If clitoral itching is combined with leukorrhea, abnormal discharge, and discharge odor, consider vulvovaginal pseudomycosis, trichomoniasis, and bacterial vaginosis. If clitoral itching is combined with loss of vulvar skin pigmentation, consider vulvar epithelial non-tumor-like lesions. Pinworms cause vulvar itching to be worse at night. Vulvar itching is particularly severe in diabetic patients with irritation of the vulvar skin by urinary sugar, especially when complicated by vulvovaginal pseudomyxomatosis, which can present as clitoral itching. Unexplained vulvar itching usually occurs only in women of childbearing age or postmenopausal women. Jaundice, vitamin A and B deficiencies, severe anemia, and leukemia cause vulvar itching, often as part of generalized itching.