Vulval and vaginal pain

There are 2 main types of vulvodynia:

• Generalised vulvodynia – pain occurs all over the vulva at different times. It can be constant or happen every now and then.
• Localised vulvodynia – pain occurs in specific areas of the vulva and often involves a burning or stinging sensation. You may experience clitoris pain (clitorodynia) or pain around your vaginal and urinary openings (vestibulodynia).

Some women experience both types of vulvodynia.

Vulvodynia pain can be caused by pressure or touch (provoked), or it can happen for no reason (unprovoked).

The most common symptom of vulvodynia is a painful, raw or burning sensation. Some women describe the pain as stinging, tearing, stabbing, throbbing or itching.

Most sexually active women who have vulvodynia report that sex is painful or impossible.

We don’t know what causes different types of vulvodynia. Some studies suggest vulvodynia is associated with:

• chronic thrush
• injury or tissue damage (e.g. childbirth, laser treatment, surgery)
• skin conditions (e.g. allergic reactions to soaps and scented toiletry products).

Vulvodynia is usually diagnosed after ruling out other conditions.

Your doctor will ask about your symptoms and your medical, sexual and surgical history. They will do a pelvic examination to look for infection or other reasons for the pain.

Your doctor may also:

• check where the pain is coming from by using a moistened cotton swab to gently apply pressure to different parts of your vulva
• check your pelvic floor muscles to see if they are tight, contracted and painful to touch
• take samples for testing if you have vaginal discharge or urinary symptoms.

Vulvodynia can have a big impact on your life. It can stop you from doing day-to-day activities and reduce your sex drive.

Fear of sex can also cause spasms in and around your pelvic floor muscles (vaginismus).

With vulvodynia, you might experience:

• anxiety
• depression
• sleep problems
• sexual problems, including painful sex
• relationship issues
• body image issues.

Treatments for vulvodynia aim to reduce pain and improve quality of life.

In about 40% of women, vulvodynia will get better on its own.

Depending on your symptoms, your doctor may recommend different treatment options. For example:

• pelvic floor physiotherapy – techniques to relax your pelvic floor muscles and manage symptoms
• medicine – oral prescription medicines, certain antidepressants, medicines for nerve pain, hormone or anaesthetic creams and nerve-block injections (if other treatments haven’t worked)
• psychology – counselling to help with relationship, intimacy and self-esteem issues
• surgery – removal of some skin and tissue inside the inner lips (labia) to reduce pain (if other treatments haven’t worked).

It may take some time to find the best treatment for you.

It’s important to take extra care of your vulva and vagina when managing this condition.

Learn more about vulval care

If you have vulval pain, it’s important to see your doctor and ask them to examine you.

Not all cases of vulval pain are due to vulvodynia – your symptoms might be caused by something that can easily be treated.

Your doctor may refer you to other specialists, for example:

• a gynaecologist
• a dermatologist
• a pelvic floor physiotherapist
• a psychologist
• a pain specialist
• a sexual health physician
• a sex therapist.

If you are diagnosed with vulvodynia, your doctor or specialist will discuss ways to reduce symptoms so you can start feeling better.

Symptoms of vulval and vaginal splits vary depending on the severity of the injury. They may include:

• itching or burning sensations
• stinging pain when weeing
• discomfort with any type of penetration
• spotting or bleeding.

Vulval and vaginal splits may be caused by:

• sex, for example, rough or strong thrusting into the vagina
• drier, thinner and less elastic vaginal tissue (common after menopause and childbirth)
• skin conditions such as lichen sclerosus, lichen planus, psoriasis and eczema
• scarring or tissue damage after surgery
• hair removal, for example, waxing or shaving pubic hair
• childbirth.

Minor splitting

Most minor splits heal by themselves, but there are ways to reduce discomfort. For example:

• use over-the-counter painkillers
• soak in a warm bath with salt or bicarb of soda (avoid scented soaps)
• gently wash and pat dry the area once or twice a day
• gently wipe your vulva from front to back after going to the toilet
• avoid having sex until the split has healed
• wear cotton or bamboo underwear and loose-fitting clothes.

Severe splitting

See your doctor if:

• any minor splits don’t heal on their own
• the symptoms get worse
• you have a fever
• you notice a smelly or discoloured discharge.

The most common symptom is pain when sitting, which gets worse the longer you sit.

Some women describe the pain as burning, shooting, aching, itching or like an electric shock. You can feel pain in your:

• clitoris
• labia
• vagina
• urethra (where wee comes out)
• anus
• rectum
• buttocks
• thighs
• feet.

You might also:

• have bladder or bowel irritation
• feel the need to go to the toilet often
• find it hard to start weeing
• feel like you have a bladder infection
• feel an urgent need to poo
• feel numbness or ‘pins-and-needles’ in your pelvic area, including your vulva
• feel swelling in the area between your vagina and anus (perineum)
• experience painful sex and find it hard to reach orgasm
• notice the pain is worse after certain types of exercise.

Pudendal neuralgia may be caused by one or more factors, including:

• repeated minor damage from sitting, cycling or horse riding for long periods of time
• repetitive heavy lifting and excessive exercise
• straining when trying to poo due to chronic constipation
• nerve, muscle or soft tissue trauma due to childbirth.trauma from a fall or broken bone in your pelvis or lower spine
• nerve damage from surgery, for example, in your pelvic or perineal areas
• lesions or growths (cancerous or benign) that press on your pudendal nerve
• nerve damage associated with diabetes and other blood vessel conditions
• overactive pelvic floor muscles that press on your pudendal nerve
• persistent pelvic pain, even if the pain isn’t associated with physical injury.

Your doctor will ask about your medical history, your symptoms and where the pain is located. If they suspect pudendal nerve entrapment, they might do other tests. For example:

• a vaginal or rectal examination to see if pressure on your pudendal nerve causes pain or other symptoms
• an MRI scan, ultrasound or CT scan of joints, ligaments and muscles of your pelvis to check for physical abnormalities, tumours around the nerve or other problems
• a nerve study to see how nearby nerves respond to mild electrical impulses
• a pudendal nerve block to see if symptoms go away when the nerve is numbed with anaesthetic.

Pudendal neuralgia can cause ongoing pain and discomfort and interfere with daily activities. It can also lead to:

• high levels of stress
• anxiety
• depression
• sexual problems, including painful sex
• problems related to weeing and pooing.

Your medical team will help you learn to manage and understand your pain, including what makes the pain better and worse.

Your doctor may recommend different treatments, such as:

• pelvic floor physiotherapy – techniques to relax and stretch your pelvic floor muscles
• medicines and nerve creams – to help to reduce the sensitivity of your central nervous system
• surgery – to remove lesions or growths, or to insert implants that help relieve pressure on the nerve and reduce the pain
• psychology – to help with mental health issues associated with persistent pain.

You can avoid activities such as:

• cycling
• horse riding
• prolonged sitting
• straining when weeing or pooing – see your doctor if constipation persists.

If you notice pelvic and vulval pain of any kind, it’s important to see your doctor. Early treatment of this condition can lead to good outcomes.