Women with vulvodynia have chronic vulvar pain with no known cause. Until recently, doctors didn’t recognize this as a real pain syndrome. Even today, many women do not receive a diagnosis. They may also remain isolated by a condition that is not easy to discuss. Researchers are working hard to uncover the causes of vulvodynia and to find better ways to treat it.
Types of Vulvodynia
Vulvodynia affects the vulva, the external female genital organs. This includes the labia, clitoris, and vaginal opening.
There are two main subtypes of vulvodynia:
- Generalized vulvodynia is pain in different areas of the vulva at different times. Vulvar pain may be constant or occur every once in a while. Touch or pressure may or may not prompt it. But this may make the pain worse.
- Localized vulvodynia is pain in one area of the vulva. Often a burning sensation, this type of vulvar pain is usually provoked by touch or pressure, such as intercourse or prolonged sitting.
Possible Causes of Vulvodynia
Doctors don’t know the cause of most forms of vulvodynia. And there is no evidence that infections, such as sexually transmitted diseases, cause vulvodynia.
Researchers are trying to find the causes of vulvodynia. They may include:
- Nerve injury or irritation
- Abnormal response in vulvar cells to an infection or trauma
- Genetic factors that make the vulva respond poorly to chronic inflammation
- Hypersensitivity to yeast infections
- Muscle spasms
- Allergies or irritation to chemicals or other substances
- Hormonal changes
- History of sexual abuse
- Frequent antibiotic use
Women with Vulvodynia: Who Has It?
A woman of any age, beginning in her teen years, may have vulvodynia. Estimates of women with vulvodynia range from 200,000 to six million. Once thought to mainly affect white females, African-American and Hispanic women are now known to be equally affected.
Signs and Symptoms of Vulvodynia
Symptoms of vulvodynia usually begin suddenly and can last anywhere from months to years.
These are the most common symptoms of vulvodynia:
- Burning, stinging, or rawness
- Aching, soreness, or throbbing
You may feel symptoms of vulvodynia:
- All the time or just once in a while
- During activities such as exercise, intercourse, or walking -- or even while at rest
- While bicycling, inserting tampons, or even sitting
- In one specific area or throughout your entire vulva
A burning pain is the single most common symptom of vulvodynia. Some women describe it as a knife-like pain or like an acid poured on the skin.
Although the vulva usually appears normal, it may look a bit inflamed or swollen.
The Physical and Emotional Impact of Vulvodynia
Vulvodynia can have a huge impact on a woman's life. It can impair her ability to have sex, exercise, socialize, or work. A National Institutes of Health (NIH) study showed that most women with vulvodynia feel ''out of control,'' unable to have sexual intercourse, and unable to fully enjoy life. If this is true for you, seek the support you need.
The Impact of Vulvodynia Symptoms
Vulvodynia symptoms are not life-threatening. Still, vulvar pain can greatly affect a woman's normal activities. For example, if symptoms are severe or make sex difficult, this might have an impact on her relationship. And this, in turn, may affect her self-image and make her feel depressed. Don’t hesitate to seek help. Many women find ways to control the vulvar pain.
Unfortunately, many health care providers may not be familiar with vulvodynia. Women suffering from this condition may need to search for health care providers who are knowledgeable about this condition.
Treatment of Vulvodynia
Self-care and treatments for vulvodynia can help bring relief. Women with vulvodynia need to identify what works best for them and they may need to try several remedies before finding a combination that provides relief. It is important for women to educate themselves about this condition. They should keep careful records of which treatments were helpful and which were not helpful.
Treatment of Vulvodynia: Self-Care
Here are a few things women can do to help relieve symptoms of vulvodynia or keep them under control.
Avoid Potential Irritants
It may help to avoid things that could be irritating the vulva. These might include certain soaps, medications, or douches. Here are a few tips:
- Use dermatologically approved detergent and don’t use fabric softener on panties.
- Use unscented toilet paper that’s soft and white.
- Wear 100% white cotton underwear, menstrual pads, and tampons.
- Avoid getting shampoo on the vulvar area.
- Avoid perfumed creams or soaps, pads or tampons, and contraceptive creams or spermicides.
- Avoid hot tubs or pools with lots of chlorine.
- Rinse the vulva with cool water after urination and intercourse.
- Avoid foods that make urine more irritating. This may include foods such as greens, beans, berries, chocolate, or nuts.
- Wear loose-fitting pants and skirts; don’t wear pantyhose.
- Keep the vulva clean and dry. Avoid prolonged sitting in a wet swim suit or damp gym clothes.
- After bathing, gently pat dry and apply a vegetable or plant-based oil or preservative-free emollient to keep the vulva protected.
Help Ease Pressure
Certain activities put pressure on the vulva. To ease the pressure:
- Use a water-soluble lubricant during sex.
- Avoid activities that put direct pressure on the vulva. This includes bicycling and horseback riding.
- Sit on a foam rubber doughnut.
These steps may help relieve vulvar pain:
- Soak in lukewarm or cool sitz baths.
- After intercourse, apply ice or a frozen gel pack wrapped inside a hand towel.
- Alternatively, topical heat applied with a heating pad can reduce pain in some women with vulvodynia.
- Try relaxation techniques.
Treatment of Vulvodynia: Medication, Therapies, and Surgery
There is no one treatment for vulvodynia that works for all women; you may need to try a combination of treatments for the best results. These are types of treatment for vulvodynia your doctor may suggest. Also, remember that chronic pain can affect you emotionally. Consider therapy or a support group.
Medications may be administered orally, topically or by injection and can include:
- Local anesthetics, such as lidocaine
- Topical estrogen creams
- Tricyclic antidepressants
- Nerve blocks
- Serotonin-norepinephrine reuptake inhibitors
- Neurostimulation and spinal infusion pump
- Medications with anti-inflammatory effects such as steroids or mast cell inhibitors
In addition, the doctor may recommend complementary or alternative medicine.
- Physical therapy, which involves exercise to strengthen pelvic muscles and lessen muscle spasms
- Biofeedback, which helps you learn to relax vaginal muscles to lessen pain
- Transcutaneous electrical nerve stimulation, a newer treatment for vulvodynia, has been used to improve pain in other chronic pain conditions
If you have a type of localized vulvodynia called provoked vestibulodynia, your doctor may suggest surgery to remove painful tissue, especially if other options have not brought relief.
If your doctor does not have experience with surgery for provoked vestibulodynia, consider seeing a gynecologist with a special interest in this condition. Ask your doctor for a referral.
10 Important Questions to Ask Your Doctor About Vulvodynia
Going to the doctor can be intimidating. You might feel rushed and forget to ask questions that are important. It’s always a good idea to know what to ask beforehand and to take notes when with the doctor. Some of the questions below may be worth asking. Print out this page and take it with you to your next appointment.
- How can you be certain of my diagnosis?
- What can I do at home to help control my symptoms?
- Will pain medications make me feel better?
- What treatment do you recommend for me?
- Are there any activities I should avoid?
- How might vulvodynia affect my sex life?
- What should I tell my partner about my condition?
- Will vulvodynia affect my ability to have children?
- What can I do for support?
- Can vulvodynia go away on its own?