Vulvodynia

Vulvodynia is a chronic pain in the vulva, the external female genital organ. The pain or discomfort has no obvious cause and can affect the labia, clitoris, or vaginal opening.

Pain can be so life-changing that it prevents you from participating in activities you enjoy. Treatment may include medication, physical therapy, surgery, and behavioral health support.

Symptoms

Vulvodynia refers to chronic pain or discomfort in the vulva, the external female genitalia. The symptoms can vary widely among individuals and may include:

Burning, stinging, or rawness: Persistent discomfort in the vulvar area, often described as a burning or raw sensation.
Stabbing or throbbing pain: Sharp or intermittent pain in the vulva, sometimes triggered by touch or pressure.
Sensitivity to touch: Increased sensitivity or pain upon contact with the vulvar area, including during sexual activity, wearing tight clothing, or even sitting for prolonged periods.
Pain during sexual intercourse: Discomfort or pain during penetration or sexual activity, which can significantly impact a person’s sex life.
Itching or irritation: Persistent itching or irritation in the vulvar region may or may not be accompanied by visible signs like redness or swelling.
Generalized discomfort: A feeling of discomfort or pain in the entire genital area.

It’s important to note that the exact cause of vulvodynia is often unclear and can involve various factors such as nerve damage or irritation, muscle spasms, hormonal changes, genetic predisposition, or past injury to the area. Diagnosis and management typically involve a comprehensive evaluation by a healthcare professional, which might include a gynecologist, dermatologist, or pelvic pain specialist.

Treatment approaches often focus on symptom management and may involve a combination of therapies, including medications (such as topical creams, nerve pain medications, or muscle relaxants), physical therapy, biofeedback, counseling, dietary changes, and lifestyle modifications. Each person’s experience with vulvodynia can differ, so treatment plans are often tailored to address individual needs and symptoms.

Types of vulvodynia

There are two types of vulvodynia. They are classified based on where the pain originates.

Localized vulvodynia

Most of the time, the pain is isolated in one spot, such as the vestibule or clitoris. The vestibule of the vagina is the skin between the inner labia (vaginal lips) and the opening of the urethra (place to urinate) and the vagina. Your clitoris is a small, bead-like organ on top of your vulva. Localized vulvodynia is sometimes called localized vulvar pain syndrome.

Generalized vulvodynia

Sometimes, the pain is not isolated to one spot. Instead, you may feel pain in different parts of your vulva and/or vagina at different times. You may feel pain throughout the vulva.

Vulvodynia can be provoked or unprovoked. In stimulated vulvodynia, you feel pain with touch or activity. With unprovoked vulvodynia, you feel pain without these factors.

Causes

Vulvodynia is a complex condition, and its exact causes remain unclear. However, several factors might contribute to its development:

Nerve Injury or Irritation: Damage or irritation to the nerves in the vulvar region may lead to chronic pain. Conditions like pudendal neuralgia or other nerve-related issues could be involved.
Muscle Spasms or Hypertonic Pelvic Floor Muscles: Tension or spasms in the pelvic floor muscles can cause pain or discomfort in the vulvar area.
Hormonal Changes: Fluctuations in hormone levels, particularly estrogen, could contribute to vulvar pain.
Inflammation: Inflammatory conditions affecting the vulvar area might lead to persistent pain.
Genetic Predisposition: Some individuals might have a genetic predisposition to developing vulvodynia.
Infections or Allergies: Previous infections or allergies could trigger ongoing discomfort or pain in the vulvar region.
Trauma or Injury: Previous injury or trauma to the pelvic area might contribute to the development of vulvodynia.
Psychological Factors: Stress, anxiety, or past traumatic experiences might exacerbate or contribute to vulvar pain.

