Vulvar itching can be uncomfortable and cause a person to lose sleep at night.
Although some of the conditions that cause vulvar itching may worsen at night, it is more likely that the itchiness gets worse during this time because a person has fewer distractions. Without daytime diversions, the itchiness can seem more intense.
Keep reading to learn about some of the common causes of vulvar itching that worsens at night, as well as what to do to get relief.
Possible causes of vulvar itching at night include:
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Bacteria are naturally present in the vagina, but an overgrowth can lead to bacterial vaginosis. This infection is more common among people who are sexually active.
Not everyone with bacterial vaginosis will have noticeable symptoms. However, common symptoms include:
- pain, itching, or burning
- burning urination
- white or gray vaginal discharge
- itching of the vulva
- a strong fishy odor, particularly after sex
Bacterial vaginosis usually requires treatment, so it is best to speak to a doctor about these symptoms.
The vagina naturally contains a fungus called Candida, which usually does not cause any problems.
However, Candida can cause a yeast infection if a change in the environment allows it to grow out of control.
Changes that may facilitate infection typically occur in the immune system or involve certain medications or hormone levels.
The symptoms of a vaginal yeast infection may include:
- pain during sex
- vaginal soreness or itching
- discomfort, pain, or burning when urinating
- abnormal thick, white discharge from the vagina
If these symptoms are occurring for the first time, it is best to see a doctor to confirm a yeast infection as the cause.
Both over-the-counter (OTC) and prescription treatments are available for yeast infections.
Allergens and irritants
Many allergens and irritants can potentially cause vulvar itching. Irritants typically cause symptoms quickly, while allergens may take a few days to produce symptoms.
Some common allergens and irritants that can cause vulvar itching include:
- tight clothing
- nylon underwear
- latex condoms
- bubble bath
- laundry detergent
- talcum powder
- baby wipes
- some medications
- panty liners
Sexually transmitted infections
Pubic lice, which people often refer to as crabs, often cause vulvar itching that may feel worse at night. It is often possible to see pubic lice during a self-examination, but it is best to visit a doctor for a proper diagnosis.
Trichomoniasis is another STI that may cause vulvar itching. As with some other STIs, it does not always cause symptoms.
When symptoms do occur, they may include:
- a burning sensation on the genitals
- unpleasant vaginal odor
- vaginal or vulvar itching
- abnormal spotting
A doctor can usually prescribe antibiotics to treat trichomoniasis.
Lichen sclerosus is a chronic skin condition. It can occur nearly anywhere on the body, but it is most common on the genitals and anus.
Lichen sclerosus causes the skin to thin, which leads to irritation, itching, and blisters. At first, lichen sclerosus may not produce any symptoms.
However, as it progresses, some of the following symptoms may start to appear:
- vulvar itching
- pain with urination
- vulvar itching-white spots that grow over time
- pain during intercourse
- anal itching or bleeding
The exact cause of lichen sclerosus remains unknown. However, the condition may run in families, result from hormone imbalances, or stem from an immune disorder.
Lichen planus is an abnormal immune response that occurs when the immune system starts to attack the mucous membranes and skin.
It can affect many different parts of the body, including the vulva.
When lichen planus appears inside the vagina, it typically presents as white patches or painful sores.
If it appears on the outside of the vagina on the vulva, it can take the form of itchy, flat, red or purple bumps.
Eczema or dermatitis
Vulvar dermatitis occurs when the vulva becomes itchy and inflamed. The area may look red or discolored.
Heat, moisture, or irritants can cause dermatitis, but so can eczema. Eczema is a long term skin condition that causes dry, cracked, scaly, and itchy skin. It can affect any part of the body, including the genitals.
If itching due to eczema or dermatitis becomes worse at night, this may be because the skin is too dry or because trapped sweat is irritating it. A person can often ease this symptom by using water and mild soap before moisturizing the affected area.
Psoriasis is an autoimmune condition that can cause dry, painful, and itchy patches on the vulva and surrounding area. In rare cases, it can also develop inside the vagina.
A type of psoriasis called inverse psoriasis is more common on the vulva, but dryness can increase the risk of plaques forming. Scratching can also cause more severe symptoms.
Psoriasis itching may feel worse at night if a person no longer has daytime distractions and focuses on the symptoms.
- vulvar intraepithelial neoplasia (VIN)
- invasive squamous cell cancer of the vulva
- vulvar melanoma
- Paget’s disease, which can also occur on the breasts
Invasive squamous cell cancer and vulvar melanoma also cause symptoms such as a lump, pain, or bleeding outside of the usual menstrual cycle.
Many people with VIN do not experience any initial symptoms. If they do, the only symptom is usually persistent itching. VIN is not cancer, but it can lead to cancer over time.
Paget’s disease of the vulva causes soreness and red, scaly patches.
People can try several at-home treatments to help relieve an itching vulva. However, unless the itch is clearly due to an allergen or irritant, it is best to see a doctor for a diagnosis and medical treatment.
Some home remedies that may help ease itching at night include:
- taking an oatmeal bath before bed
- using topical anti-itch creams on the vulva
- placing towel-wrapped ice packs on the vulva
- using a topical antihistamine
- trying OTC antifungal treatments for yeast infections
The cause of vulvar itching that gets worse at night will determine the treatment.
In cases of bacterial vaginosis and trichomoniasis, a doctor is likely to prescribe antibiotics to cure the infection.
If the itching is due to a yeast infection, a doctor may recommend an OTC treatment option or prescribe a stronger medication.
If the cause of the itchiness is an allergic reaction, the doctor may prescribe an antihistamine to relieve the symptoms.
Corticosteroids or oral medication can help stop the immune system response that causes lichen planus. A doctor may also prescribe antihistamines.
If the itching occurs as a result of lice, a person will need to destroy the insects and their eggs and then wash all of the clothing and bedding in the home thoroughly.
In cases of lichen sclerosus, a doctor may prescribe or recommend topical steroids, steroid injections, or tricyclic antidepressants to help with the pain.
Treating underlying conditions such as psoriasis or eczema with emollient creams and topical medications can help relieve symptoms. There are many other treatment options for these conditions, including phototherapy, corticosteroids, and vitamin D supplements.
Doctors will treat cancer on a case-by-case basis. The treatment plan may include:
- topical medications
Vulvar itching, including itching that gets worse at night, is often the result of an allergic reaction or medical condition that will need treatment.
People should see a doctor for itching that does not go away after some time or that occurs with other symptoms.
In most cases, treatment can effectively get rid of the infection or condition and relieve the itchiness.