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Vulvodynia & vestibulodynia

Vulvodynia is a complex pain syndrome of the vulva. It’s characterised by unexplained chronic pain or discomfort in the vulva, which lasts at least three months. It is diagnosed when all other conditions have been excluded. Vulvodynia includes vestibulodynia and clitorodynia.

Vulvodynia can be so painful that women find activities that apply pressure to the vulva such as having sex, wiping the vulva with toilet paper or sitting for prolonged periods of time, unbearable. Lying down is often the most comfortable position. Fortunately, treatments are available to reduce symptoms.

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What is vulvodynia?

Vulvodynia (pronounced vul-vo-din-ia) is a chronic condition that involves pain, burning or discomfort in the vulva, that can’t be attributed to any specific cause, and that lasts for at least three months.

It can affect women of all ages, although vulvodynia generally occurs between the ages of mid 20s to 60s. It’s estimated that around 15% of women will experience the condition in their lifetime.

Types of vulvodynia

Vulvodynia affects the external female genital organs which include the labia, clitoris and vaginal opening. There are two main types:

  1. Generalised vulvodynia — Pain can occur all over the vestibule at different times. Pain can be constant or happen every now and then.
  2. Localised vulvodynia — Pain occurs in specific areas of the vulva and often involves a burning or stinging sensation. Examples of localised vulvodynia include clitorodynia (pain in the clitoris) and vestibulodynia (pain inside the inner lips of the vulva). Sometimes localised vulvodynia can extend outside the vulva.
Vulva diagram1 RGB

Some women may experience a combination of generalised and localised vulvodynia. This is also referred to as mixed vulvodynia.

Vulvodynia pain can be:

  • Provoked — caused by pressure or touch
  • Spontaneous (previously called ‘unprovoked’) — where pain occurs without any type of touch or pressure

What is vestibulodynia?

Vestibulodynia (pronounced vestib-u-lo-din-ia) is the most common form of localised vulvodynia. This is where pain occurs around the opening of the vagina and the opening of the urethra inside the inner lips of the vulva (the area also known as the vestibule). Those who have vestibulodynia usually experience pain that is provoked. Onset for vestibulodynia seems to occur in younger age groups.

What causes vulvodynia and vestibulodynia?

Unfortunately, there is no known cause of vulvodynia and vestibulodynia, but it’s not caused by an active infection or sexually transmitted infection (STI). While more research into the condition is required, some studies suggest that one or more of the following factors may contribute:

  • chronic yeast infections (eg thrush or candida)
  • injury or tissue damage from childbirth, laser treatment or surgery and sexual abuse
  • skin conditions, particularly allergic reactions to detergents, soaps, douches, scented toilet products and sanitary products

Symptoms of vulvodynia

The most common symptom is a painful, raw or burning or stinging sensation. Some women describe it as a ‘knife-like’ pain or as if acid is being poured on their skin. Pain may be constant or it may come and go, or only occur with pressure or contact. Other symptoms may include throbbing, itching or rawness. Most sexually active women will report that sex is painful or impossible.

However, women also describe the pain as stinging, tearing, stabbing or itchy. Symptoms also include:

  • pain with pressure or touch to the vestibule, such as:
    • having sex
    • inserting a tampon
    • a pelvic exam
    • sitting for prolonged periods of time
    • wearing tight pants
    • during exercise such as bike riding or walking
  • pain that comes and goes
  • pain that only occurs in the vestibule or lower region of the vagina
  • pain on urination, in some women

Your vulva may appear slightly inflamed or swollen, however mostly it appears normal.

How is vulvodynia diagnosed?

Female gp advice vulvodynia

There is no specific test to determine whether you have vulvodynia. Diagnosis involves ruling out other causes.

Your doctor will ask about your medical, sexual and surgical history and about the kind of symptoms you have. Your doctor may also perform a pelvic examination to look for infection or other causes of your symptoms. They may also take a sample of cells from your vagina or vulva to test for bacterial or yeast infections. Your doctor might also check your pelvic floor muscles to make sure they are not tight, contracted and painful to touch.

Part of the examination may also involve a cotton swab test (Q tip test) where the doctor uses a moistened cotton swab to apply gentle pressure to various areas of your vulva to check for localised pain in that area.

Treating and managing vulvodynia and vestibulodynia

In about 40% of women, vulvodynia will spontaneously resolve .

Treatment and management of vulvodynia aims to reduce pain and improve quality of life and sexual function. Treatment may involve a multi-disciplinary team including a vulval specialist, pelvic floor physiotherapist, psychologist and your doctor. It may take some time to determine what works for you.

Physical treatments

  • Pelvic floor physiotherapy is often recommended as pelvic floor muscles are often overactive and tight, making them painful to touch in women with vulvodynia
    • Biofeedback or pelvic floor relaxation therapy to help you learn to relax your pelvic floor and control how you respond to symptoms

Medical treatments

  • Oral prescription medications
    • Certain antidepressants (tricyclic and SNRIs) have been shown to reduce chronic pain and itching
    • Medications used for epilepsy/convulsions and nerve pain ( Gabapentin or Pregabalin) are effective in the treatment of chronic pain conditions
  • Topical medications such as hormone creams (eg oestrogen or testosterone), or anaesthetic creams (eg lignocaine)
  • Local nerve block injections may be required for some women who don’t respond to any other treatments

Psychological treatments

Counselling can help you with affected relationships, intimacy and self-esteem issues, as well as sleep problems. Poor sleep tends to increase pain and reduces coping skills.

