Vulvodynia is a term used to describe chronic (long-lasting), unexplained pain and discomfort of the vulva. The vulva is the area around the opening of a woman's vagina. The pain is usually described as a burning, stinging, or raw sensation. It can make sitting or having sexual intercourse very uncomfortable. The location and severity of the pain varies among women.
Not much is known about vulvodynia and there is no known cure. The condition can go on for months or years. However, there are treatments available to help minimize the symptoms and make the condition more manageable.
The exact cause of vulvodynia is unknown. According to the National Vulvodynia Association (NVA), the condition is not caused by an infection or a sexually transmitted disease (STD).
Researchers think that one or a combination of the following may cause vulvodynia:
- damage or injury to the nerves that transmit pain from the vulva
- disturbances of brain chemicals that make the patient more sensitive to pain
- high levels of calcium oxalate crystals in the urine
- an increase in the density of the nerve fibers in the vulva
- a hypersensitivity to yeast (Candida) or another organism
- an autoimmune response to the HPV virus
- spasm of the pelvic floor muscle
- long-term or abnormal reaction to a past vaginal infection
- changes in responses to hormones
- a drop in the hormone estrogen
- sensitivity or allergy to something that touches the vulva, like soap
- sensitive skin
- repeated exposure to stress
- genetic factors
Vulvodynia is not contagious.
The exact number of women with vulvodynia is unknown. Women who get vulvodynia are typically otherwise healthy.
The condition usually starts before the age of 25. According to a review published in American Family Physician, women diagnosed with vulvodynia are usually white, between the ages of 20 and 50, and have been treated repeatedly for yeast infections in their lifetime. Vulvodynia is not associated with STDs.
The main symptom of vulvodynia is pain in the vaginal area. The pain may be described as:
The symptoms may occur after pressure is applied to the vulva. For instance, this may occur during sexual intercourse, exercise, insertion of a tampon, sitting for a long period of time, or wearing tight clothing. In some women, the pain occurs at random. The location of the pain may move around or always be in the same place. It can be constant, or it can come and go.
Types of Vulvodynia
There are two types of vulvodynia. Each type depends on where the pain is located:
In generalized vulvodynia, the pain is felt over the entire area of the vulva.
In localized vulvodynia, the pain is felt on a specific area of the vulva. When the pain is limited to the vestibule (the area around the opening of the vagina), the condition is called vulvar vestibulitis syndrome (VVS)
Vulvodynia is typically diagnosed only when other causes of pain are ruled out. Unfortunately, ruling out other causes can be a difficult and time-consuming process.
Your doctor will first take a complete medical history and ask you questions about past illnesses, injuries, and behaviors. They may ask about the duration of the pain, previous treatments, any allergies you may have, past surgeries, and your sexual history. They will carefully examine the vulva and the areas around it.
Your doctor may do one or more of the following:
- Take samples of the vaginal secretions and send them to a laboratory to test for yeast and bacterial infections.
- Take a blood sample in order to test the levels of certain hormones, such as estrogen, progesterone, and testosterone, present in your blood.
- Use a cotton swab to apply gentle pressure to different parts of the vulva and ask you to rate the severity of the pain.
- Ask for a urine sample to check for levels of calcium oxalate.
- Order a computed tomography (CT) scan or magnetic resonance imaging (MRI) in order to make sure there are no tumors or cysts compressing a nerve.
Your doctor will use the information from these tests to rule out other possible causes of the pain, such as:
- yeast infection or vaginal thrush
- recurrent herpes simplex virus (HSV) infection
- bacterial infection
- allergic reaction
- drop in estrogen levels
- certain skin conditions that cause irritation of the vulva called lichen sclerosus or lichen planus
- Behcet’s disease, a disease of the blood vessels that can cause ulcers in the genital area
- Sjögren’s syndrome and other immune system disorders that lead to vaginal dryness
You may be diagnosed with vulvodynia if your doctor can’t find another explanation for the pain.
Doctors Who Treat Vulvodynia
A primary care physician will typically be the first type of doctor to discuss your symptoms and check your medical history and current health. Once certain conditions are ruled out, your doctor may refer you to a specialist for more testing and treatment.
Specialists who treat or help manage vulvodynia include:
- obstetrician/gynecologist (OB/GYN): This is a doctor who specializes in pregnancy, childbirth, and the diagnosis and treatment of disorders of the reproductive system.
