What is Vulvodynia and What Causes It?

Vulvodynia is persistent, inexplicable pain anywhere in the vulva. The discomfort associated with this condition can be so severe that any sexual activity may be impossible. Even sitting can become intolerable.

Vestibulodynia (vulvar vestibulitis syndrome or vestibulitis) is another condition which is very similar to Vulvodynia except that pain is situated at the entryway just outside the vagina inside the labia (vestibule).

Though it is not known exactly what causes Vulvodynia, doctors speculate that there may be several triggers:

• Allergies or sensitive skin that can be easily irritated
• Hormonal changes or hormonal contraception
• Injures to the vulvar area’s surrounding nerves
• Sexual abuse
• A predisposition to yeast infections
• Pelvic floor dysfunction
• Past history of anxiety and/or depression
• Muscle spasms
• Frequent antibiotic use.

Vulvodynia has also been associated with several other chronic pain-related conditions, meaning that there is a higher likelihood of vulvodynia if a woman has any of the following:

• Interstitial cystitis: (An inflammatory condition that causes moderate to severe pain or pressure of the bladder and surrounding pelvic area).
• Fibromyalgia: (A chronic disorder causing widespread muscular, joint and tendon pain).
• Irritable bowel syndrome: (Recurrent abdominal pain, diarrhea and constipation).
• Endometriosis: (A painful disorder where tissue that is similar to the kind growing in the lining of the uterus (endometrium) grows outside of the uterus instead).
• Chronic fatigue syndrome: (An unexplained ailment with symptoms of fatigue, fever, tenderness and depression, usually following a virus).

In most cases, however, there is no absolute known cause, and the reasons for Vulvodynia remain a mystery. Investigation of this disorder is still in its medicinal infancy because it was previously thought to be a purely psychological issue.

What are the Symptoms?

• Itching
• Throbbing
• Burning
• Stinging
• Painful intercourse (dyspareunia)
• Soreness
• Rawness
• Redness
• Irritation.

These symptoms can be sporadic or constant. They can last for weeks, months or even years. They may also appear suddenly, and disappear just as abruptly. This discomfort can be centralized in one area such as the vaginal opening, or spread throughout the entire vulvar zone. This area may appear swollen or irritated, but often looks completely normal.

Vulvodynia can seriously impact a woman both physically and mentally. Inability to engage in sexual activity may jeopardize relationships. Chronic pain can also lead to irritability, anxiety, sleeping difficulties, social withdrawal, and low self-esteem. Vulvodynia, and the negative emotions that ripple from the condition, can disrupt quality of life and eventually activate full-blown depression.

How Is Vulvodynia Diagnosed?

There is no actual test for vulvodynia. Diagnosis is made by ruling out any other possible ailments that might mimic the symptoms of this disorder, such as:

• Skin conditions
• Diabetes
• Yeast or bacterial infections
• Cervicitis or inflammation of the cervix
• Endometriosis.

A medical history will need to be provided, especially past infections in the pelvic region. Any current drugs you are using, specifically hormonal replacement or contraception should be mentioned.

You will be asked pertinent questions in order to determine the problem. A pelvic exam will be done, both internally and externally to see if there is a possibility of a present infection. Even if the genitals show no visual signs of any infection, a cell sample may be taken to rule out bacterial vaginosis or yeast infection. Finally, to check for vulvodynia, a swab that has been moistened will be used to gently dab at and probe the vulva and surrounding area to determine the exact locations of your pain.

What Happens if I Have Vulvodynia? Can I Be Helped?

Yes. There are several treatments that can minimize pain or discomfort:

• Antihistamines can calm itching, steroids, anticonvulsants, and antidepressants can subdue chronic pain.
• Numbing creams or ointments containing a local anesthetic applied before initiating sex may provide temporary help, but may also cause your partner to experience numbing upon physical contact with these creams.
• Biofeedback therapy can train you to relax, in turn decreasing suffering. You can be taught how to control your body’s responses to vulvodynia symptoms. If the human body anticipates pain, it involuntary contracts to avoid it, causing the very pain it tries to ward off. In time, this pain becomes chronic. Biofeedback can help with this vicious circle, allowing the pelvic muscles to relax and minimize this innate tightening and the subsequent discomfort.
• Nerve blocks that are injected can help with chronic pain.
• Pelvic floor therapy reduces muscle tension in the pelvic floor muscles. These muscles are a support for the bladder, uterus and bowel, and relaxing them can provide vulvodynia relief.
• Surgery that removes tissue and skin affected by vulvodynia or vestibulodynia (vestibulectomy) can effectively relieve pain in many women.

Is There Anything I Can Do At Home in the Way of Self-Help?

There are some simple measures you can take to decrease some of the uncomfortable symptoms:

• Sitz bath soaking, which is sitting in cool or lukewarm water for 5 to 10 minutes two or three times a day can soothe symptoms.
• Avoid those hot tubs and long soaks in scalding water. They contribute to discomfort and itching. Chlorine pools exacerbate the problem as well.
• Save the control top pantyhose and sexy synthetic panties for special occasions. They restrict airflow to the genitals, causing the temperature down there to rise and trap moisture that can cause irritation. Try to find cotton substitutes that promote dryness through absorption, and that encourage healthy, necessary ventilation to the delicate genital area. If you’re comfortable with it, go ‘commando’ at night and skip underwear altogether.
• Cold compresses placed directly on the affected area can help itching and pain—especially after sex.
• Whenever possible, try to avoid any activity that may put pressure on your vulva, such as horseback riding or biking.
• Treat your lady parts gently. Avoid douches. Wash the area with plain water using your hand, then lightly pat it dry. Avoid soap when possible. Even residue scented laundry detergent and fabric softener in clean towels or facecloths can irritate sensitive tissue. You might even wish to put on a natural emollient without additives or preservatives after washing. Petroleum jelly creates a soothing barrier.
• If you’re able to tolerate intercourse, a lubricant can greatly help, preferably a water soluble one.
• Antihistamines before bed can stop itching and provide a restful sleep.
• Unscented white toilet paper can make a difference. So can tampons and sanitary napkins that don’t smell like they’ve been dragged through a perfume factory. Contraceptive creams and spermicides can also irritate vulvodynia.
• Harsh, irritating urine caused by certain foods and drinks like citrus beverages, beans, nuts, chocolate, berries, etc. may cause burning upon voiding. Rinsing the vulvar area after urination with cool water helps.

It is important to note that vulvodynia is not a sexually transmitted disease. It is not contagious, and is in no way an indication of any kind of cancer.

There is no cure for vulvodynia, but different remedies can ease the symptoms for different women. It may take time to find the combination that works best for you, but our doctors will work with you to help provide a comfortable, better quality of life. To schedule an appointment, call 770.720.7733 or request an appointment online.