Vulvodynia is chronic pain felt in the skin at the opening of the vagina, the vulva (including that felt in the labia, urethra and clitoris), that has been present for at least 3 months. There will be no identifiable cause of the pain as vulvodynia is not related to a skin condition or infection. The pain occurs as a result of the nerve endings in the skin becoming over sensitive. The pain is often present even when the area has no pressure on it.
Vulvodynia is a constellation of several, sometimes overlapping, diseases and processes - always with no identifiable cause. If the pain is only felt when pressure is applied, it is considered as vestibulodynia (previously known as vulva vestibulitis). The pain felt with vestibulodynia is only in a localised area where pressure has been applied; whether it be a touch, or friction when a tampon is inserted or during sex. At other times there is no discomfort.
Vulvodynia can affect otherwise healthy women of any age. It is believed to affect 15% of women. However, as with all intimate conditions, this figure is likely to be much higher but few women seek treatment. Women who suffer from vulvodynia are 2-4 times more likely to be diagnosed with Irritable Bowel Syndrome (IBS).
Vulvodynia is not life threatening, however, it can dramatically lower your quality of life as you become socially isolated to manage the pain. Your relationships can break down as you withhold from sex. This need not be the case as the symptoms of vulvodynia are highly treatable, especially when diagnosed early. To diagnose the cause of your vulval pain, and determine whether it is vulvodynia, your doctor may lightly touch your vulva and take swabs to check for infection or other clues that suggest it is not vulvodynia.
Pudendal Neuralgia
The pudendal nerve is one of the main pelvic nerves, transmitting pain signals from the lower back and pelvis to the brain. It runs right through the vulva, labia and clitoris, and is responsible for the control you have over urination, defecation and orgasms. Pudendal neuralgia is the name for the chronic pelvic pain that is a result of damage or irritation to the pudendal nerve. It is a separate condition to vulvodynia.
Treatments for pudendal neuralgia aim to cut the nerve, or stimulate it to change behaviour by electric current. Treatments for vulvodynia are unlikely to resolve incidences of pudendal neuralgia.
What are the Symptoms of Vulvodynia?
The occurrence of vulvodynia changes in person to person. Some women may suffer with only mild discomfort, others can find the pain disabling. The pain of vulvodynia can be:
- Experienced as - Burning, stinging, aching, throbbing, and/or soreness as if the skin is raw.
- Localised or generalised - The pain can be only within the vulva area, such as with vulva vestibulitis. Or at multiple points within a wide area outside of the vulva, including the buttocks and inner thighs. You can also suffer from mixed vulvodynia where pain is felt inside and outside the vulva area.
- Provoked or unprovoked - The pain may only occur when pressure is applied, or it can be constantly present.
- Primary or secondary onset - Vulvodynia is considered primary if it has always been an issue, or secondary if it is a recent issue.
- Of varying temporal pattern - The pain may be intermittent, persistent or constant. It may be an immediate or delayed response after pressure is put on the area.
The most common form of vulvodynia is a constant discomfort, that is experienced as severe pain when pressure is applied.
Other symptoms of vulvodynia include:
- No change in the appearance of the skin
- A low sex drive
- Sexual dysfunction and pain (dyspareunia)
- Depression
- Social isolation
Conditions with some similar symptoms include vaginismus, pudendal neuralgia and painful periods (dysmenorrhea).
What Causes Vulvodynia?
The pain of vulvodynia is believed to be the result of an abnormal nerve condition. A result of dysfunctional neuronal activity where there is no stimuli causing the pain (other than occasional gentle pressure). The area is oversensitive and sends abnormal signals to the brain, which is experienced as pain.
Vulvodynia is not contagious, an auto immune disorder, hereditary, or an allergic reaction.
Studies suggest vulvodynia may be contributed to, or triggered by:
- A weak pelvic floor
- An overactive pelvic floor
- Spasms of the pelvic floor
- Nerve injury or irritation - Including trapped nerves.
- Repeated infections and treatments for the infections
- Menopause and other hormonal changes
- Genetic susceptibility - Most likely to cause provoked vestibulodynia than other forms of vulvodynia.