It’s important to note that vulvodynia can be a multifactorial condition, meaning that a combination of these factors or other unknown elements might be involved in its development. Diagnosis often involves ruling out other potential causes and may require a comprehensive evaluation by a healthcare professional, such as a gynecologist or pelvic pain specialist. Treatment typically involves a multidisciplinary approach addressing the various contributing factors to effectively manage symptoms.

What conditions often happen with vulvodynia?

Vulvodynia can often coexist or be associated with several other conditions or factors.

Interstitial cystitis (IC)

Interstitial cystitis is a chronic bladder condition that causes bladder pain and pressure. Many individuals with vulvodynia also experience symptoms of IC.

Irritable bowel syndrome (IBS)

Individuals with vulvodynia might have a higher likelihood of also experiencing IBS, a gastrointestinal disorder characterized by abdominal pain, cramping, bloating, and changes in bowel habits.

Chronic pain conditions

Other chronic pain conditions like fibromyalgia or chronic fatigue syndrome might be more prevalent in individuals with vulvodynia.

Pelvic floor dysfunction

Issues with the pelvic floor muscles, such as hypertonic or muscle spasms, can be associated with vulvodynia.

Depression and anxiety

Chronic pain conditions like vulvodynia can significantly impact mental health, leading to depression, anxiety, or increased stress levels.

Sexual dysfunction

Pain during sexual activity due to vulvodynia can lead to sexual dysfunction, impacting intimacy and relationships.

Hormonal imbalances

Changes in hormone levels may be associated with vulvodynia, and hormonal imbalances could contribute to its development or exacerbate symptoms.

Allergies or skin conditions

Certain skin conditions or allergies affecting the genital area might coexist or contribute to vulvar discomfort.

It’s essential to consider that while these conditions might be associated with vulvodynia, they may not necessarily cause it. However, their presence alongside vulvodynia can complicate the management of symptoms and might require a comprehensive approach that addresses all these factors for effective treatment. Consulting with healthcare professionals, such as gynecologists, pain specialists, or therapists, can help manage these coexisting conditions alongside vulvodynia.

Diagnosis

Diagnosing vulvodynia typically involves a comprehensive evaluation by a healthcare professional, often a gynecologist or a specialist in pelvic pain. The process usually includes several steps:

Medical History: The doctor will begin by discussing your symptoms, medical history, and any previous treatments or conditions related to pelvic pain or discomfort.
Physical Examination: A pelvic exam will be conducted to check for any visible signs of irritation, infection, or abnormalities in the vulvar area. This examination helps rule out other possible causes of discomfort.
Pain Mapping: Pain mapping techniques may sometimes be used to identify specific areas of pain and assess their severity. This can involve using a cotton swab to pinpoint areas that elicit pain or discomfort.
Rule Out Other Conditions: Since vulvodynia is a diagnosis of exclusion, the doctor may perform tests to rule out other potential causes of vulvar pain, such as infections, dermatological conditions, hormonal imbalances, or neurological issues.
Additional Tests: Depending on your symptoms and medical history, additional tests might be recommended, including cultures to rule out infections, biopsies, allergy tests, or imaging studies (like MRI or ultrasound) to rule out other underlying conditions.

Discussion of Symptoms: Detailed discussions about your symptoms, including the type of pain, triggers, and impact on daily life, are essential for an accurate diagnosis.

Vulvodynia is often diagnosed when other potential causes of vulvar pain or discomfort have been ruled out. It’s a diagnosis of exclusion, meaning it’s arrived at by eliminating other identifiable causes of the symptoms. Due to its complex nature and the absence of visible signs or specific tests to diagnose it definitively, the process might involve multiple consultations and tests.

Treatment

Treating vulvodynia involves a multidisciplinary approach to managing symptoms and improving quality of life. Treatment plans are often personalized based on individual symptoms, triggers, and their impact on daily life.

Medications

Topical Treatments: Prescription creams or ointments containing anesthetics, steroids, or nerve pain medications might be recommended.

