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mild persistent vulvar clitoral itching
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mild persistent vulvar clitoral itching

Wow, there sure are a lot of itchy women out there! I was just perusing a forum on vulvar itching that has been going on for about a year. There are a lot of complaints and meandering paths, but only a few solutions. I'm confused- the website page reads "where there's a Doctor on the web", but all I saw was a lot of uncertain women swapping tales- where is the Doctor's input?
Most women are distressed by extrenme symptoms on the outer vulva, but my symptoms are mild itching in one small spot at the tip of the clitoris- nowhere else. I only notice it once every 2-5 days, but I think it is always there and just not getting irritated at all times. I can't trace it to new product allergies or eczema or psoriasis or tight synthetic clothes or my menstrual cycle. I have no discomfort during intercourse or oral sex, no unusual dryness or discharge. I am 40, but don't show any clear signs of perimenopause, and have normal periods. I am not on the pill or any other regular medicatons. The itch has been with me about 9 months, and does not seem to get significantly worse or better. It feels better when freshly washed, and is not sensitive to soap. A physician's assistant at a local gyno clinic was mystified, and suggested lichen sclerosis after a quick internet search, but had no prior experience in the area. She prescribed a very mild estrogen cream, but after searching the inet, the only prescribed solution I see for lichen sclerosis is a super ultra strong cortisone cream. That alone confuses me, because LS causes abnormal thinning of the skin, and cortisone creams are also known to cause thinning of the skin. I can't find a suggested treatment of mild estrogen cream anywhere in my searches, and it makes the itch slightly worse.
The ultimate way to get conclusive diagnosis seems to be a biopsy, but considering the sensitivity of the area, I would like to do this as a last resort. What possibilities might I consider first? Is it possible to diagnose with a skin scraping, or does it always have to be a chunk of skin removed? How much scarring and damage might this cause?
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The gyn forum has a doctor, but this particular forum is patient to patient only.

I thought lichen sclerosis sounded like a good guess.  Why were you stuck with just a mystified physician's assistant?  I'd call that clinic or another one, and insist on being scheduled to see a doctor.
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