Surgical treatment

Surgery to remove the affected skin and tissue is sometimes recommended for women with very localised vestibular pain, but this option is a little controversial. In a small number of women, surgery was successful. However, this treatment is usually a last resort and only considered when all other treatments have failed.

Vulval hygiene

Practicing good vulval hygiene can also help reduce vulval irritation and symptoms of vulvodynia. It’s recommended you:

  • Avoid washing your vulva with soap or perfumed bath products – only use water or soap-free washes
  • Don’t use douches because it disrupts the normal vaginal microbiome, which can cause irritation
  • Never use talcum powder on your vulva nor baby wipes
  • Use a barrier ointment if swimming irritates your vulva
  • Change out of swimwear immediately after swimming and shower to remove chlorine or salt. Don’t wear wet clothing
  • After gym, change out of lycra clothes immediately
  • Wear natural fibre underpants (eg cotton) rather than synthetic (eg polyester or nylon)
  • Wash underwear using unscented or hypoallergenic products, and rinse well
  • Wear comfortable clothing. Avoid G-strings, pantyhose and tight jeans
  • When urinating, lean forward to avoid a burning sensation
  • After urination and/or bowel movements, always wipe or pat from front to back, using unscented toilet paper
  • For irritation :
    • Bathe with a salt or bicarbonate of soda wash
    • Use a cold pack covered
    • Use a spray bottle with salt to wash your vulva after each time you go to the toilet
  • Use 100% cotton sanitary pads and tampons. Menstrual blood may irritate your vulva, so consider using tampons or a menstrual cup instead of pads
  • Use silicone or water-based lubricants with intercourse. Good quality, natural oils such as olive or almond oil may be suitable too, but don’t use oils with condoms as they will make them break down

For more information on vulval care go here.

Resource The Vulva Booklet

The vulva: irritation, diagnosis & treatment

You might like to read our booklet.

Risks and complications

Vulvodynia can severely impact your life and prevent you from engaging in normal day-to-day activities. It can also prevent you from wanting sex or make you fearful of sex. Fear of sex can also cause spasms in the pelvic floor muscles around your vagina (vaginismus). Other consequences of vulvodynia include:

  • anxiety
  • depression
  • relationship issues
  • sleep problems
  • sexual dysfunction
  • negative body image
  • reduced quality of life

What you can do

If you have pain in your vulva it’s important to speak to your doctor. Not all cases of vulva pain are due to vulvodynia, and your symptoms might be caused by something that is easily treated.

If you are diagnosed with vulvodynia or vestibulodynia, treatments can help you manage and reduce your symptoms, so you can start feeling better.

Remember, if you experience any unusual or new symptoms related to your vagina or vulva, see your doctor and ask them to examine you.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2021.

References

  • 1
    Jacob Bornstein MD, MPA, Andrew Goldstein MD, and Deborah Coady MD for the consensus vulvar pain terminology committee, 2015 Consensus terminology and classification of persistent vulvar pain, From the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women's Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS).
  • 2
    Harlow, B.L., Stewart, E.G., A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia?, JAMWA, 58 (2003) 82-8.
  • 3
    Henzell, H., Berzins, K. Localised provoked vestibulodynia (vulvodynia): assessment and management, Australian Family Physician, Vol 44, No. 7, 2015, pp460-466
  • 4
    Henzell H, Berzins K, Langford JP. Provoked vestibulodynia: current perspectives. Int J Womens Health. 2017;9:631-642. Published 2017 Sep 11. doi:10.2147/IJWH.S113416
  • 5
    Pagano R, Wong S. Use of amitriptyline cream in the management of entry dyspareunia due to provoked vestibulodynia. J Low Genit Tract Dis. 2012 Oct;16(4):394-7. doi: 10.1097/LGT.0b013e3182449bd6. PMID: 22622338.
  • 6
    Peterson CD, Giraldi A, Lundvall L, Kristensen F. Botulinum toxin type A – a novel treatment for provoked vestibulodynia? Results of a randomised, placebo controlled, double-blind study. J Sex Med 2009; 6:2523–37
  • 7
    Segal D, Tifheret H, Lazer S. Submucous infiltration of betamethasone and lidocaine in treatment of vulvar vestibulitis. Eur J Obst Gynecol Reprod Biol 2003; 107:105–06.
  • 8
    Frank F. Tu, MD, MPH; Kevin M. Hellman, PhD; Miroslav M. Backonja, MD. Gynecologic management of neuropathic pain. Am.JOG 2011;435-443.
  • 9
    Guidelines BSSVD
Last updated: 05 August 2021 | Last reviewed: 14 May 2021

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