Vulvodynia

Sounds like ‘vul-vo-din-ia’

Vulvodynia is pain in the vulva (the skin surrounding the entrance to the vagina).

What is vulvodynia?

Vulvodynia is the ongoing pain and discomfort of the vulva. The cause is unknown, but it is not caused by infection, skin disease or cancer. It is likely that factors relating to the body's nerves, hormones or immune system are involved.

The pain may be limited to only specific areas of the vulva, or it may involve the entire vulvar area. 

Vulvodynia is very uncomfortable and women are often embarrassed to seek help. It is quite common, affecting about 16 out of every 100 women at some point in their life.¹ It is important to talk to your healthcare provider about your symptoms. Even though there is no cure, treatment can help you feel better and lead a full and active life. 

What are the symptoms of vulvodynia?

The pain and discomfort around the vulva may be described as:

  • burning
  • stinging
  • rawness
  • itching
  • soreness
  • throbbing
  • swelling.

When do the symptoms occur?

These symptoms may occur at different times for different women. They may be:

  • constant or come and go for months or even years
  • mild or very bad
  • felt during and after sex
  • flare up when you sit on a bicycle, put in a tampon, wear snug underwear or wipe your vulva.

The pain may occur while sitting or resting and may have no relationship to touch or pressure.

Other causes of vulval pain

Pain in the vulva isn't always vulvodynia. It can have a number of other causes, such as:

  • persistent vaginal thrush or other vaginal infections
  • sensitivity to something touching the vulva, such as soap, bubble bath or medicated creams (known as irritant contact dermatitis)
  • a drop in the hormone oestrogen causing dryness of the vulva, particularly during the menopause
  • a recurrent herpes infection.

Your doctor may want to rule out these conditions before treating you for vulvodynia. Some women can have a combination of problems, for example recurrent thrush and vulvodynia, with both needing proper treatment to reduce pain.

What causes vulvodynia?

The exact cause of vulvodynia is not known. Many factors acting together may be involved. Some of these factors are:

  • Damage or irritation of the nerves of the vulva.
  • Increased number of nerve endings to some parts of the vulva.
  • Increased production of chemicals by cells in the vulva that lead to inflammation (redness and swelling).
  • Long-term reactions to certain chemicals.
  • Changes in responses to hormones.
  • Weakening of the pelvic floor muscles.

How is vulvodynia diagnosed?

There is no special test for vulvodynia, only tests to prove the pain is not caused by other conditions. Your doctor will usually do a physical exam and may take and test samples of your vagina and vulva to rule out other irritations like thrush or eczema.

How is vulvodynia 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. Vulvodynia goes away on its own in about 40% of women.²

Self-help measures

Here are a few things you can try to help relieve immediate pain and soreness:

  • To relieve itching and pain, apply a cold water compress or cool gel packs to the vulva. Don't scratch the area.
  • For pain when sitting, using a doughnut-shaped cushion can help. 
  • Vaginal lubricants may soothe the area and help moisturise the vulva. Speak to your pharmacist about a suitable product.

Here are a few lifestyle tips may help reduce symptoms of vulvodynia:

  • Bathing
    • Avoid scented soaps, shower gels, bubble bath, vaginal sprays or douches, as these can irritate your skin. Instead of scented soap or shower gel, rinse with water only or use an emollient as a soap substitute. Read more about wash-off emollients as soap substitutes.
    • Avoid hot baths or showers —use lukewarm water instead.
    • Gently pat the area dry. Do not run harshly with a towel.  
  • Some toilet papers and washing powders may have chemicals in them that can also irritate the 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.
  • Try using a vaginal lubricant such as Sylk® before intercourse or before inserting a tampon. When choosing a vaginal lubricant, avoid those with alcohol or preservatives. Avoid using KY Jelly.²   
  • Stay active, but limit exercises that can irritate the vulva, such as bike riding or horseback riding. Use petroleum jelly before swimming to provide protection from chlorine.
  • For some women, certain foods make symptoms worse such as caffeine, foods high in sugar, acidic foods and processed foods. If you suspect that some foods may be triggering your symptoms, cut out one food at a time and make a note of your symptoms.  

Physiotherapy

Pelvic floor exercises (such as squeezing and releasing your pelvic floor muscles) to help relax the muscles around your vagina may be helpful. In addition, specialised physiotherapists can help with pain symptoms through specific exercises, stretches and other techniques.

Medications

The following medications have been helpful in some women to relieve the symptoms of vulvodynia:

  • Local anaesthetic cream such as lignocaine 2%.
  • Hormone cream such as oestrogen vaginal cream.  
  • Medication that block nerve impulses and make the vulva less sensitive such as antidepressants, and gabapentin. 

Read more about medications for vulvodynia.

Learn more

The following links provide further information on vulvodynia. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Vulvodynia (vulval pain) NHS choices (UK)
Vulvodynia American College of Obstetricians and Gynecologists (US)
Vulvodynia Vulvan Pain Society (UK)
Care of vulval skin British Association of Dermatology

References

  1. Vulvovaginal health in premenopausal women BPAC 2011, December
  2. Vulvodynia DermNet New Zealand  
  3. Edwards SK, Bates CM, Lewis F, et al. 2014 UK national guideline on the management of vulval conditions. Int J STD AIDS. 2015 Aug;26(9):611-24