
With approximately 16 percent of women in the United States having vulvodynia, you probably know someone with this painful condition that affects the vulva area of the vagina. But many women are scared, nervous or embarrassed to talk about this pain with their partners, friends, family and even physicians, leading many women to suffer in extreme discomfort without seeking medical treatment.
I urge women who experience pain or discomfort of the vulva to seek out a doctor with experience treating this condition. Many patients tell me they had a challenging time finding a doctor who could help them, and that they felt like their pain was dismissed. I reassure patients that the pain is real, not in their heads. Working together, we can often manage the pain so that women can have less discomfort during activities they enjoy.
What is vulvodynia?
Vulvodynia is pain or discomfort of the vulva that lasts for at least three months. (The vulva is the area outside the body that surrounds the opening of the vagina. The vulva includes the clitoris and labia.) While vulvodynia usually affects adults, it can affect adolescents as well.
Teens may feel symptoms when they start using tampons.
Women in their 20s, 30s and 40s may develop symptoms as the result of using some methods of birth control or with breast feeding. This is due to hormonal changes.
Women in their 50s and older who are going through perimenopause or menopause may experience symptoms as their levels of estrogen fall, causing vaginal dryness that can lead to pain in the vulva.
Vulvodynia can affect women in different ways: It can cause pain when having sex, it can affect relationships, and it can hurt a woman's self-esteem. Some women who struggle with this pain for years can develop chronic stress and other mental health conditions.
What are the symptoms of vulvodynia?
Symptoms vary but women may describe the pain as mild aching, soreness, throbbing, intense burning or a stinging sensation. The pain may be constant for some women, and it may come and go for others.
Some women feel pain when there's a trigger. This is called "provoked" vulvodynia. Triggers can include touching the area, sex, wearing tight clothing, inserting a tampon, a gynecological exam or sitting for long periods of time. Other women feel pain constantly. This is referred to as "unprovoked" vulvodynia.
Some women feel pain in one particular spot of the vulva; this is called localized pain. Others feel pain in the entire vulva; this is called generalized pain.
What are the causes and types of vulvodynia?
There are several different causes and types of vulvodynia. They include:
- Vaginitis, or inflammation of the vagina. Getting several yeast or bacterial infections can lead to inflammation of the vulvar area. Inflammation causes pain, including painful sexual intercourse.
- Congenital neuroproliferative vulvodynia. Patients with congenital vulvodynia are born with the condition but usually notice their symptoms around the time of starting puberty and using tampons. Although born with the condition, patients generally don't have symptoms until their teen years.
- Hormonally mediated. Changes in hormone levels and hormone imbalances are the most common reasons for vulvodynia in women in their 20s and older. There is a link, for example, between birth control pills and vulvodynia. The pills can lower the amount of estrogen and testosterone in the vulvar area, leading to dryness and pain. Likewise, women going through perimenopause or menopause experience declines in estrogen levels, leading to vulvodynia.
- Hypertonic pelvic floor dysfunction. Tight pelvic floor muscles can lead to vulvodynia and painful sex. Doctors will check the tone of a patient's pelvic floor muscles to determine whether this is a factor in vulvar pain.
- Pudendal neuralgia. There are many nerves in the vulvar area, and the pudendal nerve is one of the largest ones. When it is compressed – for example, when sitting for a long period of time – some people feel pain the vulvar area.
Sexual trauma and injuries during childbirth can also lead to vulvodynia.
Some women are at increased risk of developing vulvodynia, women who have anxiety, depression, repeated vaginal infections, irritable bowel syndrome (IBS), or interstitial cystitis / bladder pain syndrome.
How will the doctor diagnose vulvodynia?
To diagnose vulvodynia, The doctor will first take a detailed history, asking patients about when the pain started, what happens right before the pain starts, and how the pain affects quality of life. The doctor will also ask about any products being used in the vaginal area and any medications being taken.
The doctor also will look at the vulva and vaginal area for any signs of inflammation, usually using a Q-Tip to look for the source of pain. Doctors will also take a culture and order labs to rule out other medical conditions. Testing the tone of the pelvic floor muscles is also part of the exam.
Some women have a history of trauma and get very anxious during pelvic exams. In these cases, we ask the patient for permission to perform the exam. We encourage patients to share only as much information as they want. We also offer stress balls, soft music, and hot water packs to reduce anxiety associated with exams. We try to give patients control in situations that can provoke anxiety.
How is vulvodynia treated?
There are a variety of ways to treat the symptoms of vulvodynia. Many patients find that a combination of strategies helps.
Treatment can include:
- Topical creams. These are creams that are applied to the affected area. Creams that contain estrogen can be helpful if a patient's low estrogen levels are causing vulvodynia.
- Pelvic floor therapy. Doctors and therapists can assess the entire pelvic floor area to determine whether pelvic floor therapy would be helpful. Pelvic floor therapy is a form of physical therapy that teaches patients how to relax the pelvic floor muscles to reduce vulvar pain. Pelvic relaxation exercises can be done at home to reduce pelvic muscle tension; these exercises can be particularly helpful before sex. Many women find yoga, meditation and other stress-relieving activities to be helpful as well.
- Surgery. A procedure called a vestibulectomy can be performed to remove the affected skin or tissue. Though surgery is considered a last resort, it can be successful in patients with pain that isn't improved by other treatments.
Dilators are an excellent tool to relax those pelvic muscles. This is one of the tools your doctor may suggest trying at home.
Patients can also take steps at home to manage their pain. A diet rich in anti-inflammatory foods can be helpful. That means plenty of berries and other fruits. Limiting alcohol and avoiding processed foods can also reduce symptoms.
Other lifestyle changes include wearing 100 percent cotton underwear, avoiding tight clothing, and avoiding bicycling or horseback riding for long periods of time.
To reduce vaginal infections that can lead to vulvodynia, women are encouraged to reduce their use of lotions, scented deodorants and other products near the vagina. Water is the best way to keep the area clean.
Women experiencing vulvodynia are encouraged to seek out mental health services. Coping with vulvodynia is stressful – and managing stress is important because stress and anxiety can make the pain worse. Many women also benefit from therapy as the navigate the effects of vulvodynia on relationships with their partners.
I encourage all women who are experiencing the symptoms of vulvodynia to talk to their doctors. Don't suffer. Try not to get discouraged. It may take a while to find the right combination of treatments that will help each individual woman, but we are committed to helping them have a better quality of life.