Vestibulodynia

What is vestibulodynia?

Vestibulodynia is pain that occurs at the entrance (vestibule) to your vagina. Pain may also occur in other external parts of your genitals or vulva. Vestibulodynia is a form of vulvodynia or serious and long-lasting (chronic) vulvar pain that occurs for no known reason. Your healthcare provider may also use the term vulvar vestibulitis syndrome or VVS.

What is the vulva?

Your vulva is the outer part of the female reproductive system. It protects your internal reproductive organs, such as your vagina, uterus and ovaries. It also protects your urethra, the tube in your urinary system that carries pee out of your body.

Your vulva is key to your sexual response cycle and ability to achieve orgasms. It includes your:

• Clitoris.
• Inner lips (labia minora).
• Outer lips (labia majora).
• Vestibule or opening of your vagina.

What is the difference between vulvodynia and vestibulodynia?

Vestibulodynia is a type of vulvodynia. With both conditions, you experience vulvar pain that doesn’t have an apparent cause.

There are two types of vulvodynia:

• Generalized vulvodynia: A near-constant pain occurs in multiple vulvar areas.
• Localized vulvodynia: Pain occurs in one area of your vulva such as your vestibule (vestibulodynia) or clitoris (clitorodynia). Vestibulodynia related to pressure (provoked) is the most common form of localized vulvodynia.

What is provoked vestibulodynia?

Provoked vestibulodynia refers to pain that occurs when there’s pressure on your vaginal vestibule. The pressure “provokes” or brings on chronic pain that lasts for at least three months. This pressure or provoked pain may occur from:

• Pelvic exam.
• Prolonged sitting.
• Sexual intercourse.
• Tight-fitting clothing.
• Vaginal penetration with a finger, penis, tampon or sex toy.

What are the types of provoked vestibulodynia?

Types of provoked vestibulodynia include:

• Primary (congenital) provoked vestibulodynia: Vestibular pain occurs at the very first attempt of any type of vaginal penetration, such as your first time having sex or inserting a tampon. This condition is congenital or present at birth.
• Secondary (acquired) provoked vestibulodynia: Vestibular pain occurs days, months or years after you’ve experienced pain-free vaginal penetration. This is a condition that develops over time.

How common is vestibulodynia?

As many as 1 in 4 women and people assigned female at birth experience a type of vulvodynia or unexplained vulvar pain at some point in their lives. In most cases, the pain comes from outside pressure or touch (provoked).

The actual incidence of vulvodynia may be higher as some people may be too embarrassed to talk about the problem with their healthcare providers. Others may not seek care because they think the problem is untreatable and something they must live with.

What causes vestibulodynia?

Experts aren’t sure why certain people experience vestibulodynia. It’s possible that some people have a greater number of pudendal nerves in the vulva area. Your pudendal nerves send messages of pain and pleasure to your nervous system.

Some people experience neuroproliferation (also called neuroproliferative vestibulodynia). Their pudendal nerves are hypersensitive to sensations of light touch (allodynia) and pain (hyperalgesia). Neuroproliferation may be congenital or develop as the result of nerve injuries or irritation (acquired).

Who is at risk for vestibulodynia?

Anyone with a vagina can develop vestibulodynia, although the condition is most common among sexually active white and Asian people between the ages of 20 and 40. The condition is also more common among people in menopause who experience vaginal dryness and vaginal atrophy.

You may be more prone to vestibulodynia if you have:

• Allergic reaction or sensitivities to irritants like those found in scented detergents, soaps and pantyliners.
• Chronic yeast infections.
• Fibromyalgia.
• Genetic predisposition to chronic pain, inflammation or infections.
• Interstitial cystitis (painful bladder syndrome).
• Joint pain or musculoskeletal pain.
• Mood disorders like depression or bipolar disorder.
• Pelvic floor dysfunction, weakness or muscle spasms.
• Trauma from sexual abuse (rape) or difficult labor and delivery.

What are the symptoms of vestibulodynia?

Vestibulodynia causes neuropathic (nerve) pain that lasts for at least three months. The pain may be constant or it may come and go (intermittent).

Symptoms of vestibulodynia include:

• Burning, stinging sensation or knife-like pain in the vestibular area.
• Pain during vaginal penetration, or while sitting or participating in physical activities like running, biking or horseback riding.
• Painful intercourse (dyspareunia).
• Painful urination (dysuria).
• Vestibule area that is tender, dry, raw or red.

What other conditions may occur along with vestibulodynia?

Some people with vestibulodynia also have:

• Clitorodynia: This type of localized vulvodynia causes severe pain in the clitoris.
• Vaginismus: Vaginismus causes you to involuntarily tense or contract your vaginal muscles during any attempt at vaginal penetration.

