Vulvodynia: Understanding Causes, Symptoms, Diagnosis and Treatments

Understanding Vulvodynia

Vulvodynia refers to chronic pain and discomfort around the opening of the vagina, known as the vulva. It has no identifiable cause and can significantly impact a woman's physical intimacy and quality of life.

The main symptom is a burning, stinging, irritation or sharp pain in the vulva. It may occur in just one area or affect the entire vulva region. Vulvodynia typically comes and goes over time, with flare ups followed by periods of remission.

While not a common condition, studies estimate vulvodynia affects up to 16% of women at some point. There are various treatment options available to provide relief from symptoms.

Signs and Symptoms

The hallmark symptom of vulvodynia is vulvar pain that lasts for at least three months. The specific sensations can vary between women and may include:

• Burning, stinging, rawness
• Irritation, itchiness
• Soreness, tenderness
• Throbbing, pulsating pain
• Sharp, knife-like pain
• Pain on contact or with pressure

This discomfort most often occurs when the vulva is touched or rubbed, such as during intercourse, tampon insertion, gynecological exams, exercise or tight clothing. However, some women do have constant unrelenting pain.

Pain may be localized to one site like the clitoris or vaginal opening. Alternately it can be generalized around the entire vulva region including the labia. Many women also report accompanying lower back pain.

Symptoms range from mild to completely debilitating depending on the individual. Flare ups are common and episodes may last for a few hours up to several days.

What Causes Vulvodynia?

The exact causes of vulvodynia remain unclear. Current theories include:

• Nerve damage - irritation or injury to the many nerves that innervate the vulva
• Increased nerve sensitivity - localized hypersensitivity to touch
• Pelvic floor dysfunction - spasms in pelvic floor muscles
• Hormonal changes - fluctuations in estrogen, progesterone, testosterone
• Chronic yeast infections - recurrent candidiasis alters vulvar flora
• Skin conditions - dermatological issues like lichen sclerosus or lichen planus

There are also some predisposing factors that may increase a woman's risk:

• Genetics - family history
• Other pain disorders - fibromyalgia, chronic fatigue syndrome, IC
• Mental health issues - anxiety, depression
• History of sexual assault or trauma

Types of Vulvodynia

There are two main classifications of vulvodynia based on where symptoms occur:

Generalized Vulvodynia

This refers to pain affecting the entire vulva area including the labia, clitoris, vaginal opening and perineum. It typically occurs with light touch or pressure, such as with intercourse or gynecological exams.

Localized Vulvodynia

This is pain confined to a specific site like the clitoris or vaginal entrance. The most common type is vestibulodynia, which affects the vestibule around vaginal opening. Pain usually occurs with penetration.

Other localized types include clitorodynia (clitoral pain) and hemivulvodynia (one side of vulva). The pain is described as burning, stinging or raw.

Getting a Diagnosis

Seeing a gynecologist is the first step in diagnosis. Your doctor will ask about symptoms, examine the vulva for signs of infection, inflammation or skin conditions, and test vaginal pH.

A cotton swab test may be done to identify specific painful spots. Diagnostic criteria for vulvodynia include:

• Vulvar pain lasting 3 months or longer
• No underlying cause identified
• Pain with light touch that cannot be attributed to other disorders

Other potential causes of vulvar pain like yeast infections, skin diseases, and neurologic disorders will need to be excluded. Your doctor may refer you to a specialist like a vulvar pain specialist or dermatologist for further evaluation.

Medical Treatments for Vulvodynia

Although there is no cure for vulvodynia, several medical treatment options are available to manage symptoms. Your doctor can determine the best plan based on examination findings and your preference.

Medications

Prescription medications that may provide relief include:

• Tricyclic antidepressants - help regulate nerve pathways
• Anticonvulsants - reduce nerve excitability
• Muscle relaxants - ease pelvic floor dysfunction
• Nerve blocks - block pain signals from nerves
• Hormonal treatments - regulate estrogen levels

Pelvic Floor Therapy

Physical therapy focuses on relaxing tightened pelvic floor muscles through techniques like soft tissue mobilization and trigger point release. Yoga and biofeedback training may also help.

Surgery

When more conservative measures fail, surgery to remove painful tissue or cut nerve pathways may be an option. Potential procedures include vestibulectomy, perineoplasty, and decompression surgery.

Self-Care and Lifestyle Remedies

There are also many self-care strategies women can try at home to lessen vulvodynia flare ups:

• Wear loose, breathable cotton underwear
• Avoid scented products around vulva area
• Use mild unscented soaps and gentle vulvar care
• Try cold compresses or warm baths for pain relief
• Apply coconut oil to vulva to protect skin
• Engage in relaxing activities like yoga and meditation
• Eat a balanced anti-inflammatory diet

Keeping the area clean, dry and protected can help reduce irritation. Avoiding triggers like friction from tight clothes or chemicals in hygiene products is also key.

Coping with the Psychological Impact

In addition to physical pain, vulvodynia can negatively impact a woman's psychological health and self-esteem. A few tips for coping include:

• Joining a support group to connect with other women with vulvodynia
• Seeing a counselor or therapist to discuss fears and concerns
• Communicating openly with your partner about sexual intimacy
• Exploring non-penetrative sexual activities that avoid painful touch
• Practicing self-care through relaxing hobbies, exercise, and socializing
• Focusing on your value as a whole person, not just sexual function

Give yourself permission to take a break from sexual activity during flare ups. There are still many ways to maintain intimacy and feel pleasure.

Preventing Vulvodynia Flare Ups

Strategies that may help reduce the frequency and intensity of symptoms include:

• Avoid known triggers like scented products, irritating fabrics, showering
• Wear cotton underwear and loose, comfortable pants or skirts
• Use lubricant for intercourse to minimize friction
• Engage in open communication with your partner
• Reduce stress through relaxation techniques
• Apply ice packs or cold compresses to painful areas
• Take sitz baths in plain warm water
• Take medications or supplements to build up tolerance before flare

While flare ups cannot always be prevented, being aware of your individual triggers can help avoid exacerbating vulvodynia symptoms.

When to See a Doctor

Make an appointment with your healthcare provider if you experience any persistent vulvar pain, burning or irritation. Early diagnosis and treatment provides the best opportunity for managing chronic vulvodynia.

See your doctor right away if you suddenly develop severe vulvar pain or notice any lesions, wart-like bumps, spots, or ulcers on the vulva. This could indicate an infection or skin condition requiring immediate medical care.

Schedule regular check-ups to monitor progression and adjust treatment plans as needed. With time, many women find an individualized regimen that provides adequate symptom relief.

The Takeaway

Vulvodynia is a complex chronic pain condition affecting many women. The cause remains unclear but potential factors include nerve damage, muscle spasms, hormone changes and recurrent infections.

Treatment focuses on identifying triggers, managing pain episodes, and learning techniques to prevent flare ups. With a multi-disciplinary approach involving medication, therapy, and self-care practices, most women find significant improvement in their symptoms and quality of life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.