Have you noticed pain in or around your vulva after sex? Or does exercising or wearing certain types of clothing trigger discomfort down there? While this can be frustrating, the majority of the time, we can pinpoint the things that trigger pain and try to avoid them. However, when vulva pain is persistent for more than three months and has no apparent cause, it’s called vulvodynia.
Changes in your intimate health can be really scary. However, you need not worry. You’re not alone, and your medical provider should be able to provide you with support and advice to start identifying your pain.
Here, an OB-GYN explains what vulvodynia is, how you might be able to spot it, and why so little is known about the condition that impacts the lives of so many people.
Vulvodynia is defined by the American College of Obstetrics and Gynecology (ACOG) as vulva pain that lasts three months or longer and is not caused by an infection, skin disorder, or another medical issue.
“This is in comparison to ‘vulvar pain caused by a specific disorder,’ such as infections, inflammatory conditions, or trauma,” explains obstetrician-gynecologist Dr. Jenna Beckham.
The vulva is the name given to describe the genital area including the skin surrounding the opening of the vagina. It’s very common to feel pain in your intimate area from time to time, but if that vulva pain is persistent and unexplained, then you should reach out to your health care provider for some tests.
Research has highlighted that as many as 16% of women in the United States will have vulvodynia at some point in their lives. It can occur at any age, but studies have found that women between the ages of 20 and 40 years old are most likely to experience it.
Trying to describe your pain when you can’t identify what’s causing it can be exhausting. Chloe, now 27 years old, started to become acutely aware of a painful, sometimes burning sensation around her vulva — specifically at the entrance of her vagina, in her early twenties.
“It’s usually triggered by touch, and day to day, I generally don’t feel it,” she says. “There are some days, though, where I can feel it burning, or I get a sharp stabbing pain in the area.”
Explaining what you’re experiencing to your doctor can prove tricky — and diagnosis isn’t always straightforward. In fact, one study of 2,252 US women found that vulvodynia was prevalent for 8.3% of participants. Of those, only 1.4% had actually been diagnosed with vulvodynia.
So what helps? Dr. Beckham suggests thinking about the following and then discussing your answers with your health care professional:
- Location: This describes where the pain is. Your health care provider may ask if it is generalized (pain that can be felt anywhere in the genitals, including the vulva and around the anus). Alternatively, you might notice that your pain is localized to one specific area, such as the clitoris or entrance to the vagina. Your medical professional may ask you questions about where you experience pain and if the location changes.
- Provocation: Your medical professional may ask you questions about when your pain starts. Have you noticed that it’s provoked or triggered by something? It may be spontaneous, or you may experience a mix of both.
- Onset: This refers to whether the symptoms have always been present or started after trauma or the first time you had sex (primary), or if they appeared later in life (secondary). If it developed later in life, then your medical professional may ask you about anything that could have triggered it at that time.
- Temporal pattern: It may also be helpful to establish if your pain is persistent and constant. You might experience it intermittently. It may start as a dull pain but get worse or be immediate.
Remember: advocating for yourself in a medical setting can be emotionally taxing, so having a support network who can go to appointments with you is crucial.
Once you’ve reached out to your health care provider they might take an extensive medical history. Your past medical, surgical, sexual, and mental health history could play a fundamental role in getting a vulvodynia diagnosis. And the good news is that research into the condition is on the rise, especially in helping patients manage their symptoms.
Dr. Beckham explains that the main symptom of vulvodynia is a pain in the vulva “that occurs upon contact with the vulvar vestibule (the area between the labia minora and the opening of the vagina and urethra).”
The sensation is most often described as a burning pain but can also feel like a stabbing, stinging, or raw sensation. Aching, soreness, throbbing, and swelling are also common.
By definition, the cause of vulvodynia is unknown.
Dr. Beckham says “it’s likely multifactorial,” which means there’s probably more than one reason for it. She adds: “There is a hypothesis that there is an inciting event, like an infection or trauma, that results in an inflammatory response, which then results in increased development of nerve fibers in the area coupled with lowered pain thresholds.”