- vulvovaginal specialist: This is a doctor who specializes in disorders of the vulva. These may include vulvodynia, sexual pain disorders, infections of the vulva or vagina, dermatologic diseases of the vulva, and female sexual dysfunction.
- dermatologist: This is a doctor who specializes in disorders of the skin, including allergic reactions. A dermatologist can help rule out other skin conditions that could cause vaginal pain, itchiness, or burning. A dermatologist can also help you avoid skin irritants that make vulvodynia symptoms worse.
- neurologist: This is a doctor who specializes in disorders of the nervous system, including the brain, spinal cord, and nerves. A neurologist is usually skilled in treating chronic pain.
- physical therapist: This is a professional who help patients reduce pain and improve mobility. Physical therapy can help relax tissues in the pelvic floor and release tension in muscles and joints.
- psychologist: Vulvodynia often affects a woman’s relationships and emotional well being. You may need to see a psychologist or therapist to discuss the emotional issues caused by having chronic pain.
Since the exact cause is unknown, treatment for vulvodynia is aimed at relieving the pain. Not all women with vulvodynia respond to the same types of treatments. You may need to experiment with different types of treatments or try a combination of different treatments in order to maximize pain relief.
Usually the first step in trying to relieve the pain associated with vulvodynia is to make certain lifestyle changes. The following changes are recommended:
- Wear underwear made of cotton.
- Avoid wearing tight clothing and pantyhose.
- Use mild soaps or only water to clean the vulva.
- Avoid pads or tampons with deodorants or fragrance.
- Use lubricants during intercourse.
- Avoid exercises or activities that may put pressure on or irritate the vulva, such as riding a bike or a horse.
- Apply cold compresses to the genital area.
- Soak in a bath with lukewarm water two or three times a day for five to 10 minutes.
- Apply a preservative-free emollient, like petroleum jelly, to the affected area after bathing.
Alternative therapies, like yoga, massage, or acupuncture, may also be helpful. More research needs to be done to assess their effectiveness.
For some women, the symptoms of vulvodynia are worse after they consume certain types of foods. Foods that seem to trigger the symptoms of vulvodynia include caffeine, sugary foods, acidic foods, and foods high in oxalates. Examples of foods high in oxalates include:
- Swiss chard
- soy products
Oral medications for vulvodynia can be used to block the pain. These include:
- tricyclic antidepressants
- serotonin-norepinephrine reuptake inhibitors
- anticonvulsants (seizure medications), such as gabapentin
Topical medications are applied directly to the vulva. Topical drugs that may help with vulvodynia include hormone creams, such as estrogen or testosterone, and local anesthetics, such as lidocaine ointment.
A nerve block is a type of anesthetic drug that is injected into the nerves that transmit pain signals from the vulva to the brain. An anesthetic helps to numb the pain.
Physical therapy can help relax the tissue in the pelvic floor. It can also help release any tension in the muscles. A physical therapist may use exercise, massage, or a technique called biofeedback in order to help you strengthen the pelvic floor muscles and teach you to relax them. Stronger pelvic floor muscles may help to reduce your pain.
Surgery is not recommended for women with generalized vulvodynia. It is considered a last resort for women with VVS after other treatments haven’t worked.
Surgery to remove the painful tissue from the vestibule is called a vestibulectomy. The procedure may relieve the pain.
Therapy or Psychological Counseling
Any time of chronic pain will typically cause emotional and psychological stress. A therapist or counselor can provide emotional support to women with vulvodynia. They can help you learn to cope with the pain, to handle intimacy in relationships, and reduce your overall stress.
Vulvodynia can be painful and very frustrating. It can keep you from participating in social events and wearing the clothes you want to wear. It can even make you fearful of having sex.
Vulvodynia can cause emotional problems and other complications including:
- stress and anxiety
- sleep disturbances
- relationship problems
- decreased quality of life
- body image problems
It may be beneficial to talk to other women who have vulvodynia. Alternately, a counselor can help you cope with the condition. Getting help can make you feel less alone.
Doctors still do not completely understand vulvodynia. Women can have vulvodynia for years, but the condition may eventually clear on its own over time.
According to a review published in American Family Physician, most women who receive one or more treatments experience substantial improvement. About 50 percent of all women who were once diagnosed with the condition no longer have it.