- Stress - Stress often increases the sensation of pain.
- A history of severe vaginal thrush
- Damage from childbirth
- Previous pelvic surgeries
- Anxiety or depression
- A history of childhood victimisation
To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.
How to Treat Vulvodynia
Vulvodynia is unlikely to go away on its own and cannot officially be cured as the cause cannot be eliminated until it is found. Instead, it should be considered as a life long condition that is managed through a programme of lifestyle changes and a mix of natural and medical treatments for your symptoms. Your doctor may suggest a number of conservative therapies, they may also prescribe some medications and counselling to relieve your symptoms.
Surgery to remove part of the vulva is rarely considered, as it often only resolves the pain short term. Therefore surgery is reserved for patients with debilitating localised vulvodynia only.
Conservative, Non-Medical Treatments for Vulvodynia
- Manual Kegel (pelvic floor) exercises - Pelvic floor muscle dysfunction is common in sufferers of vulvodynia. To relax the muscles around your vagina you can begin introducing Kegel exercises into your daily routine. If you are able to put things in your vagina, vaginal cones can be used to enhance your Kegel exercises, and gradually desensitise the area to pressure.
- Electronic Kegel (pelvic floor) exercises - An electronic pelvic toner uses electrical nerve stimulation to deliver relief to the painful area. The Kegel8 range of toners can be used with a vaginal probe or skin electrodes placed on the lower back or ankle. These toners can also be used to exercise your pelvic floor more effectively than doing manual exercises alone. Learn more about Manual Exercises Vs Electronic Pelvic Floor Exercises.
- Biofeedback with Kegel (pelvic floor) exercises - An electrical biofeedback machine can be used to score the strength of your muscles, as you squeeze against a vaginal probe. This helps you learn how to do more effective Kegel's, and measure your progress.
- Nerve stimulation - Using transcutaneous electrical nerve stimulation (TENS) is a simple, effective and safe treatment for managing localised vulvodynia. TENS teamed with biofeedback and pelvic floor relaxation can help improve vulvar pain in women with vulvodynia.
- Cotton and loose clothing - Wear 100% cotton (breathable) underwear, with loose trousers or skirts.
- Avoid potential irritants - Emollients can be a good substitute for other hygiene products.
- Soothe - You can sooth your vulva with cool gel packs and water.
- Modify sex and exercise - Avoid activities which can put pressure or impact on your vulva. You may be able to do sexually intimate activities other than penetration, and low-impact exercises.
- Relieve stress - Try relaxation techniques to reduce your stress, which in turn can reduce the impact of your pain.
- Urination - Urinate before you bladder is full and wash your vulva with cool to lukewarm water after.
- Avoid sitting - If you do need to sit for a long period, use a doughnut shaped cushion to relieve the pressure on your vulva.
- Protect the area with anaesthetic gel - Gels, such as 5% Lidocaine, can be applied directly to the area, or on a cotton pad which is held in place by your underwear. It is common for the gel to burn temporarily before the area goes numb - if burning persists for more than 10 minutes, wash it off. NOTE: Be aware that using anaesthetic gel can reduce the ability of condoms to protect from pregnancy and STD's.
- Protect the area with petroleum jelly - This is especially useful to protect the area from being irritated by chlorine when you are swimming.
- Elimination diet - There is evidence that suggests an elimination diet can resolve vulvodynia, when it occurs alongside Irritable Bowel Syndrome (IBS). Elimination diets can be supported by Nutritionists to look at your specific requirements. They often look to remove the common food allergens; wheat, dairy, soy, eggs, peanuts and cows milk. They will then be gradually reintroduced, at which you point you will monitor your energy levels, bowel movements, pain, weight and skin, to determine if any of the foods have an effect.
Medical Treatments and Counselling to Treat Vulvodynia
- Antidepressants - To help you manage your emotions as you undergo treatment.
- Oral pain relief - Tricyclic antidepressants (TCA's), Serotonin-Norepinephrine Reuptake Inhibitors (SNRI's) and anticonvulsants are often prescribed.