Oral Medications: Antidepressants, anticonvulsants, or medications targeting nerve pain (like gabapentin or amitriptyline) may be prescribed to manage pain.
Hormone Therapy: For some, hormonal creams or medications might be suggested to help with vulvar tissue health.

Physical therapy

Pelvic floor physical therapy involves exercises, stretches, and manual techniques to relax and strengthen the pelvic floor muscles. Biofeedback and electrical stimulation might also be used.

Behavioral therapy

Cognitive-behavioral therapy (CBT) or other forms of counseling can help manage stress, anxiety, or depression often associated with chronic pain conditions.

Lifestyle modifications

Wearing loose-fitting clothing made from natural fibers to reduce irritation.
Avoiding potential irritants such as perfumed products or harsh soaps in the genital area.
Using techniques to manage pain during sexual activity, like different positions or lubricants.

Nerve blocks or injections

In some cases, nerve blocks or injections of local anesthetics might be used to temporarily relieve pain.

Surgery

In rare cases where other treatments haven’t provided relief, surgery might be considered as a last resort. This could involve procedures like vestibulectomy to remove painful tissue.

Alternative therapies

Acupuncture, dietary changes, and supplements (like calcium citrate or vitamin D) might be explored as complementary treatments.

It’s important to note that finding the most effective treatment approach for vulvodynia often involves trial and error. What works for one person might not work for another. Patience and persistence in working with healthcare professionals to develop a comprehensive treatment plan tailored to individual needs are crucial.

Additionally, support groups or counseling services focused on chronic pain conditions can be beneficial in providing emotional support and practical advice for coping with vulvodynia. Regular follow-ups with healthcare providers are essential to track progress and adjust the treatment plan.

Prevention

Preventing vulvodynia entirely may not be possible due to its complex and multifaceted nature, often involving various factors. However, there are steps that some believe might potentially reduce the risk or minimize the likelihood of developing vulvodynia:

Practice Good Genital Hygiene
Avoid Irritants
Use Lubrication During Intercourse
Reduce Stress
Wear Comfortable Clothing
Seek Prompt Treatment for Infections

It’s important to note that these strategies are based on anecdotal evidence or common practices that some individuals find helpful. However, since the exact causes of vulvodynia are poorly understood, there’s no definitive evidence that these measures can guarantee prevention.

The bottom line

Vulvodynia is a chronic condition causing persistent pain or discomfort in the vulvar area without a clear cause. Symptoms vary and can include burning, sensitivity, or pain during sex. Diagnosis excludes other conditions; treatment often combines medications, therapy, and lifestyle changes. Though its exact cause is uncertain, a personalized approach helps manage symptoms. Support from healthcare professionals and coping strategies are crucial for individuals navigating the challenges of vulvodynia, aiming to improve their quality of life.

Additional questions

What is trigger point therapy?

Trigger point therapy is a form of manual therapy that focuses on identifying and releasing trigger points—localized areas of muscle tightness and tenderness that can cause pain and referred sensations in other parts of the body. These trigger points are believed to be small, hypersensitive nodules within taut bands of muscle fibers.

What are labia?

The labia are the external folds of skin that surround the vaginal opening in females. There are two sets of labia:

Labia Majora: These are the larger outer folds of skin that enclose and protect the other external genital structures. They’re analogous to the scrotum in males.
Labia Minora: These are the smaller inner folds of skin within the labia majora. They’re delicate and can vary in size and appearance between individuals.

What type of doctor do you see for pelvic pain?

If the pain is related to urinary issues, a urologist is appropriate, while gastrointestinal concerns might lead to gastroenterologists. For chronic pain management, a pain specialist or physiatrist could help. Specific pelvic issues might warrant a visit to a pelvic pain specialist, a physical therapist focusing on the pelvic area, or a pelvic floor specialist. Choosing the right doctor often involves an initial assessment by a primary care physician or gynecologist, who can then refer you to a specialist based on your symptoms for a comprehensive evaluation and treatment plan.