Vulvodynia

What is vulvodynia?

Vulvodynia (pronounced vul-vo-DIN-ee-a) is chronic pain in your vulva, and or vagina or genitals, with no apparent cause. Vulvar and vaginal pain are common symptoms of various conditions, including infections and skin disorders. Vulvodynia is different. Vulvodynia is pain lasting three or more months that isn’t an obvious symptom of a specific condition. The pain can be so draining that it keeps you from doing activities you enjoy.

What types of vulvodynia are there?

There are two types of vulvodynia. They’re classified based on where the pain originates.

• Localized vulvodynia: Most of the time, pain is isolated to one spot, like your vulvar vestibule or clitoris. Your vulvar vestibule is the skin located between your inner labia (vaginal lips) and the opening of your urethra (where you pee) and vagina. Your clitoris is the small, bead-like organ at the top of your vulva. Localized vulvodynia is sometimes called localized vulvar pain syndrome.
• Generalized vulvodynia: Sometimes, the pain isn’t isolated to one spot. Instead, you may feel pain in different parts of your vulva and/or vagina at different times. You may feel pain throughout your vulva.

Vulvodynia could be provoked and unprovoked. In provoked vulvodynia, you feel pain with touch or activity. With unprovoked vulvodynia, you feel pain without these factors.

How does vulvodynia affect a person’s life?

Vulvodynia can be so stressful that it’s life-altering. With vulvodynia:

• Pain from sitting for too long can make it challenging to do your job.
• The difficulty or impossibility of sexual intercourse can damage relationships.
• You may have a harder time falling and staying asleep.
• Clothing options can be limited.

Research has linked vulvodynia to depression and anxiety.

Who gets vulvodynia?

Most people diagnosed range from ages 20 to 60, but you can get vulvodynia at any age.

How common is vulvodynia?

Vulvodynia is the most common cause of painful intercourse (dyspareunia) and chronic pelvic pain among people in their reproductive years (people who menstruate).

Still, it’s hard to know just how common it is. Many people with vulvodynia likely don’t seek treatment. Also, it isn’t easy to diagnose vulvodynia because researchers don’t know its exact cause. Many people with vulvodynia get misdiagnosed. Or, they may get diagnosed with other conditions involving chronic pain, but the vulvodynia gets missed.

What are the symptoms of vulvodynia?

The pain associated with vulvodynia feels different to different people. When the pain starts, stops or feels most severe varies from person to person, too.

What does vulvodynia feel like?

The pain in your vulva may range from mild to severe. It may feel like:

• Burning.
• Stinging.
• Stabbing.
• Itching.
• Rawness.
• Throbbing.

You may feel the pain in one spot, the pain may shift from one place to another, or the pain may feel spread out throughout your entire vulva.

When will I notice the pain in my vulva?

The pain may:

• Start and stop unpredictably over several months.
• Last nonstop for several months.
• Begin all of a sudden with no obvious cause.
• Start when you’re touched or participating in an activity like sex, exercise, running, walking, inserting a tampon or even sitting.

Any of these activities can also intensify the vulvar pain that you’re already feeling.

What causes vulvodynia?

Researchers aren’t sure what causes vulvodynia, but there are many potential causes, including:

• Inflammation.
• Hormonal factors.
• Genetic (inherited) factors.
• Injury to your nerves (neuropathic problems).
• Long-term reactions to past vaginal infections.
• Weakened pelvic floor muscles or muscle spasms.
• Irritation from harsh products that touch your skin.

What conditions often happen with vulvodynia?

Often, people with vulvodynia are also diagnosed with other common pain syndromes, including:

• Fibromyalgia.
• Painful bladder syndrome.
• Irritable bowel syndrome.
• Temporomandibular disorder.

Is vulvodynia caused by stress and anxiety?

Data suggests that people with vulvodynia are more likely to have higher levels of stress, histories of abuse and certain behavioral health conditions, including:

• Anxiety.
• Depression.
• Post-traumatic stress disorder (PTSD).

Still, it’s hard to know how these conditions are associated with vulvodynia. Having a behavioral health condition may increase your likelihood of developing vulvodynia. It’s also possible that you may develop anxiety or depression because of vulvodynia’s negative impact on your life.

How is vulvodynia diagnosed?

Your healthcare provider will diagnose vulvodynia by ruling out other conditions that may be causing your pain. They’ll ask about your medical, sexual and surgery history. They’ll also ask about your symptoms, including where you’re experiencing pain, what the pain feels like, when your vulva hurts and how badly it hurts.

Tests and procedures used to diagnose vulvodynia may include:

• Physical exam. Your provider will inspect your vulva and perform a pelvic exam with a speculum to assess your vagina and cervix. Your cervix is the opening between your vagina and uterus. Your provider will also evaluate your pelvic floor muscles to identify painful areas.
• Cotton swab test (point-pressure testing). Your provider will brush a cotton swab gently over parts of your vulva and ask when (and where) the contact feels painful. This test is especially helpful for diagnosing localized pain in your vulvar vestibule.
• Swabs to test for infection. These tests can rule out conditions that may cause vulvar pain, like sexually transmitted infections (STIs), bacterial vaginosis, and yeast infections.

