Vulvodynia is a chronic pain in the vulva, the exterior female genitalia. The pain or discomfort has no obvious cause and can affect the labia, clitoris, or vaginal opening. Phyllis Mate, a co-founder of the National Vulvodynia Association, provides insight into this condition.
The International Society for the Study of Vulvovaginal Disease defines vulvodynia as chronic vulvar discomfort or pain characterized by burning, stinging, irritation or rawness of the female genitalia. Chronic is defined as existing for at least three to six months.
The cause of vulvodynia remains unknown. It may be the result of multiple factors. Physicians speculate that it may be caused by an injury to or irritation of the nerves that supply and receive input from the vulva; a localized hypersensitivity to yeast; an allergic response to environmental irritants; high levels of oxalate crystals in the urine; or spasm and/or irritation of the pelvic floor muscles. There is no evidence that vulvodynia is caused by an infection or that it is a sexually transmitted disease.
Burning sensations are most common; however, the type and severity of symptoms experienced are highly individualized. Some women describe their pain as stinging irritation or rawness. Vulvodynia may be constant or intermittent, concentrated in one area or spread out.
The two major subsets of the condition: generalized vulvodynia and localized vulvodynia. Vestibulodynia is a specific kind of localized vulvodynia.
- Generalized vulvodynia is characterized by pain that is spread out throughout the vulvar region. It can be present in the labia majora and/or labia minora. Sometimes it affects the clitoris, perineum, mons pubis and/or inner thighs. The pain may be constant or intermittent, and it is not necessarily initiated by touch or pressure to the vulva. The vulvar tissue may appear inflamed, but in most cases, there are no visible findings.
- Localized vulvodynia is more common and the pain is at only one site, such as the vestibule. Women with vestibulodynia have pain when touch or pressure is applied to the vestibule ( the area surrounding the opening of the vagina). Women may experience pain with intercourse, tampon insertion, gynecologic exam, bicycle riding, horseback or motorcycle riding, and wearing tight clothing, such as jeans. Most often, the vestibule of women with VVS is inflamed and red.
Regardless of the type of vulvodynia a woman has, the disorder imposes serious limitations on a woman’s ability to function and engage in normal daily activities. The pain can be so severe and unremitting that it forces women to resign from career positions, abstain from sexual relations, and limit physical activities. Not surprisingly, these limitations negatively affect a woman’s self-image; many women become depressed because of the physical pain itself and the associated psychological and social implications.
The diagnosis of vulvodynia is made by ruling out other conditions that can cause vulvar pain, such as sexually transmitted diseases, infections, skin disorders, and human papillomavirus. A patient’s medical history needs to be reviewed carefully, and a complete vulvar and vaginal examination is necessary.
A culture is often taken from the vagina to rule out things like sexually transmitted diseases and infections. A “q-tip” test is often administered during the exam. During this test, different areas of the vulva and vestibule are touched with a cotton swab to determine the location and severity of a woman’s pain. If the doctor sees areas of skin that look suspicious during the exam, a biopsy of the skin may be required.
Additionally, physicians may recommend a colposcopy, a procedure that uses a specialized instrument to examine the vulva more closely.
Because the cause of vulvodynia is not known, treatment is usually geared towards relieving symptoms and giving some measure of pain relief. Different treatments work better for different women, so several might be tried to find the one that works best for you. The types of treatments that might be tried include:
- Removing irritants
- Oral pain-relieving medication
- Topical medications including hormone cream, topical anesthetics, and topical compounded medications
- Pelvic floor muscle therapy
- Nerve block injections
- Complementary and alternative therapies