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 it. 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
- Allergies or irritation to chemicals or other substances
- Hormonal changes
- History of sexual abuse
- Frequent antibiotic use
Women who have vulvodynia may also have another type of pain syndrome. This means there may be a link between vulvodynia and pain conditions like:
- Painful bladder syndrome
- Irritable bowel syndrome
- Temporomandibular disorder
Who does vulvodynia affect?
- Women of all ages, even teenagers
- An estimated 8%-10% of all women
- Multiple ethnicities. It was once thought to mainly affect white females, but it’s also found in African American and Hispanic women.
Possible risk factors for vulvodynia include:
- History of abuse
- Posttraumatic stress disorder (PTSD)
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
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.
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 sex, exercise, 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.
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.
- 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.
Easing Pressure and Relieving Pain in Vulvodynia
Some activities like bathing, sex, and even what you eat can affect your vulva. Here are some ways you can ease the pressure and pain.
Be gentle when you wash. Use cool or lukewarm water and your hand, then a clean towel to dry off. Keep shampoo, which can flow down from your head while showering, away from your vaginal area.
After bathing, gently pat your vulva dry and apply a vegetable or plant-based oil or preservative-free emollient to protect it.
Protect yourself before sex by applying a water-soluble lubricant. Avoid contraceptive creams and spermicides. If you want to temporarily numb the area, try a topical anesthetic, like lidocaine gel.
After sex, pee and rinse with cool or lukewarm water to clean around your vagina. If you feel a burning sensation, wrap a frozen ice cube or gel pack in a small towel and hold it gently on your vagina for a few minutes.
If having sex is painful, and you’ve tried the topical anesthetic and frozen ice cubes, consider trying a different sexual position. You can also try other sexually intimate activities until the pain eases.
What you eat may have an effect on your symptoms, for better or for worse.
Processed foods, and those that have caffeine, acid, and lots of sugar, can make symptoms worse. Try taking one thing out of your diet at a time. Keep track of how your body reacts.
You may also want to avoid foods that make your urine more irritating. This may include greens, beans, berries, chocolate, and nuts.
Pressure on your bladder and bowel can cause vulvodynia to flare up. Pee regularly instead of waiting for your bladder to be full, and rinse the vaginal area with water afterward to clean it off. Add fiber to your diet to help you stay regular.
Here are some other tips you can use to ease or relieve vulvar pain:
- Avoid activities that put direct pressure on your vulva. This includes bicycling and horseback riding.
- Sit on a foam rubber doughnut.
- Soak in lukewarm or cool sitz baths.
- Try a heating pad.
- Try relaxation techniques.
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.
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
- Nerve blocks
- Serotonin-norepinephrine reuptake inhibitors
- Neurostimulation and spinal infusion pump
- Medications with anti-inflammatory effects such as steroids or mast cell inhibitors
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-voltage electrical current to ease pain.
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.