Vulvodynia is persistent, unexplained pain of the vulva, the skin surrounding the vagina. There is usually no obvious cause, but much can be done to help relieve the pain so that it no longer causes problems.
The pain of vulvodynia is often described as a burning, stinging or raw sensation. Some women describe a feeling of a needle being stuck in their genitals.
Vulvodynia can be:
- unprovoked vulvodynia – pain that is constantly in the background or that comes on spontaneously, with no particular trigger
- provoked vulvodynia – pain triggered when the vulva is lightly touched (for example, after inserting a tampon or during sex)
The pain can also be limited to the vulva (localised) or may be more widespread (generalised), spreading to the urinary tract, the bottom or the inside of the tops of the thighs.
It can be made worse by activities such as cycling or horse riding, which put prolonged pressure on the vulva.
The following information and advice about vulvodynia covers:
- who is affected
- what you should do
- the possible causes of vulvodynia
- how vulvodynia is managed
Who is affected?
Vulvodynia affects women of all ages, from 20 to 60, but often starts in women younger than 25. It can be very distressing, significantly affecting quality of life.
Women with vulvodynia are usually otherwise healthy, with no history of sexually transmitted infections. However, some women with vulvodynia also have vaginismus, when the muscles around their vagina tighten involuntarily whenever penetration is attempted.
What you should do?
If you have persistent vulval pain, see your doctor or visit your local genitourinary medicine (GUM) clinic.
Your doctor may touch your vulva lightly with the tip of a cotton bud to see if this causes pain. A diagnosis of vulvodynia is made based on your symptoms.
What causes vulvodynia?
The cause of vulvodynia is not understood. It's possible that it is caused by:
- a nerve problem– irritation or damage of the nerves around the vulva, oversensitive nerve endings in the skin of the vulva, or (less likely) a trapped nerve in the spine
- previous surgery to the vulva, especially if it resulted in scarring
Your doctor will want to rule out other conditions that can cause some similar symptoms to vulvodynia, such as:
- persistent vaginal thrush
- irritation to antifungal treatment
- sensitivity or allergy to something touching the vulva, such as soap or bubble bath (known as irritant contact dermatitis)
- a drop in the hormone oestrogen, causing dryness of the vulva, especially during the menopause
- a recurrent herpes simplex infection
- lichen sclerosus or lichen planus (skin conditions that may cause intense irritation and soreness of the vulva)
- Behcet's disease (a disease of the blood vessels that can cause genital ulcers)
- Sjogren's syndrome (a disorder of the immune system that can cause vaginal dryness)
A combination of some of the following treatments can help relieve symptoms of vulvodynia and reduce its impact on your life. Discuss these options with your doctor.
The antidepressant amitriptyline has been found to relieve the pain of vulvodynia for some women. However, possible side effects are drowsiness, weight gain and dry mouth.
The anti-epilepsy medicines gabapentin and pregabalin can also help control pain. Make sure you talk to your doctor about the side effects, and how you should take the medication.
Your doctor will probably recommend that you start on a low dose of amitriptyline, and gradually increase the dose until your pain subsides. This may take several weeks and you may need to take the medication for three to six months.
Over-the-counter gels and lubricants
Some women with vulvodynia find that applying the anaesthetic gel lidocaine to their vulva 15–20 minutes before sex may make intercourse possible, although lidocaine can sometimes irritate the area.
A tube of 5% lidocaine can be bought over the counter from a pharmacy.
Vaginal lubricants and aqueous cream (also available over the counter) may soothe the area and help moisturise the vulva if it is dry.
Speak to your pharmacist about these treatments.
Your doctor may refer you to a physiotherapist if you also have vaginismus.
The physiotherapist may teach you some pelvic floor exercises (such as squeezing and releasing your pelvic floor muscles) to help relax the muscles around your vagina.
Another technique to relax the muscles in the vagina involves using a set of vaginal trainers. These are four smooth, penis-shaped cones of gradually increasing size and length, which can be used in the privacy of your own home.
The smallest one is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size, and so on. It is important to go at your own pace and it does not matter how long it takes, whether it is days or months.
When you can tolerate the larger cones without feeling anxious or any pain, you and your partner may want to try having sexual intercourse.
Read more about the treatment of vaginismus.
Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act. It can often help women cope with the impact that vulvodynia has on their life.
CBT focuses on the problems and difficulties you have now, and looks for practical ways you can improve your state of mind on a daily basis.
Talk to your doctor about whether CBT may benefit you, and whether you can be referred to a therapist for this.
The following lifestyle changes may help:
- Wear 100% cotton underwear and loose-fitting skirts or trousers.
- Avoid scented hygiene products such as bubble bath and soap.
- Avoid cycling and any other activities that put prolonged pressure on the vulva.
- If sexual intercourse is painful, try to find a position that is comfortable (many women find that being on top is the most comfortable position).
Further advice and support can be found by visiting the following websites:
- International Society for the Study of Vulvovaginal Disease