Vulvodynia

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What is vulvodynia?

Vulvodynia is pain or discomfort when the area around the vaginal opening (vestibule) is touched, particularly when pressure is applied such as after trying to insert a tampon, wearing tight pants, or sitting for a long time. Discomfort can be limited to the vestibule (area around the opening of the vagina) or it can involve more of the vulva. The most common complaint is “burning;” however, the feeling can also be described as “stinging”, sharp”, and “raw.”

What causes vulvodynia?

Doctors are not sure what causes vulvodynia but they do know that it is not caused by sexually transmitted infections. Researchers think that possible causes may include:

  • Changes in the nerve endings at the opening of the vagina (vestibule)
  • Genetic factors
  • Weakness of the pelvic floor muscles
  • Injury or trauma to the nerves of the vulva that transmit pain and other feelings
  • Irritation from Candida (yeast) which can cause an area around the vulva to be very sensitive

How is vulvodynia diagnosed?

Vulvodynia is usually diagnosed by your health care provider (HCP) when you go for a check-up and explain your symptoms of burning and discomfort in the vulva and no other cause is found. Your HCP will ask you questions about your medical and sexual history including when the discomfort started, what makes it worse/better, and if you have had any recent localized infections. Your HCP will likely check for any skin diseases and for vaginal infections such as a yeast infection.  You HCP may do a “cotton swab test” in which a soft, moistened cotton-tipped applicator is gently touched to different areas in the vestibule (the area outside and around the opening to the vagina) to help determine the location of the discomfort.

How is vulvodynia treated?

Treatment for vulvodynia can be challenging, takes time, and may include: medications (anti-depressants, creams and ointments), biofeedback, counseling, sexual counseling, physical therapy, nerve blocks, and rarely, surgery. Treatment is sometimes managed by a specialist who has expertise in this condition. Complementary therapies such as acupuncture have also been used. Comfort measures aimed at lowering pain and irritation may include:

  • Avoiding anything that could possibly irritate your vulva such as perfumed lotion, shampoos, and soaps or douching
  • Avoid shaving/removing pubic hair (only trim if desired)
  • Using a mild soap or just water to clean your vulva
  • Using cool/packs to the vulva area for pain control
  • Try lukewarm sitz baths
  • Avoid hot tubs
  • Rinsing the vulva with water after peeing
  • Patting the vulva dry instead of rubbing it dry
  • Switching to cotton or organic menstrual pads; no deodorized pads
  • Wearing underwear that is made out of 100% cotton (no thongs)
  • Avoid tight fitting clothes and tights
  • Avoid bike riding and horseback riding
  • Using a lubricant (make sure no alcohol in the ingredients) when having sex

 

Additional Resources:

National Vulvodynia Association