Condition Center: Vulvodynia

This informational guide, part of POPSUGAR’s Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Any type of discomfort in your nether regions is uncomfortable, but if you have generalized, prolonged pain around your vagina, you may be experiencing vulvodynia.

Vulvodynia is the medical term used to describe chronic, recurrent pain in the vulva, or the area of skin just outside and around the vagina, that has no known cause, says Kyle Graham, MD, a board-certified ob-gyn at Pediatrix Medical Group in San Jose, CA. “This means that there may be pain in the vulva, but it’s not because of an infection, rash, trauma, pinched nerve, or any lesion,” he explains. “It is pain with no obvious etiology.”

Vulvodynia is chronic and by definition lasts at least three months, Dr. Graham says. The pain can be constant, but you may not experience it daily, as it can sometimes only be related to touch (e.g. during sex, putting in a tampon, or during a pelvic exam), he explains.

Unfortunately, vulvodynia is not necessarily preventable, since there are so many potential causes (more on that soon), but there are various treatments to minimize symptoms and reduce pain, says Sameena Rahman, MD, an ob-gyn at Center For Gynecology and Cosmetics. Here’s everything you need to know about vulvodynia, including its potential causes and most effective treatments.

Understanding Vulvodynia

Vulvodynia is generalized, long-term pain or discomfort around the vulva, says Dr. Rahman. It’s usually localized to a specific area and causes a burning, itching, or stabbing sensation, she explains. The pain is also common during sex, while inserting a menstrual product like a tampon, or during a routine pelvic exam, adds Dr. Graham. “Any contact or touch of the genital region, no matter how gentle or slight, can elicit pain.”

The condition mostly occurs in women before menopause, though it can affect people of all ages, Dr. Graham explains. Research finds vulvodynia occurs in all races, religions, and ethnic backgrounds, and 16 percent of women suffer from vulvodynia at some point, with the highest incidence between ages 18 and 25, Dr. Rahman adds.

You can technically have sex with vulvodynia, but it’s usually too painful, especially at initial entry or with deep penetration, says Dr. Rahman. As a result, the pain can lead to a lack of desire, which makes sex even more difficult, she adds.

In terms of getting diagnosed, your doctor will first conduct a thorough medical history to discuss when the pain started, how you prefer to have sex, whether you’ve used a tampon before, if you use birth control, and where you are on your menstrual cycle, Dr. Rahman says. “Vulvodynia is a descriptive term, but the diagnosis comes from a true investigation,” she explains.

From there, your provider will typically perform a cotton-swab pressure-point test, where they use a small cotton-swab tip to apply pressure to various areas around the vulva and ask where your pain is located, Dr. Graham says. They will also do an internal exam of the vagina, uterus, ovaries, bladder, and pelvic muscles to look for signs of pain. This is done by gently placing one or two fingers inside the vagina with one hand while pressing down on the lower abdomen with the other and using a speculum to examine the walls of the vagina and cervix. Your doctor will also look at your back and spine for potential injuries and examine the vulva for subtle skin changes, Dr. Rahman explains.

Causes of Vulvodynia

There is not one known cause of vulvodynia, Dr. Graham says. By definition, the cause of pain is not identifiable, however it’s partially related to the immune system and nervous system, since there can be over-sensitized nerves and an excessive amount of nerve endings in the vulvar area, he explains. An injury to the back can also cause vulvodynia pain if nerves transmit their signal from the spinal cord to the vulva, Dr. Rahman adds.

Vulvodynia can also be hormonal and related to a hormone deficiency such as chronic birth control use, menopause, perimenopause, postpartum, and/or if you’re breastfeeding, Dr. Rahman says.

Additionally, vulvodynia can be caused by chronic inflammation from vaginal infections, disease, or skin conditions such as lichen planus, pelvic floor dysfunction, and genetics, Dr. Rahman adds.

The Most Effective Vulvodynia Treatments

There are various medications for vulvodynia, but topical creams like lidocaine are usually the first-line treatment, Dr. Graham says. Estrogen creams such as estradiol or Premarin are also a treatment starting point, while oral medications such as gabapentin, venlafaxine, and nortriptyline also have success in reducing symptoms, he explains. Botox injections and nerve blocks may also be recommended to help minimize pain, adds Dr. Rahman.

Pelvic floor physical therapy is almost always another part of treatment, Dr. Rahman says. “Due to the pain of the vulva, many patients clench or guard the muscles of the pelvic floor, and this causes the tone of the pelvis to increase, and ultimately the muscles become weak,” she explains. Your doctor may discuss specific pelvic floor exercises or refer you to a pelvic floor specialist.

Lastly, cognitive behavioral therapy with a licensed therapist can help tremendously, as anxiety and depression often accompany vulvodynia, Dr. Rahman says. “Treatment is a multidisciplinary approach.”

Ultimately, vulvodynia can be difficult to diagnose and finding a successful treatment may be trial and error before finding an option that works for you. That said, it’s important to see a doctor anytime you are bothered by your vulvar pain, especially if it’s lasted for prolonged periods of three to six months, Dr. Rahman says. “Awareness and education are key, and finding someone who listens to you is paramount.”