Vulvodynia

Topic Overview

Is this topic for you?

This topic is for women who have vulvodynia, a type of vulvar pain with no known cause. If your doctor has told you that the pain in your vulva is caused by something else, like an infection or a skin problem, see the topic Female Genital Problems and Injuries.

What is vulvodynia?

Vulvodynia is pain in the vulva that can't be explained by another health problem, such as an infection or a skin problem. The vulva is the area around the opening of your vagina.

The main parts of the vulva are:

• The clitoris. This is the small, sensitive female organ that gets aroused during sex.
• The labia. These are the folds of skin that cover the vagina and the opening of the urethra.
• The opening of the urethra. The urethra is the tube that carries urine from the bladder to the outside of your body.

See a picture of the vulva.

What causes vulvodynia?

Doctors don't know the exact cause of vulvodynia. But some things that may help cause it include:

• Swelling of or injury to the nerves of the vulva.
• Spasms or weakness of the muscles that support the organs of the pelvis.
• A family history of vulvodynia.

In most cases, vulvar pain is a symptom of some other problem. And when that problem is treated, the pain often goes away. Some conditions that may cause vulvar pain include yeast infections and other vaginal infections, atrophic vaginitis, lichen sclerosus, lichen planus, or an allergic reaction to soaps or other products, such as vaginal sprays or douches.

What are the symptoms?

Pain is the main symptom of vulvodynia. Depending on the person, the pain may:

• Be felt only in one spot, such as near the opening of the vagina, and only when something touches that area. This is called localized vulvodynia. Or you may feel the pain on or around most of the vulva, even when nothing touches those areas. This is called generalized vulvodynia.
• Be constant or come and go for months or even years.
• Be mild or very bad.
• Be felt during and after sex.
• Flare up when you sit on a bicycle, put in a tampon, or wipe your vulva.

Other symptoms may include:

• Burning or stinging.
• Itching.
• Swelling.
• Throbbing.
• Rawness.

How is vulvodynia diagnosed?

Your doctor will first ask you about your past health, your sexual history, and your symptoms. Then he or she will do a pelvic exam to rule out other possible causes for your pain, such as an infection or a skin problem.

During the exam, your doctor may use a cotton swab to touch different areas on and around your vulva to see where the pain is and how bad it is. If he or she sees a problem or any skin changes, you may need a biopsy. This means that your doctor will remove a small piece of tissue from your vulva and send it to a lab to be studied for the cause of your pain. Your doctor may also recommend an exam called a colposcopy to take a closer look at the cells on your vulva.

If a cause for your pain is not found, you may have vulvodynia.

How is it treated?

There are many treatments for vulvodynia, but what works for someone else may not help you. Work with your doctor to find what is best for you. Even though there is no cure, treatment can help you feel better and lead a full and active life.

Treatment may include:

• Medicines. Some examples are antidepressants, seizure medicines, nerve blocks, and medicated creams. These can help make the tissues of the vulva less sensitive. And antihistamines can help relieve itching.
• Biofeedback . This treatment can help you learn how to control and relax your pelvic muscles. Tightness or spasms in these muscles can make vulvar pain worse.
• Physical therapy . Specific exercises can help you strengthen your pelvic muscles.
• Estrogen creams. Putting this cream on your skin can help relieve pain.
• Lidocaine jelly. Lidocaine jelly is sometimes used to relieve pain.
• Surgery. In rare cases, surgery is done to remove tissue that is very sensitive.

There are other things you can try to relieve your symptoms:

• Always clean your vulva gently.
• Avoid soaps and other products, such as vaginal sprays or douches, that irritate your skin.
• Wear loose-fitting cotton clothes. Avoid nylon and other fabrics that hold moisture close to the skin. This may cause irritation and allow an infection to start.
• Avoid hot baths, and don't use soaps or bath products to wash your vulva. Rinse with water only, and gently pat the area dry.
• Relieve itching and pain with a cold water compress or cool baths. Don't scratch the area.
• Try using a vaginal lubricant, such as Astroglide or K-Y Jelly, to reduce irritation from having sex.
• Stay active. But limit exercises that can irritate the vulva, such as bike riding or horseback riding.

How can you live better with vulvodynia?

When you have vulvodynia, you may find it hard to do your daily tasks. It may hurt to walk, exercise, or sit for long periods of time. And it may hurt to have sex. All of these things can affect your life, work, and relationships.

At times you may feel overwhelmed, tired, and angry. These feelings are normal. Most women who have vulvar pain feel this way at one time or another.

Even though living with vulvar pain can be stressful, the good news is that you can do some simple things to feel better.

• See a counselor. Cognitive-behavioral therapy allows you to express your emotions and concerns and to learn new ways of coping with vulvar pain. Sex therapy can also help you and your partner find ways to be intimate that don't cause pain.
• Keep a pain diary. You can track moods, thoughts, activities, and medicines that affect pain. Having a record of pain can help you and your doctor find the best ways to treat it.
• Get support from other women. A support group, online forum, or chat group helps you share your concerns and hear how other people cope with the pain and challenges of living with vulvodynia.
• Practice relaxation and breathing exercises. Meditation and guided imagery are two examples of how you can reduce stress and relax your mind and muscles.