What is vulvodynia?
Vulvodynia is chronic pain that is felt in the vulva which is the external genital region. It usually lasts for more than three months with no identifiable cause. The pain may be prolonged or may persist on and off on occasions.
There are two types of vulvodynia -
- Generalised vulvodynia - Pain is felt all over the vulva
- Localised vulvodynia - Pain is felt specifically only around the vaginal opening
This pain may cause sexual dysfunction and can negatively impact a woman’s quality of life.
What could be the causes?
In provoked vulvodynia, the pain could be provoked by certain factors like -
- Contact during sexual intercourse
- Contact during a pelvic examination by the gynaecologist
- Sitting for longer periods of time
- Wearing tight pants
Whereas some women may have unprovoked vulvodynia where they experience pain without any known cause.
Some of the following are associated with a higher risk of developing vulvar pain -
- Nerve injury or irritation, in the nerves that supply the groin region.
- Increased levels of pain-producing substances and increased sensitivity of pain fibres carrying sensations from the vulva.
- Vulvar cells may respond to an infection or trauma in a peculiar manner and start off with vulvodynia.
- Genetic susceptibility to long-standing infection of the vulva, pain and difficulty fighting off infections.
- Pelvic floor muscle weakness.
What are some symptoms you may experience?
- You could experience pain on the vulva in one place only in the case of localized vulvodynia and diffuse pain all over the vulva with periods of relief in the case of generalised vulvodynia.
- In the case of localised pain, it is worsened by pressure particularly after exercise, tampon insertion, gynaecological examination and sexual intercourse. The pain of generalized vulvodynia is interspersed with periods of relief.
- The most common pain felt is a burning sensation. But it may also present as a stinging sensation, irritation in the area, soreness, stabbing or piercing sensation
- Dryness and itching
- Difficulty during sex and exercise
- In severe cases, women may hard find it hard to perform daily tasks
How is vulvodynia diagnosed?
First, your doctor will make sure to rule out other possible conditions that could cause pain, such as
- Genital infections - Such as herpes, fungal or bacterial, trichomoniasis or candidiasis. Sample of your discharge may be taken to rule out any kind of genital infection
- Inflammatory conditions - Such as lichen sclerosis, lichen simplex or allergic contact dermatitis. The skin in the affected area is closely examined by the doctor
- Previous trauma to the genital area that may cause pain to flare up on occasion
- Nerve related disorders like neuropathy or any injury to the nerve supply in the genital region
- Oestrogen deficiencies in menopausal/post-menopausal women – This is ruled out by carrying out blood tests
- Cancer of the genital region
When the above-mentioned conditions are ruled out, it is diagnosed as vulvodynia. A cotton swab test is done where a cotton swab is placed on the upper thighs and is slowly moved towards the external genital region. This is done in order to gauge the exact location of the pain, the degree of pain and of what nature the pain is.
What are the treatment options?
Vulvodynia treatment takes time and care and a combination of several options may be suggested to relieve your pain
- Medications
- Topical medication – These are creams or ointments that you can directly apply to the affected area and usually contain small amounts of a local anaesthetic like Lidocaine
In some cases, estrogen hormone supplements are also prescribed along with topical medications to relieve pain
- Oral medication – This kind of medication is prescribed when pain doesn’t seem to reduce with topical application. These are pain-blocking drugs which are antidepressants, like amitriptyline and nortriptyline given in a different dosage as compared to treating clinical depression. Other drugs that could be prescribed are gabapentin and pregabalin
- Physiotherapy
- Massages and acupuncture
- Biofeedback training – This treatment helps you to control your pelvic muscles so you can relax them to relieve pain
- Meditation, yoga and breathing techniques – In some cases, the pain may be triggered by stress or emotional distress. Practising meditation daily coupled with a few breathing exercises is sure to reduce your stress levels, thus relieving some of your pain
- A nerve block – This is a medication that is administered via injection and it interrupts the signals that send pain from nerves to the brain.
- Surgery - In extremely rare cases, surgery is used as a last resort. Vestibulectomy is a surgical procedure to remove tissue in the area where the patient feels pain. This can be helpful for women who have localised vulvodynia and haven’t been significantly helped by other treatments.
- Psychotherapy and counselling – This might be recommended since vulvodynia can affect sexual relationships, self-esteem and overall quality of life. If left unaddressed, anxiety disorders may crop leading to a stressful life and low self-esteem hence it is important to receive counselling when this condition starts to disrupt your mental health.
What can I do to relieve the pain of vulvodynia?
Treatment starts with the patient maintaining basic personal hygiene and care. It is recommended to keep a few points in mind while the condition is being treated
- Avoid wearing tight pants
- Try and switch to cotton underwear as they are extremely breathable and will absorb excess moisture
- It is advised to not use harsh soaps or chemical agents to clean your genital area
- Try and use lubricants during sexual contact to remove the risk of any kind of injury to the region.
- Try and keep your genital area dry at all times
- It is suggested to avoid exercises that put pressure on the vulva like cycling and horse-back riding
- In some cases, certain foods may trigger pain. It is advised to keep a close watch on your food through a food diary to figure out which exact food may be triggering your pain
- Reduce your stress levels through meditation, yoga/breathing exercises and get adequate sleep.
In conclusion – Since the exact causes of vulvodynia are unknown, try and make sure you follow through the treatment plans. Do make an effort to maintain a stress-free lifestyle which will remove any triggers that cause pain. Talking to a counsellor will also help you deal with this condition in the healthiest way and will help you maintain a normal lifestyle.
Disclaimer: This information is educational and should not be construed as medical advice. Please consult your doctor before making any dietary changes or adding supplements.
Proactive For Her is a digital clinic for women, offering accessible, personalised, and confidential healthcare solutions. We offer out-patient care, diagnostic services and programs for various health concerns of Indian women, across their lifetime - from puberty to pregnancy to menopause.