Many women experience pain and discomfort in the vulva at some point in their lives. When the pain is persistent for more than three months and has no apparent cause, it’s called vulvodynia.
It’s estimated that 16 percent of women in the United States will have vulvodynia at some point in their lives. Vulvodynia can occur at any age, but recent research has found that women between the ages of 20 and 40 years are most likely to experience it.
What is the vulva?
The vulva is the tissue around the opening to the vagina. It includes the outer folds of skin, called the labia majora, and the inner folds, called the labia minora. Other parts include:
- the vestibule, which leads to the vaginal opening
- the clitoris, a highly sensitive organ at the top of the vulva
Types of vulvar pain
There are four main types of vulvar pain.
Generalized vulvodynia starts spontaneously. It causes general vulvar pain and can last for months or even years at a time.
Pain that is centered around a certain area in the vulva is referred to as localized vulvodynia. For example, the pain may be in the folds or “lips” of the vagina. This pain often appears and then disappears.
This vulvar pain comes and goes with a woman’s menstrual cycle. Pain generally tends to be worse right before monthly menstruation starts.
This is vulvar pain that occurs at the opening, or vestibule, of the vagina.
Symptoms of vulvar pain
Most women with vulvar pain report a burning, stinging, or throbbing discomfort in the vaginal area. Sometimes, the pain is constant. Other times, it’s only felt when there is pressure on the area. That pressure may be caused by:
- inserting a tampon
- wearing tight, form-fitting pants
The vulvar tissue often looks healthy and normal in people with vulvar pain.
Causes of vulvar pain
Vulvar pain isn’t well understood. Vulvar pain is not contagious, nor is it spread through sex. It’s also not a sign of cancer.
Researchers have seen a link between vulvar pain and some conditions and factors in some women, such as the following.
Recurrent yeast infections
In one study, mice that were subjected to and treated for yeast infections three times were more likely to encounter vulvar pain than mice without yeast infection. The researchers theorized that the multiple yeast infections increased the production of nerve fibers in the mice. The increased nerve fibers resulted in more vulvar pain.
The study used mice, not humans, so more research is needed to determine the link between yeast infection and vulvar pain in women.
Some women are born with genetic differences that cause cells to overreact to inflammation or hormones. That can cause pain when inflammation occurs in the vulvar region. Inflammation causes tissue to swell, fill with more blood, and feel hot and sore.
Physical or sexual trauma
Vulvar nerve endings can become damaged during childbirth, sexual abuse, or sex without enough vaginal lubrication. Activities that put a lot of pressure on the vaginal region, such as bicycling or horseback riding, can also harm nerve endings and tissue.
Chronic pain conditions
Women with vulvodynia may be 2 to 3 times more likely to have chronic pain conditions like fibromyalgia and irritable bowel syndrome. Both of those are inflammatory diseases, so this type of vulvodynia may be related to inflammation as well.
Soaps, gels, and feminine deodorant products can cause an allergic reaction in the vulvar region in some women. That can lead to irritation, inflammation, and pain.
One study found that women with chronic vulvar pain were more likely to have used hormone therapy than those who didn’t have pain. According to another study, there doesn’t appear to be a link between vulvar pain and the use of birth control, however.
When to seek help for vulvar pain
It’s important to talk openly with your doctor about vulvar pain. Vulvar pain can affect your lifestyle and relationships. Your doctor can help identify the cause of your pain so that you can begin treatment.
Diagnosing vulvar pain
Your doctor will take your medical and sexual history. They may ask whether:
- you’ve been treated for vaginal infections
- your pain is worse with sex
- you have vaginal dryness
Your physician will perform a pelvic exam to look for signs of inflammation or infection. They may also take a tissue sample to test for a bacterial or yeast infection. They may use a cotton swab to gently probe the vaginal area to help determine if your pain is generalized or located in only one spot.
Treatments for vulvar pain
If an infection is causing your pain, your doctor will treat it. If your pain is caused by an allergic reaction to a product, your doctor will recommend you stop using that product. They may also prescribe an anti-inflammatory cream.
If no cause for your pain can be found, your doctor will help you manage the discomfort. They may recommend some of the following treatments:
- pain-relieving creams, such as those containing lidocaine, applied directly to the skin
- low-dose tricyclic antidepressants (TCAs) to help block pain receptors
- anticonvulsants, which may also work similarly to TCAs
- biofeedback, in which sensors placed in the vagina send impulses to help you strengthen your pelvic floor muscles and teach you how to relax them
- massage to relax tight muscles and contracted areas
- cognitive behavior therapy, a type of psychological therapy, to help you manage chronic pain
Surgery may be recommended in rare cases for women with pain around the vaginal vestibule, or opening. The procedure, which involves removing irritated tissue, is called a vestibulectomy.
Effective treatment does exist. Seek help from a gynecologist, gynecologic urologist, or a pain management specialist.
Tips for prevention
There are some things you may be able to do to help prevent vulvar pain. Try these:
- Wear 100-percent cotton underwear. It’s more absorbent than synthetic materials. Avoid wearing underwear to bed.
- Wear loose-fitting clothes in the vulvar area.
- Clean the vulvar area with water only. Avoid soaps, shampoos, and perfumed products that could contain irritants.
- Avoid tampons and sanitary pads with deodorants. Instead, opt for unscented feminine hygiene products.
- Use a vaginal lubricant during sex, especially if you have vaginal dryness.
- If your skin is particularly dry, gently apply a thin coat of petroleum jelly to the vulva after bathing to seal in moisture and add a protective layer to skin.
- Gently rinse and pat dry your vulva after urinating. Wipe front to back, towards the anus, so you don't bring germs from the anus toward your vagina.
- If the vulva is tender or painful, apply a cool gel pack.
If you regularly experience pain, talk to your doctor. It may be due to an underlying condition that requires treatment.