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Finding Relief From Vulva Pain

At least 200,000 American women suffer from chronic vulva pain, a condition that perplexes doctors and can destroy a woman's sex life.

By Leanna Skarnulis
WebMD Feature

Reviewed by Brunilda Nazario, MD

Vulvas get little respect. They're the brunt of bad jokes, thanks to an ill-named Swedish car, and medically they're a forgotten part of a woman's anatomy. In the U.S. at least 200,000 women suffer from vulva pain. A condition once called "burning vulva syndrome" it can last for years, causing repeated episodes of severe pain and destroying sexual desire.

Just where is the vulva? Many women refer to their entire genital region as the vagina, but the vagina is internal and ends at the shiny tissue that surrounds the vaginal opening, or the vestibule. The outside of the female genital area is called the vulva.

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For women with vulvodynia, symptoms could include persistent pain or burning and itching of the vulva. The symptoms can be so severe that it makes sexual intercourse agonizing. There's no apparent tissue damage, no discharge, no infection, no fungus -- in short, nothing is seen on exam except chronic inflammation, but no one knows exactly what the inflammation is from and doctors aren't sure what to treat. This can be frustrating to many women.

For a couple of reasons, a woman might spend months or years seeking treatment without getting relief, says Elizabeth G. Stewart, MD, co-author of The V Book: A Doctor's Guide to Complete Vulvovaginal Health. "The first reason is all genital pain has been regarded as psycho-sexual for centuries. I've seen an awful lot of women who were told they were crazy and have undergone months or years or psychotherapy or sexual therapy. The second reason is physicians and nurses receive virtually no training regarding all the things that can go wrong with the vulva. We're taught about yeast infections, and that's about it."

Hearing "it's all in your head" is probably the greatest injustice, says Howard Glazer, PhD. He's a neurophysiologic psychologist who specializes in pain management, sexual dysfunction, and electromyographic biofeedback, and is quick to point out that vulvodynia is not a psychological disorder. "It's a real, organic condition. A woman becomes emotional in response to pain that's interfering with an important part of her life. To physicians who don't understand psychological processes, they see flaky women who have nothing wrong with them having painful sex -- go have a drink and relax. That's inappropriate and insulting."

Types of Vulvodynia

There are two main types of vulvodynia. Vulvar vestibulitis syndrome (VVS) is a painful response to touch or pressure around the vaginal opening. Dysesthetic vulvodynia (DV) is generalized, unprovoked pain. Vulvar pain can affect women of any age.

In VVS, women feel sharp stabbing pain when touched at specific spots at the vaginal opening where the major vestibular glands are located. "When the gynecologist pokes around with a Q-tip, there's very localized point tenderness," says Glazer, associate professor of psychology in psychiatry and in obstetrics and gynecology, at Cornell University Medical College in New York.

DV, which is far less common than VVS. The pain is a spontaneous burning sensation, sometimes all over the vulva and even down the legs. "It's often associated with menopause, so there may be a hormonal component," says Glazer.

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