Health care professionals have highlighted that past irritation or injury to the nerves in your vulva, infections, allergies, or hormonal changes could lead to the onset of vulvodynia. A genetic predisposition or changes in the pelvic floor muscles over time can also contribute. However, research into this is limited, and symptoms can stop and start without any trigger.
Vulvodynia can often be triggered by touch, such as during sexual intercourse, inserting a tampon, sports like riding a bicycle, wearing tight clothing, or sitting for long periods of time. It can also be triggered by psychological factors, including trauma or stress.
Though research is limited, one study found that women who were diagnosed with an anxiety disorder have a higher risk of developing vulvodynia. The link between vulvodynia and mental health works both ways as the study also found that vulvodynia can trigger anxiety in sufferers. Further research found that people with vulvodynia are more likely to experience depression and anxiety.
It can be easy to ignore small instances of pain, but Dr. Beckham says that “Individuals should feel empowered to speak to a health care professional about vulva pain anytime it occurs.”
If the pain you’re experiencing starts to interfere with your personal life, such as having sex or using tampons, you should reach out to your medical provider to be examined.
“Individuals should also seek medical attention if there are other signs or symptoms such as infection, inflammation, or a skin condition like [unusual] discharge or skin lesions,” she adds.
In order to diagnose vulvodynia, your health care provider will examine the vulva and vagina in order to write off any causes, such as infections or skin conditions. This can be done either by a visual examination or a swab to check for infections. They might also examine your pelvic floor muscles and ask you about any factors that could be triggering symptoms such as sleep quality, stress, or any issues around sex.
Another common method is the cotton swab test, in which gentle pressure is applied to various vulva sites and you’re asked to rate the severity of the pain. If any areas of pain don’t seem quite right, your doctor may examine them further or take a biopsy of the area.
If you’re nervous about speaking to your medical professional about the pain you’re experiencing, you could consider bringing someone you trust to your appointment with you to act as an advocate for you. They may help you remember any information your health care provider gives you and ask any questions. If at any point during the examination it becomes too painful, then you’re well within your right to ask your doctor to pause or stop.
Once vulvodynia has been diagnosed, there are a variety of treatments that can be used to help relieve the pain. “The [exact] treatment used will depend on the specific features of an individual’s condition,” says Dr. Beckham.
- Managing pain at home by avoiding exercises that put pressure on the vulva, like cycling or horseback riding. You should also steer clear of possible irritants like deodorants or bubble baths, avoid tight-fitting clothing, and apply cooling substances (like an ice gel pack) to the vulva.
- Soaking or sitz baths using oatmeal or Epsom salts several times a day for 5 to 10 minutes.
- Using lubricants during sex, although it’s important to be careful to avoid any substances that contain alcohol or warming agents. Instead, choose water-based lubricants, coconut oil, or aloe vera.
- Pelvic floor physical therapy is offered to people whose pelvic floor muscles impact their vulvodynia. Treatments include exercise, education, and manual therapies, such as massage, soft-tissue work, and joint mobilization. Some people use vaginal dilators, which stretch the vaginal opening and canal, increasing blood flow to the nerves.
- Psychological treatments such as cognitive-behavioral therapy (CBT) or couples/sex therapy can be offered to people who find their mental health has been impacted by their condition. This can also be used in cases where vulvodynia is triggered by trauma, stress, or anxiety.
- Medications, like topical lidocaine– a local anesthetic that can provide temporary relief when applied to the painful area. Antihistamines can help soothe itching in the area. Antidepressants or other neuropathic pain agents such as gabapentin can be taken orally or as a cream and are known to help treat chronic pain. Nerve block injections might be offered for pain that doesn’t respond to other treatments.
Vulvodynia is a complex pain disorder characterized by discomfort in the vulva that is present for at least three months. For some, it may present as a raw or itching sensation, while others may describe it as burning or stinging.
Intimate pain can be really frustrating and interrupt your day-to-day life. However, if pain stops you from being sexually intimate, exercising, or using sanitary products like tampons, then you should reach out to your health care provider. They will examine you and work with you to ease your symptoms.
Organizations such as the National Vulvodynia Association are helping to fund more research on vulvodynia. This will hopefully mean that in years to come, there will be an increased understanding of the condition and even more treatment options available.
Written by Ella Glover