About Vulvodynia

What is vulvodynia?
Vulvodynia, simply put, is chronic vulvar pain without an identifiable cause. The vulva is the external part of the female genitalia.  Women with vulvodynia may experience discomfort or pain in the labia majora or minora (outer folds of the vulva), the vestibule (tissue surrounding vaginal and urethral openings), the clitoris, or the perineum (area between the vulvar and anus). The pain can either be highly localized or in multiple areas.

What are the causes of vulvodynia?
Vulvodynia is not caused by either an active infection or a sexually transmitted disease. The causes are unknown due to a lack of research on the disorder. Current studies are investigating potential causes and trying to determine risk factors for developing vulvodynia. Researchers speculate that one or more of the following may cause, or contribute to, vulvodynia:

  • an injury to, or irritation of, the nerves that supply sensation to the vulva
  • an abnormal response of different cells in the vulva to environmental factors (such as infection or trauma)
  • genetic factors associated with susceptibility to chronic vestibular inflammation
  • a localized hypersensitivity to candida (yeast)
  • spasm or weakness of the pelvic floor musculature

What are the symptoms of vulvodynia?
The most commonly reported symptom is burning, but some women report stinging, stabbing, irritation, and/or rawness. The severity of the condition ranges from mild discomfort to excruciating, disabling pain.

The two major subtypes of vulvodynia (which can co-exist) are:

  • generalized vulvodynia
  • vulvar vestibulitis syndrome (aka vestibulodynia)

Women with generalized vulvodynia typically have relatively constant pain that can radiate to the inner thigh and buttocks in some cases. The pain occurs spontaneously, but there may be occasional periods of relief. Vulvar pressure, as with sitting or wearing pantyhose, exacerbates symptoms.

Women with vulvar vestibulitis syndrome experience pain primarily when pressure is applied to the vulvar vestibule, such as with tampon insertion, sexual intercourse, or a gynecological exam.

Who gets vulvodynia?
Vulvodynia affects women of all ages and even occasionally occurs in preadolescent girls. According to a Harvard study funded by the National Institutes of Health (NIH), almost 16 percent of American women suffer from vulvodynia at some point during their lives, with most reporting ongoing pain for many years. According to the study, symptoms can begin at any age but are most likely to begin between the ages of 18 and 25. Once assumed to affect primarily Caucasian women, several recent studies have shown that African American and Hispanic women are equally likely to develop vulvodynia.

How is vulvodynia diagnosed?
Vulvodynia is a diagnosis of exclusion because it is only considered after all other causes of vulvovaginal pain have been ruled out. Upon examination, the vulvar tissue can either appear inflamed and swollen or perfectly normal. After taking a thorough medical history and asking questions about symptoms, the healthcare provider should carefully examine the vulva, vagina, and vaginal secretions to rule out an active infection or skin disorder. Routine cultures for yeast and bacterial infections should be performed. Different areas of the vulva may be touched with a cotton-tipped swab to determine the location and severity of pain. If any area appears suspicious, it can be examined more closely with a special instrument, or a biopsy may be performed.

How is vulvodynia treated?
Currently there is no cure for vulvodynia. Treatment is directed toward alleviating symptoms and may provide either partial or complete relief. Some women may experience relief with a particular treatment, whereas others do not respond and/or experience unacceptable side effects. No single treatment is appropriate for every woman, and it may take some time to find a treatment (or combination of treatments) that alleviate pain. A multidisciplinary approach that may even include psychological counseling is favored because the condition often impacts several areas of a woman’s life.

Discontinuing the use of feminine hygiene and other products that can cause vulvar irritation is the first step in treatment. Oral "pain-blocking" medications, such as tricyclic antidepressants (Elavil®), anticonvulsants (Lyrica®, Neurontin®, Trileptall®), and SSNRIs (Effexor®, Cymbalta®) are often recommended. Topical medications, such as estrogen, anesthetic, or unique compounded formulations, are often used in combination with an oral medication. Pudendal and/or spinal nerve blocks provide relief for some women. Vulvodynia sufferers with associated pelvic floor muscle spasm or weakness may have physical therapy, biofeedback, and/or Botox® injections incorporated into their treatment plan. When the diagnosis is vulvar vestibulitis syndrome, surgery to remove the painful tissue may be recommended. In severe cases, opioid medications or interventional pain management techniques, such as neurostimulation, may help to control symptoms.

While seeking effective treatment for vulvar pain, certain coping measures help to relieve symptoms and prevent further irritation. These include wearing all-white cotton underwear and using a dermatologically approved laundry detergent, such as Purex or Clear. Wearing loose-fitting pants, skirts, and underwear and avoiding pantyhose is recommended. Soft, white, unscented toilet paper should be used, and rinsing the vulva with water after urination is often helpful. Some women with vulvodynia recommend using 100 percent cotton tampons and menstrual pads. For sexual intercourse, using a water soluble lubricant is helpful; after intercourse, applying an ice pack or bag of frozen peas wrapped in a towel minimizes symptoms. Exercise that puts direct pressure on the vulva, such as bicycle or horseback riding, and using chlorinated pools or hot tubs should be avoided. Many women find that using a foam rubber donut for long periods of sitting is very helpful. Lastly, it is important to prevent constipation by eating a high-fiber diet and drinking lots of fluids.

What conditions can overlap with vulvodynia?
Published scientific research indicates that women with vulvodynia can also suffer from:

Data from self-report surveys indicate that women with vulvodynia also report suffering from:

Vulvodynia is often times misdiagnosed as: