Vulvodynia: Causes, Symptoms, and Treatments

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.
• Vulvar vestibulitis syndrome is pain in the vestibule. This is the entrance to the vagina. Often a burning sensation, this type of vulvar pain comes on only after touch or pressure, such as during intercourse.

Possible Causes of Vulvodynia

Doctors don’t know the cause of most forms ofvulvodynia. 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. There is no consensus on how many women have vulvodynia. Estimates of women with vulvodynia range from 200,000 to 6 million. Once thought to mainly affect whites, African-American and Hispanic women are now known to be equally affected.

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.

Signs and Symptoms of Vulvodynia

Lasting months to years, symptoms of vulvodynia usually begin suddenly.

Common Symptoms of Vulvodynia

These are the most common symptoms of vulvodynia:

• Burning, stinging, or rawness
• Aching, soreness, or throbbing
• Itching

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.

How Symptoms of Vulvodynia Vary

Symptoms can vary a great deal in women with vulvodynia. For example, burning is common but not always present. And the severity of symptoms also varies. The pressure of bicycling, inserting tampons, or even sitting sometimes prompts symptoms of vulvodynia or makes symptoms worse.

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
• In one specific area or throughout your entire vulva

The Impact of Vulvodynia Symptoms

The symptoms of vulvodynia are not a sign of a life-threatening condition. 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 that are comfortable this condition.

Treatment of Vulvodynia

Although there is no cure, self-care and treatments for vulvodynia can help bring relief. Women with vulvodynia need to identify what works best for them because this varies from individual to individual. Women may need to try several things before finding a combination that helps relieve their vulvar pain. 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.

Help Ease Pressure

Certain activities put pressure on the vulva.

• 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.

Relieve Pain

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. Women 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

• Local anesthetics, such as lidocaine
• Topical estrogen creams
• Tricyclic antidepressants
• Anticonvulsants
• Nerve blocks
• Interferon injections

Therapies

• 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

Surgery

If you have a type of vulvodynia called vulvar vestibulitis syndrome, your doctor may suggest surgery to remove painful tissue, especially if other options have not brought relief.