What is vulvodynia?
Vulvodynia is chronic pain in the vulva, the area on the outside of a woman’s genitals. It is usually described as a sensation of burning, stinging, itching or rawness. Vulvodynia is defined as pain that lasts more than three months and doesn’t have a clear identifiable cause, such as an infection or a skin disorder. This pain may cause sexual dysfunction and it can negatively impact a woman’s quality of life.
Symptoms and Causes
What causes vulvodynia?
Knowledge about the cause of vulvodynia is limited. There are many suspected causes, including inflammation, injury to nerves in the area (neuropathic problems), hormonal factors, musculoskeletal problems and genetic (inherited) factors. Often, women with vulvodynia also suffer from other common pain syndromes. These pain syndromes can include:
What are the risk factors for vulvodynia?
Several risk factors for the development of vulvodynia can include:
Diagnosis and Tests
How is vulvodynia diagnosed?
Vulvodynia is diagnosed by ruling out other conditions that might be causing the pain. Your doctor will ask about your medical and surgical history, where it hurts, when it hurts and how badly it hurts. An examination of the vulva area might include touching areas around the vulva with a cotton swab to evaluate the location and intensity of the pain. A pelvic exam will be completed to assess your pelvic floor muscles and help to identify any other areas of pain.
Tests might include:
- Swabs to test for infection
- Biopsy: An examination of tissue removed from the area. This test is not done routinely and is only performed if there is a lesion or abnormal exam finding.
Management and Treatment
How is vulvodynia treated?
Vulvodynia treatment takes time. Finding the treatment or combination of treatments that will bring you relief from pain is a process of trial and error, and treatments that work might not work immediately.
Treatments you and your doctor might try include:
- Topical medications: Creams and ointments containing anesthetics or nerve-stabilizing medications and are applied to the vulvar area. Sometimes these are used before sexual intercourse.
- Oral medication: These medications can include antidepressants and anticonvulsants, to address nerve pain.
- A nerve block: This is an injection of medication that interrupts the signals that send pain from nerves to the brain.
- Physical therapy: Physical therapy is used for the treatment of vulvodynia, but not for muscle strengthening. This treatment is used for myofascial release. Muscles in the pelvic floor are often in spasm in women with vulvodynia. Working with a physical therapist trained in pelvic floor disorders can help to relax these muscles.
- Vestibulectomy: This is a surgical procedure to remove tissue in the area where the patient feels pain. This can be helpful for women who have localized vulvodynia and haven’t been significantly helped by other treatments.
- Counseling: This might be recommended, since vulvodynia can affect sexual relationships, self-esteem and overall quality of life.
What else can I do to relieve the pain of vulvodynia?
- Avoid tight clothing and pantyhose.
- Wear all-cotton underwear.
- Use cold compresses or gel packs.
- Avoid exercises that put pressure on the vulva, like cycling or horseback riding.
- Wash the area gently with plain water. Don’t use soap in the genital area, don’t douche, and don’t use other possible irritants like deodorants or bubble bath.
- Use a lubricant during sex, but stay away from the lubricants that are flavored or designed to create a cooling or warming sensation.
- If you have to sit down for prolonged periods, it might help to sit on a foam “donut” or some other type of cushion that reduces pressure on the area of the vulva.
- Reduce your stress levels and get adequate sleep.
How does vulvodynia affect a woman's life?
Vulvodynia is not a life-threatening condition, but it can be a stressful and life-altering one in many ways.
- Pain from sitting for prolonged periods can make it difficult to do your job.
- The difficulty or impossibility of sexual intercourse can damage relationships.
- Like any kind of pain, it can affect the ability to sleep well.
- Clothing options can be limited.
Research has linked vulvodynia to depression and anxiety.
When should I see a doctor about vulvodynia?
Some women hesitate to discuss this problem. If you have persistent pain in the area of your vulva, you should tell your gynecologist or primary care physician. If it gets worse, you should call again.