She calls it a headache,
an general feeling of being ill, or a vague feeling of pain “down there.” He calls it an excuse not to have sex tonight. But what if it’s an actual condition?


Women, it’s not yet time to rejoice that there’s an actual name for it, but yes, there IS a condition that means “an unspecified pain in the vulva.” It’s called “vulvodynia.”


The good news is that vulvodynia does not imply the indisputable presence of an STD. The bad news is that an STD may still be a cause of vulvodynia, but only in some cases.


The vulva, which is mainly affected in this condition, is the external portion of the female genital area. Pain that affects this area is common among women.
Vulvodynia is the vulvar pain that lasts for three months or longer, with no clear identifiable cause. Hence, it is not directly caused by a skin disorder, infection, or other medical condition. The severity of the pain, constancy, and exact location may vary among vulvodynia sufferers.
 Vulvodynia is considered a multi-faceted problem because of the following reasons:
1) it affects the genital area
2) may involve the pelvic floor muscles

3) chronic pain is associated with the condition

4) which may lead to emotional distress.  

Symptoms typically vary, but most women describe vulvodynia pain as a “burning sensation.” Other women report a raw discomfort, irritation, stinging, or a sharp “knife-like pierce through the vulva.” Some women also feel soreness, throbbing, aching, and swelling. These may be felt in a small area or the entire vulva. For most afflicted with the disorder, symptoms can come and go without warning or may occur only when the area is touched.



The two main categories of vulvodynia are:

1) localized vulvodyniaMost women with this subtype, experience pain at one vulvar site only. Aless common form of localized vulvodynia called the “clitorodynia” (pain in the clitoris) is known to be very painful.

2) generalized vulvodynia–  With this category, women feel pain over the entire vulva or report pain at multiple sites; the pain is relatively constant and spontaneous, with some periods of relief. Once a doctor diagnoses you with this type, it will be beneficial to consult with an anesthesiologist or pain management doctor.

Mixed Vulvodynia also occurs in some women. Women with the mixed form experience the symptoms of both subtypes just mentioned.


What’s The Difference Between Provoked Vestibulodynia, Vulval Vestibulitis, Or Vulvodynia?

Technically, both “provoked vestibulodynia,” and “vulvalvestibulitis” are both subtypes of “vulvodynia.” All of them are chronic pain of the vulva, but with specific differences:


Vulvodynia refers to an unspecified pain in the vulva that lasts around three months or longer. It is not provoked by touch. It is just a chronic pain that can be persistent or may be increased with pressure.
“Provoked Vestibulodyniarefers to vulvar pain that is exacerbated by touch. In the case of sexual contact, this can then be considered “dyspareunia.”For vestibulodynia as a whole, affected women report experiencing pain when urinating. Additionally, even if the pain is not present all the time, it can last for hours. This can prevent sexual contact altogether.

Vulval Vestibulitis actually refers to “vestibulodynia,” as well. “Vestibulodynia” is just a more precise term to specify that the pain is localized in the area of the “vestibule,” or the major part of the vulva covering the structures outside the clitoris, urethra, and vagina, but just before the labia minora. When the pain is focused on the vestibule, these terms can be used. [Source: Vulval Pain Society]





While the exact causes of vulvodynia have yet to be accurately determined, here are some probable factors working together, that are linked with the syndrome:

Nerve irritation, and possibly injury of the nerves of the vulva
Increase in the sensitivity and number of pain-sensing vulval fibers
A hormonal imbalance
Chronic yeast infections, resulting in hypersensitivity
Being a previous victim of sexual abuse
Constant use of antibiotics
When infections or trauma create an abnormal response in the cells of the vulva
A genetic predisposition of poor response to chronic inflammation
Irritation or allergies to chemicals and other synthetic substances
Muscular spasms
Pelvic floor instability or muscle weakness
Sensitivity to particular foods
Conditions that affect nearby bones or muscles

The condition may be made worse or triggered further by the following factors:

Skin infections (e.g., candidiasis a.k.a. “thrush”)
Surgery or laser treatment
Chronic skin conditions
Injury or trauma
Skin irritation caused by douches, soaps, detergents, panty liners, and condoms
Tight clothing
Walking and sitting
Emotional factors (e.g., anxiety or stress)

Diagnosis of Vulvodynia


If you have symptoms that mimic vulvodynia, such aspain, your healthcare provider (usually a gynecologist or urogynecologist), should evaluate you to rule out conditions. Based on your clinical symptoms, you may be referred to specialists for continued care.


