Vulvodynia

 

What Is Vulvodynia?

Vulvodynia is a chronic pain condition of the vulva (outer female genitals). It usually lasts more than 3 months and there’s no known cause. Even though it’s the leading cause of painful sex among women who haven’t gone through menopause, it’s hard to know how widespread vulvodynia is. Many women find it hard to discuss the problem with their doctor. And once they do, it’s easy for doctors to diagnose vulvodynia as something else. Researchers are working hard to uncover the causes and to find better ways to treat it.

Types of Vulvodynia

Vulvodynia affects the vulva, your external female genital organs. This includes the labia, clitoris, and vaginal opening. There are two main types:

  • Generalized vulvodynia  is pain in different areas of the vulva at different times. Vulvar pain may be constant or happen every once in a while. Touch or pressure may or may not cause iit. But it may make the pain worse.

  • Localized vulvodynia is pain in one area of the vulva. Often a burning sensation, this type of vulvar pain usually results from touch or pressure, like sex or prolonged sitting.

Vulvodynia Causes and Risk Factors

Doctors don’t know the cause of most forms of vulvodynia. And there’s no proof that infections, such as sexually transmitted diseases (STDs), lead to vulvodynia.

Researchers are trying to find the causes. 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

  • Allergiesor irritation to chemicals or other substances

  • Hormonal changes

  • History of sexual abuse

  • Frequent antibiotic use

Women who havevulvodynia may also have another type of pain syndrome. This means there may be a link between vulvodynia and pain conditions like:

  • Fibromyalgia

  • Painful bladder syndrome

  • Irritable bowel syndrome

  • Temporomandibular disorder

 Who does vulvodynia affect?

  • Women of all ages, even teenagers

  • An estimated 200,000 to 6 million women

  • Multiple ethnicities. It was once thought to mainly affect white females, but it’s also found in African American and Hispanic women 

Possiblerisk factors for vulvodynia include:

  • Anxiety

  • Depression

  • History of abuse

  • Post-traumatic stress disorder (PTSD)

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Signs and Symptoms of Vulvodynia

Symptoms of vulvodynia usually begin suddenly and can last anywhere from months to years.

The most common symptoms of vulvodynia include:

  • Burning, stinging, or rawness

  • Aching, soreness, or throbbing

  • Itching

You may feel symptoms of vulvodynia:

  • All the time or just once in a while

  • During activities such as  exercise, sex, or walking

  • When you’re resting

  • While bicycling, inserting tampons, or even sitting

  • In one specific area or throughout your entire vulva

A burning pain is the single most common vulvodynia symptom. Some women describe it as a knife-like pain or like someone poured acid on their  skin.

Most of the time your vulva will look normal, but it might appear inflamed or swollen.

 

Vulvodynia Diagnosis

To diagnose vulvodynia, your doctor may:

  • Ask about your medical, sexual and surgical history.This helps them understand exactly where and how much pain (and other symptoms) you’re having.

  • Give you a pelvic exam.They’ll check your external genitals and vagina for things that might be causing your symptoms. They might take a sample of cells from your vagina to test for an infection.

  • Do a cotton swab test. For this test the doctor uses a cotton swab to check for exact areas of pain in your vulvar region.

  • Do a biopsy. The doctor will take a small piece of tissue from a particular area to examine it further. They’ll only do this if they find a sore or something else unusual.

Physical and Emotional Impact of Vulvodynia

Vulvodynia symptoms aren’t life-threatening, but they can still have a huge impact on your life. Vulvar pain can take a toll on your normal activities. It can make it hard to have  sexexercise, socialize, or work. Severe symptoms or trouble having sex can also affect your relationship. This, in turn, could harm your self-image and make you feel depressed. A National Institutes of Health study showed that most women with vulvodynia feel ''out of control,'' unable to have sex and unable to fully enjoy life. If this is true for you, don’t hesitate to seek the help and support you need.

Many women find ways to control their pain. Unfortunately, many doctors aren’t familiar with vulvodynia. If you have this condition, look for a doctor who has experience treating it. Also, remember that  chronic pain can affect your emotions. Think about getting therapy or joining a support group.

