Vulvodynia

The exact cause of vulvodynia is unknown. Researchers are working to learn more about the condition. Causes may include:

• Irritation or injury to the nerves of the vulva
• Hormonal changes
• Overreaction in the cells of the vulva to infection or injury
• Extra nerve fibers in the vulva
• Weak pelvic floor muscles
• Allergies to certain chemicals
• Genetic factors that cause sensitivity or overreaction to infection or inflammation

Sexually transmitted infections (STIs) do not cause this condition.

There are two main types of vulvodynia:

• Localized vulvodynia. This is pain in just one area of the vulva, usually the opening of the vagina (vestibule). The pain often occurs due to pressure on the area, such as from sexual intercourse, inserting a tampon, or sitting for a long time.
• Generalized vulvodynia. This is pain in different areas of the vulva. The pain is fairly constant, with some periods of relief. Pressure on the vulva, such as from sitting for a long time or wearing tight pants can make symptoms worse.

The vulvar pain is often:

• Sharp
• Burning
• Itching
• Throbbing

You may feel symptoms all the time or just some of the time. At times, you may feel pain in the area between your vagina and anus (perineum) and in the inner thighs.

Vulvodynia may occur in teens or in women. Women with vulvodynia often complain of pain during sexual activity. It may occur after having sex the first time. Or, it may occur after years of sexual activity.

Certain things may trigger symptoms:

• Sexual intercourse
• Inserting a tampon
• Wearing tight under wear or pants
• Urinating
• Sitting for a long time
• Exercising or bicycling

Your health care provider will perform a physical exam and ask questions about your medical history. Your provider may do a urinalysis to rule out a urinary tract infection. You may have other tests to check for a yeast infection or skin disease.

Your provider also may perform cotton swab test. During this test, the provider will apply gentle pressure to different areas of your vulva and ask you to rate your pain level. This will help identify specific areas of pain.

Vulvodynia is diagnosed when all other possible causes have been excluded.

The goal of the treatment is to reduce pain and relieve symptoms. No one treatment works for all women. You also may need more than one type of treatment to manage your symptoms.

You may be prescribed medicines to help relieve pain, including:

• Anticonvulsants
• Antidepressants
• Opioids
• Topical creams or ointments, such as lidocaine ointment or estrogen or testosterone cream

Other treatments and methods that may help include:

• Physical therapy to strengthen the pelvic floor muscles.
• Biofeedback, which helps relieve pain by teaching you to relax your pelvic floor muscles.
• Injections of nerve blocks to decrease nerve pain.
• Cognitive behavioral therapy to help you deal with your feelings and emotions.
• Diet changes to avoid foods with oxalates, including spinach, beets, peanuts, and chocolate.
• Acupuncture may help to relieve pain, but be sure to find a practitioner familiar with treating vulvodynia.
• Other complementary medicine practices such as relaxation and meditation.

LIFESTYLE CHANGES

Lifestyle changes may help prevent vulvodynia triggers and relieve symptoms.

• Do not douche or use soaps or oils that may cause inflammation.
• Wear all cotton underwear and don't use fabric softener on underpants.
• Use laundry detergent for sensitive skin and double rinse your underwear.
• Avoid tight-fitting clothes.
• Avoid activities that put pressure on the vulva, such as biking or riding horses.
• Avoid hot tubs.
• Use soft, uncolored toilet paper and rinse your vulva with cool water after urinating.
• Use all-cotton tampons or pads.
• Use a water-soluble lubricant during intercourse. Urinate after sex to prevent a UTI, and rinse the area with cool water.
• Use a cold compress on your vulva to relieve pain, such as after intercourse or exercise (be sure to wrap the compress in a clean towel - do not apply it directly to your skin).

SURGERY

Some women with localized vulvodynia may need surgery to relieve pain. The surgery removes the affected skin and tissues around the vaginal opening. Surgery is done only if all the other treatments fail.

You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.

More information and support for people with vulvodynia and their families can be found at:

• National Vulvodynia Association - www.nva.org

Vulvodynia is often a complicated condition. It may take weeks to months to achieve some pain relief. Treatment may not ease all symptoms. A combination of treatments and lifestyle changes may work best to help manage the symptoms of vulvodynia.

Having this condition can take a physical and emotional toll. It can cause:

• Depression and anxiety
• Problems in personal relations
• Sleep problems
• Problems with sex

Working with a therapist can help you better deal with having a chronic condition.

Contact your provider if you have symptoms of vulvodynia.

Also contact your provider if you have vulvodynia and your symptoms get worse.

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Dolan MS, Hill CC, Valea FA. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Micheletti RG, James WD, Elston DM, McMahon PD. Pruitis and neurocutaneous diseases. In: Micheletti RG, James WD, Elston DM, McMahon PD. Andrews' Diseases of the Skin Clinical Atlas. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 4.

Stenson AL. Vulvodynia: diagnosis and management. Obstet Gynecol Clin North Am. 2017;44(3):493-508. PMID: 28778645 pubmed.ncbi.nlm.nih.gov/28778645/.

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Updated by: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.