Vestibulodynia

Vestibulodynia (formerly known as vulvar vestibulitis syndrome) is pain that occurs at the entrance to your vagina. This area is called the vestibule. It’s a type of vulvodynia, which is long-lasting vulvar pain that has no known cause.

Most cases of this condition are provoked vestibulodynia. This means you feel pain when there’s pressure on your vaginal vestibule. The pressure “provokes” or brings on pain that lasts for at least three months. This pressure may come from:

• A pelvic exam
• Penetration with a finger, penis, tampon or sex toy
• Prolonged sitting
• Tight-fitting clothing

Types

There are two types of provoked vestibulodynia:

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

Symptoms of vestibulodynia

Vestibulodynia causes nerve pain at the entrance of your vagina that lasts for at least three months. The pain may:

• Be constant
• Come and go
• Feel like burning or stinging
• Feel knife-like

Pain can start and stop without warning. Or it may occur only when something touches the area (provoked). In rare cases, your vestibule may also have increased redness or discoloration.

If you have persistent pain near your vagina, see your primary care provider or a gynecologist. The sooner you seek help, the sooner you can find a treatment that works for you.

Vestibulodynia causes

Experts don’t know the exact cause of vestibulodynia. One theory is that some women may have more pudendal nerves in the vulva area. Your pudendal nerves send messages of pain and pleasure to your nervous system.

In general, healthcare providers think many factors may contribute to vestibulodynia. You may be more prone to it if you have:

• Allergic reactions or sensitivities to irritants like dyes and scents
• 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
• Trauma from sexual assault or a difficult labor and delivery
• Vaginal dryness and atrophy from menopause

Complications of this condition

Chronic pain from vestibulodynia can disrupt your life. Complications include:

• Difficulty exercising or sitting for a long time
• Difficulty with intimate relationships
• Mental health conditions, like depression or anxiety
• Sexual dysfunction

Because of these complications, it’s important to get medical help. You and your partner(s) may also benefit from talking to a therapist, like a couples therapist or sex therapist.

How doctors diagnose this condition

Your healthcare provider will ask about your symptoms and what triggers them. During a pelvic exam, your provider may use a cotton swab to apply gentle pressure to parts of your vulva. You’ll rate your level of pain.

Other, more common conditions can cause vulvar pain. So, your provider may recommend tests to rule out other causes. Tests may include:

• Blood tests
• Urinalysis to check for UTIs and bladder inflammation
• Vaginal swab to check for yeast infections and STIs
• Pap smear to check for cervical dysplasia or cervical cancer
• Vulvar biopsy to check for skin diseases

How is it treated?

Treatments for vestibulodynia focus on easing pain and managing symptoms. It can take time to find the right treatment. Your healthcare provider may first suggest options like:

• Lifestyle changes, like wearing loose-fitting clothing and cotton underwear and avoiding scented products
• Pelvic floor physical therapy with biofeedback
• Anesthetic (numbing) skin creams
• Topical hormone creams
• Pain relievers
• Talk therapy, couples therapy or sex therapy

If these treatments don’t work, your provider may suggest one or more of the following:

• Antiseizure and nerve pain medications, like gabapentin
• Tricyclic antidepressants (for pain)
• Transcutaneous electrical nerve stimulation (TENS)
• Topical corticosteroids or steroid injections
• Nerve blocks

If you continue to have severe pain after trying these treatments, your provider may recommend surgery. It’s called a vestibulectomy. Your surgeon removes sensitive skin and tissue. It provides permanent symptom relief in many cases.

Healthcare providers for 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
• Urologist or urogynecologist

What can I expect if I have this condition?

It’s hard to know what to expect when you have vestibulodynia. It affects people differently. And treatments that work for some may not work for others.

There’s no cure. But many women can manage their symptoms with a combination of medical, physical and psychological therapies.