Vaginal pain or lower pelvic pain could have a physical source, such as endometriosis, or an emotional source, such as the after-effects of rape. Find out what could be the source of your pain.
Vulvodynia is persistent pain of the vulva. The vulva is the area around the opening of the vagina. It includes the opening of the vagina, the pubic mound, the inner and outer labia (vaginal lips), and the clitoris.
The term typically is used to describe chronic pain of the vulva that lasts for at least three months and has no identifiable cause (such as a cut or infection).
Signs and Symptoms
Vulvar pain can feel different to different people. Signs and symptoms of vulvodynia may include: burning or stinging pain, stabbing or throbbing pain, vulvar or vaginal itching, soreness or rawness (feeling like something rough is rubbing on the area), painful intercourse, painful tampon insertion. Some women have pain in a specific area of the vulva, such as the clitoris or the vaginal opening. Others experience pain all over the vulva.
Symptoms may be constant, or they may come and go, such as when the area is touched, during exercise, or after urinating.
Causes and risk factors
It’s not clear what causes vulvodynia. Researchers think that one or more of the following may cause or contribute to vulvodynia:
- Damage to or irritation of the nerves that transmit pain signals from the vulva to the brain.
- Having a greater than usual number of pain-sensing nerve fibers in the vulva
- Chronic inflammation of the vulva
- Genetics (some people may be prone to chronic vulvar pain)
- Hypersensitivity to yeast or other infection-causing organisms in the vagina
- Pelvic floor spasms or weakness
- Conditions that could affect pelvic muscles and bones
- Alterations to the normal, healthy bacteria on the skin and vagina called the vaginal microbiome.
How is it diagnosed?
Your gynecologist or other healthcare provider will ask you questions about your symptoms and carefully examine the vulva and vagina. Your doctor may try to rule out common causes of vulvar pain, such as infection, by checking a sample of vaginal fluid or discharge. Your gynecologist may apply gentle pressure to different parts of the vulva with a cotton swab and ask you to rate the severity of your pain. He or she may also take a small sample of tissue from the vulvar skin to look at under a microscope. This is called a biopsy.
Prognosis
Vulvodynia is a complex condition. No single treatment works for everyone. You may need to try multiple treatments before finding one — or a combination — that helps to alleviate pain. It may take a few months before you start to experience relief.
Duration
By definition, vulvodynia is chronic pain of the vulva that lasts for three months or longer. The pain may be constant for some women. For others, it may come
and go.
Treatment Options
No one treatment works for everyone. If you are experiencing vulvar pain, talk to your doctor about what treatments might work best for you. Your provider may refer you to a pain specialist. A pain specialist may use a technique called biofeedback, which relieves pain with electrical stimulation. Physical therapy or pelvic floor therapy to help address pelvic floor dysfunction may help to relieve vulvodynia in some women. Surgery may be an option for people with some types of vulvar pain. During the surgery, your doctor will remove tissue from the painful area of the vulva. Surgery isn’t recommended for most people with vulvodynia.
Medication Options
Potential medications may include:
- Topical numbing ointments, such aslidocaine, which appear to have a short-term benefit, according to the results of a randomized controlled trial from 2010
- Hormonal creams, such such as estrogen or testosterone
- Oral medications to help block pain signals to the brain, includingtricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and certain anticonvulsants
- Injectable nerve blocks with steroids or anesthetics
Lifestyle, Alternative, and Complementary Therapies
There are a number of steps you can take at home to help ease vaginal or vulvar pain. If you have vulvodynia, avoiding products that may be irritating to the area may help to reduce or relieve symptoms.
- Avoid tight-fitting underwear, pantyhose, and pants
- Wear 100 percent cotton underwear
- Do not wear underwear while sleeping
- Don’t douche
- Clean the vulva with water only (avoid vaginal wipes, deodorants, bubble baths, and scented soaps)
- Use lubrication during sex (but avoid lubricants with flavor or those that produce a warming/cooling sensation)
- Avoid scented pads or tampons
- Avoid exercises or activities that put pressure directly on the vulva, such as bicycling and horseback riding
- Take 5- to 10-minutesitz baths in warm water, then moisturize the area with a thin layer of petroleum jelly
In addition to home remedies, some studies suggest that low-risk modalities such as yoga and acupuncture may be helpful in reducing pain from vulvodynia. Some practitioners recommend dietary reduction or elimination of certain foods that contain oxalates or linoleic acid.
Complications
There are few medical complications associated with vulvodynia. But vulvar or vaginal pain can take its toll emotionally or psychologically. Some women with vulvodynia may benefit from psychological treatments that teach relaxation or techniques for coping with pain. Sex therapy may also help individuals or couples who are experiencing painful intercourse due to vulvodynia.
Who Has Vulvodynia?
As many as 16% percent of women may experience vulvodynia in their lifetime. The condition can occur in women of all ages, but it is most commonly reported in women between the ages of 18 and 25.
Related Conditions and Causes of Vulvodynia
Vaginal Dryness This happens when the tissues of the vagina are not well lubricated. Any woman can get vaginal dryness, but it’s most common in older women. Potential causes include:
- Lowestrogen (caused by menopause, perimenopause, and other factors)
- Douching, scented products, and other irritants
- Certain medications, including antihistamines andantidepressants
Vaginal Pain During Pregnancy
Many women complain of vaginal or vulvar pain during pregnancy. Causes of vaginal or vulvar pain during pregnancy include:
- Vaginal yeast infections
- Varicose (enlarged) veins in the vulva
- Increased pressure on the pudendal nerve (the main nerve that runs between the genitals and the
anus)