Your doctor may begin your evaluation of this condition with a comprehensive medical history taking, where you will be asked questions relating to your symptoms, sexual history, and medical-surgical history. During the physical examination, your physician will carefully examine the vagina, the vulva, as well as the presence of vaginal secretions to check for an active infection or skin problem.


You may undergo a blood test to examine levels of estrogen, testosterone, and progesterone. A “Q-tip” or cotton-swab test is typically done to complete the examination. In this test, your doctor will use a cotton swab to apply pressures on various portions of the vulvar area gently. You may also be asked to rate pain, includingits characteristics and severity, if applicable. The goal will be to find the location of the pain and characterize it for proper management. If your doctor suspects an abnormality, he or she may use a magnifying glass to examine the area or perform a biopsy of the vulvar skin.


We bring you some solutions you can use to deal with the condition in succeeding sections.


How is Vulvodynia Treated?


There are various treatment options available for managing Vulvodynia. You should understand that, as in most health conditions, no single method works all the time for everyone. Upon initiation of treatment, it can take a month or several months before significant relief is achieved. At times, more than one treatment is necessary.


It may be helpful to keep a “pain diary” to help you track your symptoms and responses to different therapies. The healthcare professional managing your pain may use techniques such as the ultrasound to relieve your pain.


Self-Care for Vulvodynia

Maybe surgery is not an option for you right now. Perhapsyou prefer to see if the pain goes away on its own. Because the exact cause may not be known for most individuals, treatment for vulvodynia is commonly directed towards the relief of symptoms, especially pain.


Here are some tips on how you can manage the pain of vulvodynia:


Avoid activities that put pressure on the vulva. You may be a biking or horseback riding enthusiast, but maybe it’s time to park the sport for now. Engaging in activities may worsen the pain of the condition. Since the choice is between your love of the sport and your daily quality of life, choose what would let you get through the day.
Keep the vulval area dry and free of unnecessary moisture. After swimming, wash and change immediately. Also, do not swim in pools with excessive chlorination. This will also contribute to the pain of vulvodynia.
Avoid food and drink that adds irritants to the urine. These foods may be irritating to the urethraand may exacerbate vulvodynia: beans, greens, berries, nuts, and chocolate. You may also check the Mayo Clinic, as well as Healthline’s food guides for the Overactive Bladder, to see what other types of food to avoid. Also, check out these diet suggestions:
Eliminate over-the-counter feminine products.Generally, healthcare providers will advise you to steer clear of bubble baths, douches, soaps, and sprays that tend to irritate the vulvar tissues.
Sit on a doughnut or a similarly-shaped pillowwhen you’re sitting down for long periods. This will help ease the pressure of vulvodynia when you’re working or doing any other tasks that require sitting down for an extended duration. More importantly, even if your work involves sitting down for long periods, find time to intersperse intervals of standing and walking around.
Self-care during and after sexual contact: Use a water-based lubricant during sex, and then apply a frozen gel pack after intercourse to relieve the pain. Spermicides and contraceptive creams are not advised. For painful intercourse, your provider may prescribe the application of a topical anesthetic such as Lidocaine 5-10 minutes before intercourse. It is also recommended to urinate and rinse the vulva with cool water right after sexual intercourse.
For temporary relief, use cold or lukewarm home remedies. It has been found effective to wrap a frozen gel pack or ice in a thin towel and apply for 15 minutes to the vulvar area. You may also opt to take a sitz bath with cool or lukewarm water to relieve the pain associated with vulvodynia.
Learn some relaxation techniques. The Chronic Pain Control Workbook by Catalano and Hardin, as well as The Relaxation and Stress Reduction Workbook by Davis, Eshelman, and McKay, are recommended. [Source: National VulvodyniaAssociation]



Other Preventive Self-Help Strategies

While seeking the most effective treatment that will work for you, following the guidelines below have been found effective for the prevention of vulvodynia:



Use unscented, soft, white toilet paper.
Avoid getting shampoo on the vulval area.
Wash the vulva with lukewarm to cool water only.
Urinate before your bladder becomes full, and be sure to rinse the vulval area with clean water right after.
Drink ample liquids, especially water, and add fiber to your diet to prevent constipation.
Use only 100% cotton tampons or menstrual pads.


