Conditions Basics

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 genital area outside the body that surrounds the opening of the vagina and the urethra. It also includes the clitoris and the labia.

What causes it?

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. This is called localized vulvodynia. Or you may feel the pain on or around most of the vulva. This is called generalized vulvodynia.
• Occur only when something touches the area. Or it may happen when nothing touches the area.
• 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.

How is it diagnosed?

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

During the examination, 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 your doctor sees a problem or any skin changes, you may need more tests. Your urine, blood, or other fluids may be checked for infection. Or 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 examination 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 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.

Treatment may include:

Medicines.

Medicines that are applied to the skin, such as estrogen cream or lidocaine ointment, may help relieve pain. Other medicines that may be used include antidepressants, seizure medicines, and nerve blocks.

Physiotherapy and biofeedback.

Specific exercises can help you learn how to control and relax your pelvic muscles. Tightness or spasms in these muscles can make vulvar pain worse.

Cognitive behavioural therapy.

This is a type of counselling that can help you learn to change the way you think about and manage your 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 a cool bath. 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 it?

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.

Here are some things that may help.

See a counsellor.

Cognitive behavioural 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.

A support group can help 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.