How is vestibulodynia diagnosed?

There isn’t a diagnostic test for vestibulodynia. Your healthcare provider will assess your symptoms. During a pelvic exam, your provider may use a cotton swab to apply gentle pressure to various areas of the vulvar area while you rate your level of pain or discomfort.

You may also get one or more of these tests to diagnose or rule out other problems:

• Blood tests.
• Urinalysis or urine culture tests to check for urinary tract infections (UTIs), bladder inflammation (cystitis), yeast infections and sexually transmitted diseases and infections (STDs and STIs).
• Pap smear and colposcopy (if needed) to check for cervical dysplasia or cervical cancer.
• Skin biopsy to check for skin diseases.

What providers treat vestibulodynia?

Although vestibulodynia affects your genitals, it isn’t necessarily a gynecologic problem. You may see various specialists for treatment, including:

• Ob/Gyn (obstetrician/gynecologist).
• Dermatologist.
• Neurologist.
• Pain management specialist.
• Pelvic floor physical therapist.
• Psychologist, sex therapist or couples therapist.
• Urologist or urogynecologist.

How do providers treat vestibulodynia?

Treatments for vestibulodynia focus on easing pain and managing symptoms.

Nonmedicinal treatments for vestibulodynia include:

• Anesthetic (numbing) skin creams.
• Cognitive behavioral therapy (CBT), couples therapy or sex therapy.
• Lifestyle changes, such as wearing loose-fitting clothing and cotton underwear and avoiding scented products.
• Pelvic floor physical therapy like Kegel exercises (pelvic floor exercises) that incorporate biofeedback.
• Vaginal lubricants and vaginal dilators.

Medicinal treatments for vestibulodynia include:

• Antidepressants.
• Antiseizure and nerve pain medications like gabapentin.
• Botulinum toxin injections (Botox®).
• Topical corticosteroids or steroid injections.
• Topical hormone creams (hormone therapy).
• Nerve blocks.
• Pain relievers.

Can surgery treat vestibulodynia?

Some people with provoked vestibulodynia who don’t respond to treatments benefit from surgery to remove sensitive skin and tissue. This surgery (a vestibulectomy) provides permanent symptom relief in many cases.

Can you prevent vestibulodynia?

These steps for vulvar care can prevent and ease vulvar pain:

• Avoid using scented products on your genitals, such as feminine deodorant sprays, talcum powder and pantyliners.
• Don’t use birth control options that go inside your vagina (like a diaphragm or cervical cap). You should also avoid spermicides and contraceptive foams, which can cause irritation.
• Rinse your genitals after urination with water from a squeeze bottle or a bidet instead of toilet paper.
• Use unbleached toilet paper and unscented sanitary products like tampons and pads.
• Sit on a donut-shaped pillow to ease pressure on your vulva.
• Soak in a tub of warm water to ease pain. Wash your genitals with water only (no soap) and avoid bubble baths, bath salts and bath oils.
• Wear cotton underwear, loose-fitting pants or shorts and avoid pantyhose, tights or tight leggings.

What are the complications of vestibulodynia?

Chronic pain from vestibulodynia can be extremely uncomfortable and life-disrupting. The condition can affect your ability to exercise and even do things like sit for an extended period of time.

Vestibulodynia can also lead to sexual dysfunction. It can affect your ability to enjoy sex and may negatively impact your relationships and self-confidence. You and your partner may benefit from talking to a therapist, such as a couples therapist or sex therapist.

What is the outlook for someone with vestibulodynia?

Vestibulodynia often improves over time (remission). Unfortunately, the vulvar pain also tends to come back (relapse). It’s important to follow your healthcare provider’s recommendations to prevent and minimize vulvar pain.

When should I call the doctor?

You should call your provider if you experience:

• Foul-smelling or unusual vaginal discharge.
• Genital itching.
• Painful intercourse.
• Painful urination.
• Signs of a yeast infection, UTI or other infection.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the vestibulodynia?
• What type of vestibulodynia do I have?
• What are my treatment options?
• Should I consider medications or surgery?
• Should I look for signs of complications?

Do STDs cause vestibulodynia?

No. There’s no known link between vestibulodynia and STDs. However, some STDs like chlamydia and gonorrhea cause similar symptoms like a painful, burning sensation. You should see your healthcare provider to determine the cause of these symptoms and get proper treatment.

A note from Cleveland Clinic

Vulvar pain from vestibulodynia is very real. Painful vaginal penetration or persistent pain in the vulvar area isn’t something you should be embarrassed to discuss with your healthcare provider. You may have vestibulodynia, a type of vulvodynia that causes chronic pain at the opening of your vagina (the vestibule). This vestibular pain often occurs spontaneously for no apparent reason. Medications and nonmedicinal treatments can help.