections during the same visit if an infection is suspected as the cause of the itching.

  • What can you do yourself to relieve genital and anal itching?

    Being gentle on the skin can help: use water or an unperfumed, rich cream instead of soap, avoid wet wipes and perfumed products, wear loose-fitting cotton underwear, and scratch as little as possible. If the itching lasts more than a couple of weeks, it should be examined.