Vulvodynia (vulval pain)

Symptoms of vulvodynia

The main symptom of vulvodynia is persistent pain in and around the vulva. The vulva usually looks normal.

The pain may be:

• a burning, stinging or sore sensation
• triggered by touch, such as during sex or when inserting a tampon
• constantly in the background and can be worse when sitting
• limited to part of the vulva, such as the opening of the vagina
• more widespread – sometimes it can spread to the buttocks and inner thighs

Some women also have problems such as vaginismus (where the muscles around the vagina tighten involuntarily), interstitial cystitis (a painful bladder condition), painful periods and irritable bowel syndrome (IBS).

Having chronic pain can also affect relationships, reduce sex drive, and cause low mood and depression. Pain in the genital area is often difficult to talk about with friends and it's not uncommon to feel isolated.

When to get medical advice

See your GP or visit your local genitourinary medicine (GUM) clinic if you have persistent vulval pain.

Vulvodynia is unlikely to get better on its own and some of the treatments are only available on prescription. There are also a number of other causes of vulval pain that need to be ruled out.

Your doctor will ask about your symptoms and may touch your vulva lightly with the tip of a cotton bud to see if this causes pain. A swab may also be taken to check for conditions such as infections.

Many people with vulval pain can have the condition for many years before a diagnosis is made and proper management started.

Find a vulval clinic in the UK on the British Society for the Study of Vulval Disease website

You cannot self-refer to these services, but you could discuss a referral with your GP.

Treatments for vulvodynia

A combination of some of the following treatments can often help relieve symptoms of vulvodynia and reduce its impact on your life.

Self-care

The following lifestyle tips may help reduce symptoms of vulvodynia:

• Wear 100% cotton underwear and loose-fitting skirts or trousers.
• Avoid scented hygiene products such as feminine wipes, bubble bath and soap – an emollient is a good substitute for soap.
• Apply cool gel packs to your vulva to soothe the pain.
• Use petroleum jelly before swimming to provide protection from chlorine.
• Try not to avoid sex or touching your vulva completely, as this may make your vulva more sensitive – if sex is painful, try to find a position that's more comfortable, or if penetration is painful do other sexually intimate activities together until you've sought advice.
• Try to reduce stress, as it can increase the pain of vulvodynia – read some relaxation tips to relieve stress.
• For pain when sitting, using a doughnut-shaped cushion can help.

Over-the-counter gels and lubricants

Applying the anaesthetic gel lidocaine to your vulva about 10 minutes before sex may make it more comfortable. To stop the gel getting on your partner, either wipe it off just before having sex or ask your partner to wear a condom (if using condoms, use latex-free ones as latex condoms can be damaged by lidocaine).

If your pain is more constant, applying lidocaine regularly throughout the day may help. Lidocaine can also be used overnight. A tip is to put some on a cotton make-up removal pad and put it onto the sore area so it's held in place by your underwear.

It's very common to have some burning when the lidocaine is initially applied which can last several minutes before going numb. Try to give the lidocaine time it to work, but if the burning continues for 10 minutes, wash it off thoroughly.

Tubes of 5% lidocaine gel, cream or ointment can be bought over the counter from a pharmacy, although it's a good idea to get a doctor's advice before trying it.

Vaginal lubricants and aqueous cream (also available over the counter) may soothe the area and help moisturise the vulva if it's dry. Speak to your pharmacist about these treatments.

Prescription medication

Conventional painkillers such as paracetamol won't usually relieve the pain of vulvodynia. But several medications available on prescription can help, including:

• antidepressants called amitriptyline and nortriptyline – possible side effects include drowsiness, weight gain and dry mouth
• anti-epilepsy medicines called gabapentin and pregabalin – possible side effects include dizziness, drowsiness and weight gain

Your doctor will probably start you on a low dose and gradually increase it until your pain subsides. You may need to take the medication for several months.

If you have pain in a specific area of your vulva, injections of local anaesthetic and steroid medication into a nearby nerve may provide temporary pain relief.

Physiotherapy

A physiotherapist can 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 and desensitise it involves using a set of vaginal trainers. These are smooth cones of gradually increasing size and length which can be inserted into your vagina in the privacy of your own home.

Some physiotherapists may also suggest trying TENS (transcutaneous electrical nerve stimulation) to reduce your pain. This is where a machine is used to deliver a mild electrical current to the painful area.

Therapy and counselling

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.

Psychosexual counselling is helpful when pain is affecting intimacy between you and your partner. This is a type of therapy that aims to address problems such as fear and anxiety about sex, and to restore a physical relationship with your partner.

Surgery

Only in very rare cases, surgery to remove part of the vulva may be an option. Pain however can recur and it's usually not recommended.

Possible causes of vulvodynia

The exact cause of vulvodynia is unknown.

It's thought it may be the result of a problem with the nerves supplying the vulva, although it's not clear what causes this.

Possible triggers that have been suggested include damage due to previous surgery or childbirth, trapped nerves or a history of severe vaginal thrush.

Vulvodynia is not contagious. It has nothing to do with personal hygiene and isn't a sign of cancer.

Other causes of vulval pain

Pain in the vulva isn't always vulvodynia. It can have a number of other causes, such as:

• persistent vaginal thrush or other vaginal infections
• sensitivity to something touching the vulva, such as soap, bubble bath or medicated creams (known as irritant contact dermatitis)
• a drop in the hormone oestrogen causing dryness of the vulva, particularly during the menopause
• a recurrent herpes infection
• lichen sclerosus or lichen planus (skin conditions that can cause intense irritation and soreness of the vulva)
• in rare cases, Behcet's disease (a condition of the blood vessels that can cause genital ulcers) or Sjogren's syndrome (a disorder of the immune systemthat can cause vaginal dryness)

Your doctor may want to rule out these conditions before treating you for vulvodynia. Some women can have a combination of problems, for example recurrent thrush and vulvodynia, with both needing proper treatment to reduce pain.

Support and more information

Living with a long-term painful condition such as vulvodynia can be frustrating and stressful.

You may find it useful to contact a support group for more information and advice or to get in touch with other women who have vulvodynia.

Two of the main support groups are:

• the Vulval Pain Society 
• the Pelvic Pain Support Network