Laundry and Clothing

Wear loose-fitting pants, all-white cotton underwear, or skirts.
Wear knee-high or thigh-high hose, instead of the pantyhose.
Double rinse your undies and clothing that comes in contact with the vulvar area.
Fabric softeners on undergarments are not allowed.
Remove wet suits (e.g., swimwear) promptly.
Use dermatologically-approved detergent.


Education & Support

It may be beneficial to discuss the problem with an open disposition, and even bring your partner to appointments with your healthcare providers.
Consult with your physician to achieve maximum comfort before engaging in sexual contact.
Have a warm bath to help you relax, and temporarily relieve the pain you may be feeling.
It may be wise to have a sex counselor or therapist whom you can discuss emotional aspects of the condition, and for advice on ways to enjoy intimacy during sexual intercourse, even without vaginal penetration.


Long-Term Treatment For Vulvodynia

No one wants to have to deal with the pain in the nether regions for years. Which is why some of us would prefer to have to deal with vulvodynia once and for all. Here are some of the medical, surgical, and somewhere-in-between options that you have in treating vulvodynia.


Medical Options:

Psychiatric medications, including antidepressants and anticonvulsants. Tricyclic antidepressants (TCA), opioids, serotonin-norepinephrine reuptake inhibitors (SNRIs), and anticonvulsants, especially gabapentin. These medicines decrease nerve hypersensitivity, providing pain relief. [Source: ACOG]
Anti-inflammatory medications, including mast cell inhibitors and steroids. Both act to calm down the inflammation in the cells in the surrounding area, hopefully addressing the pain.
Topical creams, including estrogen and testosterone creams. An alternate topical estrogenand testosterone treatment was performed on vulvodynia sufferers, and the treatment was effective. [Source: PubMed]

If any or all of these options do not address vulvodynia, now is the time to consider more aggressive therapies:

Botox. “Freezing” the area via the Botulinum Toxin will also freeze the nerves and spare you from further pain.
Nerve blocks, including Lidocaine. Nerve blocks serve to, as the term suggests, block neural activity. With the decreased to eliminated neural activity, you then cease to feel any sensation, including pain, in the affected area. Lidocaine is a topical anesthetic, so it also numbs the area and eliminates pain.
Pelvic floor strengthening via transcutaneous electrical stimulation and biofeedback. This employs the use of an electronic device to electronically stimulate the muscles in the area, thereby strengthening the pelvic muscles, while easing the muscle tension, alleviating pain. [Source:PubMed]
Conventional physical therapy. Treatment may involve manual therapies such as soft-tissue work, massage, and joint mobilization. Effective exercises that address your pelvic floor muscle spasms or weakness may also be taught by your physical therapist.
Use of the biofeedback machine & insertion of a vaginal sensor. The machine works by providing visual feedback of the strength of pelvic floor muscles. This is typically utilized while you are performing exercises that normalize these muscles’ function. These are performed by physical therapists or trained healthcare providers.
Surgery. When all else fails, your doctor may recommend the removal of the painful tissue, to give permanent relief.


Looking Ahead

Currently, there are several studies on vulvodynia, with most kinds of research focusing on its causes and treatments. These studies show that roughly 16% of women in the US suffer from the condition at some point in their lives.

As with other long-standing pain syndromes, you can anticipate that a complete cure may not be the outcome at all times for everyone. However, with initial management from your healthcare providers, significant improvements are commonly achieved after a few months. Moreover, identifying and managing triggers of pain will help lessen the flares of symptoms.

Be prepared to face associated pains that can come with the condition, including dysmenorrhea, musculoskeletal pains, and migraine. Depression and anxiety should also be managed appropriately, if present, and be prioritized in care management.

If you’re interested in viewing studies that need participants, you may visit the National VulvodyniaAssociation’s website.


Pain is pain. Ask any other patient with a chronic pain disorder. The quality of life is definitely diminished, and the pain might be severe enough to cause mental distress. It is no different for a vulvodynia sufferer. If you or someone you love suffers from vulvodynia, don’t despair. We’ve outlined here the ways by which you can cope with the disorder, and by diligently finding the right intervention for the condition, you may be able to live a pain-free life, picking up where you left off before vulvodynia.

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