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Vulvar Pain: Practical Explanations for Pain and Itching in the Vulvar Area

Vulvar pain can be caused by several different factors, from infections to sex injuries and hormonal therapy. Flo explains some possible causes of vulvar pain and itching and ways to ease it.

The external female genital area is referred to as the vulva. Constant pain in the vulvar area is a complex problem that can be frustrating and difficult to diagnose. The cause of vulvar pain may be idiopathic (from an unknown cause) or due to certain disorders.

According to the classification and terminology of vulvar pain adopted by the International Society for the Study of Women’s Sexual Health, International Pelvic Pain Society, and International Society for the Study of Vulvovaginal Disease, there are different types of vulvar pain:

1. Vulvar pain that occurs from specific causes

  • Inflammation (e.g., lichen planus, lichen sclerosus, and immunobullous disorders)
  • Infection (e.g., herpes and recurrent candidiasis)
  • Abnormal tissue growth (e.g., squamous cell carcinoma and Paget’s disease)
  • Nervous system disorders (e.g., neuroma, nerve injury, and postherpetic neuralgia)
  • Traumatic injury (e.g., trauma during delivery and genital cutting)
  • As a result of medical care or treatment (e.g., postoperative, radiation, and chemotherapy)
  • As a result of hormonal deficiencies (e.g., lactational amenorrhea, genitourinary syndrome of menopause, and vulvovaginal atrophy)

2. Vulvodynia — pain in the vulvar area for at least three months without any distinct, identifiable cause.

Sexually transmitted infections such as gonorrhea, genital herpes, trichomoniasis, and chlamydia, as well as other infections such as yeast infections, can also result in vulvar pain and itching along with a burning sensation.

The fungus candida is responsible for vaginal yeast infections, also called vaginal candidiasis. Candida is normally present in your vagina, but when the balance of the yeast is disturbed, it can grow rapidly and result in an infection.

Some skin conditions that can affect the vulva and cause vulvar pain and itching include the following:

  • Folliculitis appears as red, small, and painful bumps on the vulva. It occurs due to infection of a hair follicle by bacteria and can happen as a result of waxing, shaving, or friction from clothing.
  • Contact dermatitis occurs when the vulvar skin is irritated by things, including perfumes, fabrics, or soaps. Symptoms can include vulvar pain, intense itching, burning, stinging, and rawness.
  • The Bartholin glands are on either side of the vaginal opening beneath the skin. If these glands are blocked, it can result in the formation of a cyst that looks like a swollen bump close to the vaginal opening. If this cyst gets infected, it can form an abscess that can cause vulvar pain.
  • In lichen simplex chronicus, thickened and scaly plaques can appear on the skin of the vulva. These plaques can be so itchy that they interfere with your sleep.
  • Lichen sclerosus is a disorder of the skin that can cause burning, itching, skin tearing, and pain during sex. The skin of the vulva may look white, thin, and crinkled.
  • Lichen planus is an autoimmune disorder of the skin that commonly affects the mucous membranes in the mouth. It can also affect the genital skin, occasionally causing vulvar pain and itching, abnormal discharge, and burning.
  • Genitourinary syndrome of menopause (GSM) or vulvovaginal atrophy can occur when sex hormones, including estrogen, are reduced. This usually happens during menopause and perimenopause. Some of the symptoms are vaginal dryness, bladder problems, vulvar pain and itching, burning, and recurrent urinary tract infections. You may also experience pain during sex.
  • In vulvar intraepithelial neoplasia (VIN), abnormal cells that aren’t yet cancerous are present in the vulva. Human papillomavirus (HPV) is often the cause of VIN.
  • An HPV infection can also cause vulvar cancer. There are other types of cancer that can affect your vulva, including Paget’s disease and skin cancer (melanoma). Paget’s disease in the vulva may indicate the presence of cancer in another region of the body, including the colon and breast. Symptoms of vulvar cancer include vulvar pain and itching, inflammation, burning, changes to the color of the skin, and a sore or lump in the vulva or groin.

You can develop vaginal and/or vulvar pain as a result of physical injury to the area. The injury can be from shaving, having sex, or from childbirth (the latter being the most common reason for physical injury to the vulva or vagina).

Childbirth often leads to tearing of the vagina for women delivering their first child. The tear can extend into your perineum (the area between the anus and the vagina) and is referred to as a perineal tear.

You can develop vaginal and vulvar pain that lasts for several days after having sexual activity that results in vaginal tears.

Some factors that can increase your likelihood of getting a vaginal tear while having sex include:

  • Vigorous or rough penetration
  • Vulvovaginal atrophy
  • Vaginal dryness
  • Vaginal tissue damage or scarring
  • Skin disorders such as psoriasis, eczema, and lichen planus
  • Some medications such as corticosteroids

Vulvodynia is the presence of vulvar pain with no distinct cause for three months or longer. The vulvar pain and itching that accompanies vulvodynia can make having sex or sitting for a long time almost impossible. Some possible causes of vulvodynia are early fetal developmental abnormalities, immune or genetic factors, inflammation, hormonal factors, infection, dietary oxalates, and neuropathic changes.

