Although some of the conditions that cause vulvar itching can get worse at night, the itching is more likely to get worse during this time because the woman has fewer distractions. Vulvar itching can be uncomfortable and lead to loss of sleep at night. Read on to find out some of the common causes of vulvar itching that gets worse at night, and what you can do to relieve it.
Causes
Possible causes of nocturnal vulvar itching include:
bacterial vaginosis
Bacterial vaginosis is one of the possible causes of nocturnal vulvar itching. Bacterial vaginosis is the most common vaginal infection in women between the ages of 15 and 44. Bacteria are naturally present in the vagina, but an overgrowth can lead to bacterial vaginosis. This infection is more common in sexually active people.
Symptoms of bacterial vaginosis are not always noticeable. However, the most common symptoms are:
pain, itching or burning
burning on urination
white or gray vaginal discharge
itchy vulva
a strong “fishy” smell, especially after intercourse. Bacterial vaginosis usually requires treatment, so it’s best to talk to a doctor about these symptoms.
yeast infections
The vagina naturally contains a fungus called Candida, which usually causes no problems. However, Candida can cause a yeast infection if a change in the environment allows it to grow out of control. Changes that may favor infection usually occur in the immune system or involve certain medications or hormone levels.
Symptoms of a vaginal yeast infection may include the following
pain during sex
vaginal pain or itching
discomfort, pain, or burning when urinating
abnormal, thick, white vaginal discharge.
If these symptoms appear for the first time, it is best to consult a doctor to confirm that yeast infection is the cause.
Over-the-counter or prescription treatments are available for yeast infections.
Allergens and irritants
Some bubble bath products can cause vulvar irritation. Many allergens and irritants can potentially cause vulvar itching. Irritants usually cause symptoms quickly, while allergens can take a few days to produce symptoms. Common allergens and irritants that can cause vulvar itching include:
tight clothes
the soap
spermicides
nylon underwear
the perfumes
latex condoms
bubble bath
lubricants
laundry detergent
douching
talc
baby wipes
certain medications
panty liners
Sexually transmitted infections
Some sexually transmitted infections (STIs), including pubic lice and trichomoniasis, can cause vaginal itching. Another STI that can cause vulvar itching is trichomoniasis. As with other STIs, it does not always cause symptoms.
When symptoms appear, they may include
a burning sensation on the genitals
an unpleasant vaginal odor
vaginal or vulvar itching
abnormal losses
A doctor can usually prescribe antibiotics to treat trichomoniasis.
lichen sclerosus
Lichen sclerosus is a chronic skin condition. It can appear almost anywhere on the body, but is most common on the genitals and anus. Lichen sclerosus causes thinning of the skin, which leads to irritation, itching, and blistering. At first, lichen sclerosus may not produce any symptoms.
However, as it progresses, some of the following symptoms may begin to appear:
itchy vulva
pain on urination
vulvar itching – white patches that spread over time
pain during sex
anal itching or bleeding
bulbs
The exact cause of lichen sclerosus remains unknown. However, this condition can be hereditary, result from a hormonal imbalance or an immune disorder.
lichen planus
Lichen planus is an abnormal immune reaction that occurs when the immune system begins to attack mucous membranes and skin. It can affect many parts of the body, including the vulva.
When lichen planus appears inside the vagina, it usually appears as white spots or painful sores. If it appears outside the vagina, on the vulva, it may appear as flat, itchy red or purple bumps.
Eczema or dermatitis
Vulvar dermatitis is manifested by itching and inflammation of the vulva. The area may be red or discolored. Heat, humidity, or irritants can cause dermatitis, but so can eczema. Eczema is a long-lasting skin condition that results in dry, cracked, scaly, and itchy skin. It can affect any part of the body, including the genitals. If the itching due to eczema or dermatitis gets worse at night, it may be because the skin is too dry or because trapped sweat is irritating it. A person can often alleviate this symptom by using mild soap and water before moisturizing the affected area.
Psoriasis
Psoriasis is an autoimmune disease that can cause dry, painful, 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 plaque formation. Scratching can also cause more serious symptoms.
Psoriasis itching can get worse at night if the person has no distractions during the day and focuses on the symptoms.
Vulvar cancer
In very rare cases, itching of the vulva can be a sign of vulvar cancer. Types of cancer and precancerous conditions that can cause itching around the vulva include:
vulvar intraepithelial neoplasia (VIN)
invasive squamous 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 have no initial symptoms. If so, the only symptom is usually a persistent itch. VIN is not cancer, but it can become one over time.
Paget’s disease of the vulva causes pain and red, scaly patches.
Remedies
There are several home treatments that can be tried to relieve itchy vulva. However, unless the itching is clearly due to an allergen or irritant, it is best to see a doctor for a diagnosis and medical treatment.
Here are some home remedies that can help relieve nighttime itching:
take an oatmeal bath before bed
using topical anti-itch creams on the vulva
placing ice packs wrapped in a towel over the vulva
use a topical antihistamine
try over-the-counter antifungal treatments for yeast infections.
Medical treatments
A doctor can tell if an itchy vulva needs medical treatment.
The cause of vulvar itching that gets worse at night will determine the treatment.
In the case of bacterial vaginosis and trichomoniasis, the doctor will likely prescribe antibiotics to cure the infection.
If the itching is due to a yeast infection, the doctor may recommend an over-the-counter treatment or prescribe a stronger medication.
If the cause of the itching is an allergic reaction, the doctor may prescribe an antihistamine to relieve the symptoms.
Corticosteroids or oral medications can help stop the immune system reaction that causes lichen planus. The doctor may also prescribe antihistamines.
If the itching is due to the presence of lice, the insects and their eggs should be destroyed, then all clothes and bedding in the house must be thoroughly washed. Pubic lice, which people often call crabs, often cause vulvar itching that can get worse at night. It is often possible to see pubic lice during a self-examination, but it is best to see a doctor for a correct diagnosis.
For lichen sclerosus, the doctor may prescribe or recommend topical steroids, steroid injections, or tricyclic antidepressants for pain relief.
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 treat cancer on a case-by-case basis. The treatment plan may include
a surgical intervention
topical medications
chemotherapy
radiotherapy
Summary
Vulvar itching, including that which is worse at night, is often the result of an allergic reaction or a medical condition that requires treatment. A doctor should be consulted if itching does not go away after a while or is accompanied by other symptoms. In most cases, treatment can effectively eliminate the infection or condition and relieve the itching.
