Vulvar itching affects the outer female genitals, and it can be irritating and annoying, especially at night. While this symptom can happen at any time of day, it might seem more pronounced at night because there are fewer distractions. This makes you hyperaware of the itching.
Some conditions do get worse at night, but overall, lying still while you’re trying to sleep is often a cause of this heightened awareness of bodily sensations. There are a variety of causes of vulvar itching, and it’s important to find out what it is in order to address the itch.
Here are six common causes of vulvar itching:
Candida is a kind of yeast found in the vagina. Approximately 20 percent of women normally have candida without any symptoms. However, sometimes the yeast multiplies, causing a yeast infection.
In the United States, yeast infections are the second most common vaginal infections after bacterial infections. It’s safe to say that most women have experienced a yeast infection in their lives.
Symptoms of a yeast infection can include:
- itching in the vagina, particularly the vulva
- soreness in the vagina
- pain with sex or urinating
- abnormal discharge
Because yeast infections are so common, many women will apply over-the-counter antifungal creams as soon as they experience vulvar itching. This might not work, especially if the itching is caused by something unrelated, like a sexually transmitted infection (STI).
Your doctor can diagnose a yeast infection based on your symptoms and a pelvic exam. They might also take a sample of discharge from your vagina to send to a lab to determine what kind of fungal infection you have.
Treatment for a yeast infection can consist of oral or vaginal medication, both topicals and suppositories. The amount of time you’ll have to stay on medication will vary based on the severity of the infection.
Bacterial vaginosis (BV) is more common than yeast infections, making it the most common vaginal infection in women between the ages of 15 and 44. It’s not known what causes BV or how women get it.
The infection occurs when too much of certain bacteria is in the vagina, and it often occurs in women who are sexually active.
BV doesn’t always cause symptoms, but when it does, they can include:
- a thin white or gray discharge
- vaginal pain or itching
- a fishy odor
- burning during urinating
- vulvar itching
BV will need to be diagnosed by a doctor through an exam or lab tests from samples of discharge.
While BV sometimes goes away without treatment, this is not the norm. If you have symptoms, it’s best to see a doctor for treatment with antibiotics.
Sexually transmitted infections, or STIs, can cause a variety of symptoms, including vulvar itching. However, many people with STIs do not have any symptoms. STIs that can cause vulvar itching include trichomoniasis and pubic lice.
Most people with trichomoniasis (also called trich) have no symptoms at all, but you could experience:
- vulvar and vaginal itching
- unpleasant vaginal odor
- abnormal spotting
- genital burning or redness
If you’re diagnosed with trich, it can be easily treated with antibiotics.
Pubic lice, or crabs, are another kind of STI that can cause vulvar itching, often getting worse at night. You can usually see if you have pubic lice by looking at your genital area, but you should also see your doctor for an official diagnosis.
Treatment is similar to that of head lice: You need to treat the infection and kill the lice on your clothes and bedding. Special lice shampoos and lotions are necessary, and you can pick off any remaining lice or eggs.
If over-the-counter treatment doesn’t work, there are prescription lotions and pills that might be necessary.
Sometimes the source of vulvar itching is something as simple as a skin irritant or allergy. Different chemicals might cause eczema, leading to inflammation and itching.
Common irritants and allergens include:
- bubble bath
- nylon underwear
- certain types of clothing
- spermicides or lubricants
- talcum powder
- baby wipes
- latex condoms
- panty liners
If you suddenly notice vulvar itching after switching to a new product, it’s worth stopping use of the product to see if your symptoms improve.
Lichen planus can affect various parts of the body, including the skin, hair, nails, and mucous membranes. When the condition occurs in the vagina, it causes white patches and sores that might be painful. If they occur externally on the vulva, it can manifest as flat, itchy, plum-colored bumps.
This skin condition is an abnormal immune response: The immune system starts attacking the skin or mucous membranes. Exact causes and triggers aren’t known, but some things that might be triggers include:
If you have symptoms that sound like lichen planus, see your doctor. They will be able to diagnose this condition based on your symptoms, an exam, and a biopsy of the area, if necessary.
To relieve vulvar itching due to lichen planus, your doctor might prescribe topical corticosteroids or oral medication to address the abnormal immune response. Antihistamines might also be helpful in addressing the itching.
Lichen sclerosus is a chronic skin condition common in post-menopausal women. It thins the skin and can cause itching, pain, and even blisters. Although it can occur anywhere on the body, it’s often seen on the genitals and anus.
The exact causes of the condition aren’t known, but it can run in families. Other factors that might be at play include hormone imbalances, particularly estrogen, and immunological problems.
Lichen sclerosus might not cause any symptoms in the beginning, but as it progresses, you may notice:
- white spots on the skin that later grow and become areas of thinning
- vulvar itching
- painful intercourse
- anal itching or bleeding
- pain with urination
Your doctor can do an exam and determine whether this condition may be causing your symptoms.
Treatment often consists of:
- topical steroids to help manage any pain or itching
- steroid injections
- oral medication
- tricyclic antidepressants to help vulvar pain
You know your body and what’s normal for you and what’s not.
If you notice any kind of itching that doesn’t go away, take note of the time of day and intensity of the itch. This way you can give your doctor more information about your symptoms.
If your vulvar itching is severe or doesn’t go away within a few days, call your doctor for an appointment. You should also call your healthcare provider if you experience additional symptoms, such as abnormal bleeding or discharge.
While you may not be able to fully prevent all vulvar itching, you can practice self-care to keep your vagina healthy. Practice safer sex to reduce your risk of STIs, and get regular gynecologic exams and screenings.
Vulvar itching doesn’t always equal yeast infection, so it’s important to see a doctor if you notice any itching that doesn’t go away or feels out of the ordinary.
Your vulva is a sensitive skin area, so it’s important to care for it appropriately. Wear loose clothing and cotton underwear, and use your fingers to wash instead of a rough washcloth.
Take note of the cleansers you use. Artificial scents and multiple chemicals can be abrasive to the area and even cause allergic reactions.
Vulvar itching can be caused by a variety of conditions, and it can often seem worse at night due to lack of distractions.
If you’ve noticed vulvar itching that doesn’t go away after a few days, or is present with other symptoms like discharge or redness, call your doctor. They can perform an exam, provide a diagnosis, and develop any necessary treatment plan.