Pain during your period is called dysmenorrhea. Period pain generally starts just before your period starts, as the prostaglandin levels rise in the uterine lining. As your period continues and the uterine lining is shed, the prostaglandin levels go back down, leading to a reduction in vulvar pain during your period.

Treatment for vulvar pain depends on the cause of the pain and varies from person to person. Some of the treatment options include the following:

  • Folliculitis often gets better by itself. You can speed up the healing process by keeping the genital area clean, applying warm compresses, and wearing loose clothing.
  • You can often treat a vaginal yeast infection by taking over-the-counter medication. Make sure to talk to your doctor if symptoms persist. 
  • Sexually transmitted infections need to be treated with prescription drugs.
  • For contact dermatitis, if you know the source of the irritation, avoid that substance and apply cold compresses to reduce the itching and pain.
  • A Bartholin gland abscess may need to be drained by a doctor.
  • Treating lichen simplex chronicus involves stopping the itch-scratch cycle to let the skin heal. Your doctor may prescribe steroid creams to relieve the itching.
  • To treat lichen sclerosus, your doctor may prescribe a steroid cream.
  • To treat lichen planus, your doctor may recommend medicated ointments or creams, prescription pills, injections, or vaginal tablets. This condition may need long-term follow-up and treatment.
  • There are many treatments available for GSM. You can use vaginal lubricants and moisturizers to help relieve vaginal dryness and vulvar pain during sex. You can also use estrogen therapy in the form of a vaginal ring, cream, or tablet. This therapy is available by prescription.
  • You can treat VIN by applying a cream to the affected skin, undergoing surgery, or getting a laser treatment. The vaccine for HPV may help prevent VIN.
  • Treatment for vulvar cancer depends upon the stage of cancer. You may need surgery to remove the cancerous tissue. You may also need chemotherapy and/or radiation therapy, along with surgery.
  • A doctor can stitch any serious vaginal tear that occurs during childbirth. You can also take over-the-counter painkillers to reduce vulvar pain from tears and cuts. You should also avoid using scented or harsh products in the genital area, avoid using any products inside your vagina, and use a pillow to sit on if necessary.
  • To treat dysmenorrhea, your doctor may recommend painkillers or hormonal birth control. Making certain lifestyle changes, such as exercising and getting plenty of sleep, may also help.
  • There are various treatment options for vulvodynia, including medication, biofeedback therapy, local anesthetics, nerve blocks, pelvic floor exercises, and surgery. The main focus of treatments is to relieve the symptoms of vulvar pain.

If you have vulvar pain, you should consult your doctor. They may refer you to a gynecologist. Your doctor will examine you and run any tests needed to find the cause of vulvar pain. Bacterial or yeast infections, herpes, GSM, precancerous conditions of the skin, and medical issues, including diabetes, can be treated.

Your doctor will ask about your symptoms and might touch your vulva gently using a cotton swab to find out if it leads to pain. They may examine your vagina and vulva and run tests such as vaginal pH, wet mounts, Gram stain, and fungal culture or polymerase chain reaction tests.

You can try the following home remedies to ease vulvar pain:

  • To ease vulvar pain and itching, place cold compresses directly on external genitalia.
  • Soak in comfortably cool or lukewarm water with colloidal oatmeal or Epsom salt for 5–10 minutes.
  • Don’t wear tight-fitting underwear made of nylon. Instead, wear loose underwear made of cotton.
  • Don’t soak in hot tubs or hot baths.
  • Avoid using deodorant pads or tampons.
  • Wash the vulvar area gently.
  • Avoid activities that put excess pressure on the vulva, including biking.

It is important not to use over-the-counter or at-home treatments without consulting your doctor first. Once your doctor evaluates your symptoms, they may recommend treatment to help manage the pain.

Vulvar pain and itching can occur for a wide variety of reasons. You can follow certain self-care measures to help prevent problems with the vulva. Maintain good hygiene by rinsing the vulva using warm water and patting it gently to dry. Wearing pantyhose and tight-fitting underwear or pants can make symptoms worse. Avoid using scented toilet paper or perfumed soap, and don’t use talcum powders, feminine sprays, or douches. Make sure to avoid tampons and pads with a plastic coating or deodorant.

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Persistent-Vulvar-Pain?IsMobileSet=false

https://www.nva.org/wp-content/uploads/2015/01/2015_ISSVD_ISSWSH_and_IPPS_Consensus_Terminology.2.pdf

https://health.clevelandclinic.org/pain-down-there-5-reasons-your-vagina-hurts/

https://www.acog.org/Patients/FAQs/Disorders-of-the-Vulva-Common-Causes-of-Vulvar-Pain-Burning-and-Itching?IsMobileSet=false

https://my.clevelandclinic.org/health/diseases/5019-yeast-infections?

https://www.uptodate.com/contents/evaluation-and-management-of-female-lower-genital-tract-trauma

https://www.acog.org/Patients/FAQs/Dysmenorrhea-Painful-Periods?IsMobileSet=false

https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427

https://www.nhs.uk/conditions/vulvodynia/

https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-20353423

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