Your guide to understanding vulvodynia

Overview

Vulvodynia is a chronic condition that affects the vulva (the outer female genitals). It is characterised by pain and discomfort that can’t be linked to a specific cause. We take a look at the causes of vulvodynia, its symptoms and treatments.

What is vulvodynia?

Vulvodynia is a long-term pain condition of the vulva (the opening to the vagina). The condition is usually described as a burning, stinging, itching or rawness sensation.

Vulvar pain is diagnosed if it lasts more than three months and doesn’t have an identifiable cause, such as an infection.

The pain associated with vulvodynia can have a significant impact upon your quality of life. Sexual intercourse can be very painful, which may lead to sexual dysfunction. In some cases, the pain can make sitting for long periods uncomfortable.

Many women find it hard to talk about the problem with their doctor, so it is difficult to know how widespread vulvodynia is. But it is thought to be the leading cause of painful sex among women who haven’t gone through the menopause.

The condition is not contagious, so women with vulvodynia can’t spread it to other people. It also has nothing to do with personal hygiene and is not a sign that you have cancer.

What are vulvodynia causes?

The exact cause of vulvodynia isn’t known. However, a common theory is that it is caused by a problem with the nerves supplying the vulva. This damage may have been cause by:

• Surgery
• Childbirth
• Trapped nerves
• Severe vaginal thrush

Other theories on what causes vulvodynia include:

• Inflammation in the pelvic area
• Hormonal factors, such as hormone imbalance
• Musculoskeletal problems
• Genetic factors

It should be noted that pain in the vulva is not always vulvodynia. There are several other causes of pain in the genital area that can cause pain. These include:

• Vaginal infections or persistent vaginal thrush
• Sensitivity to soap or medicated creams
• Dryness of the vulva and vagina, caused by fall in the hormone oestrogen. This is particularly common during the menopause
• Herpes infection
• A skin condition, such as lichen sclerosus or lichen planus, that causes irritation and soreness of the vulva
• Behçet’s disease, which is a rare disorder of the blood vessels that can cause genital ulcers
• Sjögren’s syndrome, which is a disorder of the immune system. In rare cases, it can cause vaginal dryness

Your doctor may want to rule out these conditions before treating you for vulvodynia

What are vulvodynia symptoms?

The main symptom of vulvodynia is pain in the genital area. This pain can be described as:

• Burning
• Soreness
• Stinging
• Rawness
• Throbbing
• Itching
• Pain during sexual intercourse, which is called dyspareunia

The pain can be felt over the entire vulva area or it might be localised to a specific part of your body, such as the opening to your vagina. In addition, the tissue surrounding the vulva may feel sensitive to the touch. Although in most cases, the vulva will appear normal, it might look slightly inflamed or swollen.

How do you diagnose vulvodynia?

If you are experiencing symptoms of vulvodynia then your doctor will first rule out other possible causes, such as a yeast or bacterial infection, which are more easily treatable.

Once the doctor has taken note of your medical history, they will conduct a pelvic examination, which may include touching the vulva area with a cotton swab to find out the precise location and intensity of the pain.

After the initial examination, you may be referred for other tests. These include:

• A test for infection: This may be a blood test or a swab test and is used to determine whether you have an infection in the vulva
• Biopsy: A small tissue sample will be removed from the painful area. The tissue sample can then be looked under a microscope for further examination

Once the doctor has evaluated your symptoms, they can recommend treatments or ways to help you manage your pain.

What are vulvodynia treatments?

Finding the right treatment or combination of treatments for vulvodynia can take time. In most cases, it will be a case of trial and error to see which treatments work. Treatments for vulvodynia include:

Over-the-counter vulval gels and lubricants

Vaginal lubricants and aqueous cream may soothe the area and help moisturise the vulva if it’s dry. You can also use an anaesthetic gel, such as lidocaine. This can be applied regularly throughout the day or overnight. It can also be applied prior to having sexual intercourse. Conventional over-the-counter painkillers, such as paracetamol, do not usually relieve the pain of vulvodynia.

Prescription medication

These include antidepressants and anticonvulsants, which act to reduce nerve pain. You may need to take this for several months for it to be effective.

Local anaesthetic and steroids injections

These are used only for temporary pain relief and work by injecting a local anaesthetic and steroids into a nerve located near the pain.

Physiotherapy

This can help by relaxing the muscles around your vagina, which can help to reduce pain. A physiotherapist will show you how to do exercises for your pelvic floor muscles. Another technique to relax and desensitise the vagina involves using a vaginal trainer, which you can use in the privacy of your own home. These are smooth cones of gradually increasing size that can be inserted into your vagina.

Therapy and counselling

This includes cognitive behavioural therapy (CBT), which can help women cope with the impact that vulvodynia has on their life. Psychosexual counselling is usually recommended due to the impact that it can have on sexual relationship, self-esteem and quality of life.

Living with vulvodynia

Because the main symptom of vulvodynia is long-term chronic pain, there are several lifestyle changes that you can make that may help with relieving pain. These include:

• Avoiding tight clothing, such as tights
• Wear loose-fitting skirts or trousers
• Wear cotton underwear
• Avoid soaps, bubble bath, and scented hygiene products, such as feminine wipes
• Wash your genitals gently with water
• Use an unflavoured lubricant during sexual intercourse and try to avoid touching your vulva too much
• Apply a cold compress or cool get pack to your vulva
• If you like to go swimming, apply petroleum jelly to the vulva to protect it from chlorine
• Reduce stress levels because stress can increase the pain
• Use a doughnut-shaped cushion when sitting for long periods
• Avoid exercises that put pressure on the vulva, such as cycling

Help for vulvodynia

A consultation with an experienced gynaecologist is often the quickest and simplest way to resolve your problem. They will be able to diagnose the cause of your pain and talk with you about the best treatment options for your specific situation.

An appointment with an experienced consultant at your nearest Circle Health Group hospital can be helpful. They will assess and diagnose the cause of your symptoms and then discuss any suitable treatment options for your specific situation. To schedule your visit, book a specialist appointment online today.

To find out more about vulvodynia, download our Women's Health Matters report.