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Vulvodynia Home Remedies

It may help to stay away from things that could irritate your vulva. These might include certain soaps,  medications, or douches. You can:

  • Use a dermatologist-approved detergent 

  • Don’t use fabric softener on your panties.

  • Use unscented toilet paper that’s soft and white.

  • Wear 100% white cotton underwear

  • Use 100% white cotton menstrual pads, and tampons.

  • Don’t get shampoo on the vulvar area.

  • Avoid perfumed creams or soaps, pads or tampons, and contraceptive creams or spermicides.

  • Stay out of hot tubs or pools with lots of chlorine.

  • Rinse your vulva with cool water after you pee or have sex.

  • Avoid foods that make your urine more irritating. This may include greens, beans, berries, chocolate, and nuts.

  • Wear loose-fitting pants and skirts

  • Don’t wear pantyhose.

  • Keep your vulva clean and dry. 

  • Remove wet swimsuits or damp gym clothes as soon as you can.

  • After bathing, gently pat your vulva dry and apply a vegetable or plant-based oil or preservative-free emollient to protect it.

Ease pressure

Some activities put pressure on your vulva. To ease it you can:

  • Use a water-soluble lubricant during sex.

  • Avoid activities that put direct pressure on your vulva. This includes bicycling and horseback riding.

  • Sit on a foam rubber doughnut.

Relieve pain

These steps may help relieve vulvar pain:

  • Soak in lukewarm or cool sitz baths.

  • After sex, apply ice or a frozen gel pack wrapped inside a hand towel to the area.

  • Try a heating pad.

  • Try relaxation techniques.

Vulvodynia Treatments

There’s no one treatment for vulvodynia that works for all women. You may need to try a combination of things for the best results. Your doctor may suggest. 

Medications

You might get a pill, a cream or ointment you rub onto the skin, or a shot. Your doctor may suggest:

  • Local anesthetics, such as lidocaine

  • Topical estrogen creams

  • Tricyclic antidepressants

  • Anticonvulsants

  • Nerve blocks

  • Serotonin-norepinephrine reuptake inhibitors

  • Neurostimulation and spinal infusion pump

  • Medications with anti-inflammatory effects such as steroids or mast cell inhibitors

  • Botox

Therapies

The doctor may also suggest treatments like:

  • Physical therapy, which involves exercise to strengthen pelvic muscles and ease muscle spasms

  • Biofeedback, which helps you learn to relax vaginal muscles to lessen pain

  • Transcutaneous electrical nerve stimulation (TENS). This treatment uses a low volt electrical current to ease pain. 

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Surgery

If you have a type of localized vulvodynia called provoked vestibulodynia, your doctor may suggest surgery to remove painful tissue, especially if other options  haven’t helped.

If your doctor doesn’t have experience with surgery for provoked vestibulodynia, consider seeing a  gynecologist with a special interest in this condition. Ask your doctor for a referral.

WebMD Medical Reference Reviewed by Trina Pagano, MD on September 09, 2020

Sources

SOURCES: 
National Vulvodynia Association: ''Fact Sheet;'' ''What Is Vulvodynia?;'' ''What Causes Vulvodynia?;'' ''Self-Help Tips for Vulvar Skin Care;'' and ''Treatment.'' 

The American College of Obstetricians and Gynecologists: ''Vulvodynia;' ACOG Committee Opinion No 673: “Persistent Vulvar Pain.

"American Academy of Family Physicians: ''What Is Vulvodynia?''

Office of Research on Women’s Health: ''Vulvodynia.''

UpToDate:"Clinical manifestations and diagnosis of vulvodynia (vulvar pain of unknown cause),” “Treatment of vulvodynia."

Mayo Clinic: “Vulvodynia.”

Cleveland Clinic: “Transcutaneous Electrical Nerve Stimulation (TENS),”  “Vulvodynia.”

Fort Memorial Hospital, Fort Health Care: “Vulvodynia & Vaginismus.”

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