In rare instances, your provider may order a colposcopy or a biopsy of your vulva to rule out conditions unrelated to vulvodynia that may be causing your pain.

How is vulvodynia treated?

Vulvodynia treatment takes time. Finding the treatment or combination of treatments that bring you pain relief involves trial and error. Treatments that eventually work might not work immediately.

Treatments may include:

• Topical medications: You can apply creams and ointments that numb your vulva (anesthetics) or stabilize your nerves. Your provider may also prescribe topical creams that contain estrogen or a mix of estrogen and progesterone.
• Oral medication: Antidepressants and anticonvulsants that you can take by mouth can reduce nerve pain.
• A nerve block: Your provider may recommend an injection that prevents pain signals from traveling from your nerves to your brain.
• Physical therapy: Physical therapy can loosen muscle tension in your pelvic floor (the muscles, ligaments and connective tissue in your pelvis). It may also reduce how often your pelvic floor muscles spasm (contract involuntarily). Muscle spasms are common with vulvodynia. Treatment may involve stretching, lengthening and strengthening weak pelvic floor muscles.
• Vestibulectomy: This surgery can be helpful for people with localized vulvodynia whose pain hasn’t improved with more conservative treatments. During the procedure, your healthcare provider removes tissue in the part of your vulva that feels painful.
• Counseling: Individual counseling, couple’s counseling or sex therapy may help you improve those areas of your life negatively impacted by vulvodynia, like sexual relationships.

Limited data suggests that treatments like acupuncture and hypnosis can reduce pain associated with vulvodynia and improve sexual dysfunction, too.

How can I manage vulvodynia symptoms?

Many good practices that keep your vulva and vagina healthy (vulvar care) may also help with vulvar pain.

To manage pain, you should:

• Take baths with Epsom salt or colloidal oatmeal.
• Use mild, unscented soap (or just water) when washing your vulva.
• Use a mild, unscented laundry detergent on fabrics that touch your vulva.
• Wear all-cotton underwear during the day and no underwear at night.
• Apply cold compresses or gel packs to your vulva (no more than 15 minutes at a time).
• Use an unscented or unflavored lubricant during sex without cooling or warming effects.
• Use a foam “donut” or some other type of cushion that reduces pressure on your vulva if you have to sit for prolonged periods.
• Get enough sleep each night (between 7 to 9 hours).
• Incorporate stress reduction and relaxation techniques into your everyday routine.

Avoid:

• Wearing tight pantyhose, pants or jeans.
• Using scented toilet paper, tampons, pads or panty liners.
• Wearing a wet swimsuit or sweaty workout clothes for too long.
• Douching or using possible irritants like deodorants or bubble bath.
• Cycling, horseback riding, or other exercises that put pressure on your vulva.

Can I prevent vulvodynia?

Unfortunately, vulvodynia isn’t preventable.

Does vulvodynia ever go away?

There isn’t enough evidence to predict when (or if) your vulvodynia will ease or resolve on its own. Instead of trying a wait-and-see approach, schedule a visit with your provider to begin treatments that can help.

When should I see my healthcare provider about vulvodynia?

If you have persistent pain in your vulva, schedule an appointment with your primary care provider or gynecologist. It may take some time to find the treatment that works for you. Treatment may require a team-based care approach involving a gynecologist, physical therapist, counselor, etc. The sooner you can connect to these resources, the sooner you can experience relief.

What questions should I ask my doctor?

• What testing would you suggest to find out what’s causing my pain?
• Are there activities I should avoid that may be making my symptoms worse?
• Is my vulvodynia likely related to another condition I have?
• What steps can I take to have a healthy sex life with vulvodynia?
• What medications, procedures or lifestyle changes would you recommend for treatment?

How do you fix vulvodynia?

Unfortunately, vulvodynia isn’t an easy fix. The treatment that works for you will depend on what’s causing your pain. Medications, physical therapy, counseling and surgery are all potential solutions that can provide you pain relief.

What is the fastest way to get rid of vulvodynia?

If you need quick pain relief, apply a topical anesthetic to numb the area that’s hurting. Finding long-term pain relief may take some trial and error as you work with your provider to find the proper treatment or combination of treatments.

A note from Cleveland Clinic

Contact your provider if you’re experiencing pain in your vulva. Your pain may be related to a specific condition, or it may be vulvodynia. Either way, there are likely treatments that can help. At first, it may take time for your provider to find the treatments that provide you relief. The treatments that work best for someone else may not work for you. Still, the sooner you begin exploring treatment options, the better off you’ll be. Don’t live with pain — or compromise your well-being — when you don’t have to.