- Topical medications - Hormonal creams, anaesthetics (e.g. lidocaine) and compounded formulations which do not have skin irritations.
- Local anaesthetic or steroid injections - Often injected into the pudendal nerve, these can provide temporary pain relief.
- Cognitive behavioural therapy - To help you cope with the impact vulvodynia has on your life, this therapy can change the way you think about the condition and practical ways you can change how it affects you.
- Psychosexual counselling - If you are experiencing sexual intimacy problems as a result of suffering from vulvodynia, psychosexual counselling can help address any anxiety or fear you have.
- Intralesional injections - Injections to the vulva can be useful if you are triggered by touch.
- Acupuncture - Studies using acupuncture show some relief in vulva pain, suggested to be in part due to the associated relaxation and regular contact with a specialist.
To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.
Sources
Bornstein, J. Goldstein, A. T. Stockdale, C. K. Bergeron, S. Pukall, C. Zolnoun, D. Coady, D. (2016). Journal of Lower Genital Tract Disease. 2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. [online] 20(2), p 126-130. [viewed 17/05/18]. Available from: https://www.nva.org/wp-content/uploads/2015/01/2015_ISSVD_ISSWSH_and_IPPS_Consensus_Terminology.2.pdf
British Association of Dermatologists. (2012). Vulvodynia and Vestibulodynia. [online] British Association of Dermatologists, 2012. [viewed 17/05/18]. Available from: http://www.bad.org.uk/library-media/documents/Vulvodynia%20and%20Vestibulodynia%20Updated%20Sept%202012%20-%20lay%20reviewed%20Aug%202012.pdf
Drummond, J. Ford, D. Daniel, S. Meyerink, T. (2016). Integrative Medicine: A Clinician's Journal. Vulvodynia and Irritable Bowel Syndrome Treated With an Elimination Diet: A Case Report. [online] 1594), p42-47. [viewed 17/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991650/
Dionisi, B., Anglana, F., Inghirami, P., Lippa, P., Senatori, R. (2008) Use of Transcutaneous Electrical Stimulation and Biofeedback for the Treatment of Vulvodynia (Vulvar Vestibular Syndrome): Results of 3 Years of Experience. Minerva Ginecologica [online]. 60(6), pp. 485-491 [viewed 10/10/2018]. Available from https://www.ncbi.nlm.nih.gov/pubmed/18981976
Henzell, H. Berzins, K. Langford, J. P. (2017). International Journal of Women's Health. Provoked vestibulodynia: current perspectives. [online] 9, p631-642. [viewed 17/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602415/
International Pelvic Pain Society. (2014). Chronic Pelvic Pain. [online] The International Pelvic Pain Society, 2014. [viewed 02/05/18].
Murina, F., Bianco, V., Radici, G., Felice, R., Di Martino, M., Nicolini, U. (2008) Transcutaneous Electrical Nerve Stimulation to Treat Vestibulodynia: A Randomised Controlled Trial. BJOG [online]. 115, pp. 1165-1170 [viewed 10/10/2018]. Available from: https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1471-0528.2008.01803.x
National Vulvodynia Association. (2016). Vulvodynia: A Self-Help Guide. [online] National Vulvodynia Association, 2016. [viewed 17/05/18]. Available from: http://www.isswsh.org/images/PDF/NVA.Self-help.guide.pdf
NHS Trust. (2016a). Pudendal neuralgia. [online] National Health Service Trust, 2016. [viewed 17/05/18]. Available from: https://www.nhs.uk/conditions/pudendal-neuralgia/
NHS Trust. (2016b). Vulvodynia (vulval pain). [online] National Health Service Trust, 2016. [viewed 10/05/18]. Available from: https://www.nhs.uk/conditions/vulvodynia/
Powell, J. Wojnarowska, F. (1999). Journal of the Royal Society of Medicine. Acupuncture for vulvodynia. [online] 92(11), PMC1297434. [viewed 10/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297434/pdf/jrsocmed00003-0037.pdf