Vaginal Pain (Vulvodynia)

Illustration of Vagina

Vulvodynia refers to pain in the area of the vulva and vaginal opening. Vulvodynia is considered pain for which there is no known cause. It is different from the pain that is located deep in the pelvis or internally in the vagina. This article focuses on pain in the vulvar region and at the opening (introitus) of the vagina. Deeper vaginal pain can also occur due to infections, tumors, and conditions that cause more generalized pain in the pelvic organs.

• Vaginal pain can be chronic and can last for years in some women.
• The degree of severity varies among women.
• It often occurs in the absence of physical signs or visible abnormalities.
• It can be severe and can interfere with sexual activity and cause painful intercourse (dyspareunia).
• However, there are several other causes of vaginal pain during or after sex.

The pain of vulvodynia can be debilitating and interfere with daily activities and sexual intercourse. It can make women feel a loss of control of their bodies, causing profound emotional and physical discomfort.

Symptoms of vulvodynia and vaginal pain may include:

• Burning or stinging pain in the vulva or vaginal opening
• Sharp, aching, or throbbing pain in the vagina or vulva
• Vaginal itching, sometimes with pain
• Pain that is constant or comes and goes
• Pain that occurs during sex or exercise

Some women report pain that is localized to one side or one area of the vulva, while others have more generalized and widespread pain. Usually, no physical signs or changes occur in and around the vagina with vulvodynia; however, sometimes the skin may be inflamed.

It is unclear why some women develop vulvodynia. It is not thought to be related to sexually transmitted diseases (STDs), although some women with vulvodynia have had multiple STDs.

Some theories suggest that vulvodynia may be related to:

• damage or irritation of nerves,
• abnormal responses to irritation or inflammation,
• allergic reactions,
• muscle spasms,
• a history of sexual abuse, or
• frequent use of antibiotics.

Familial or genetic factors also have been suggested to play a role in vulvodynia. Unfortunately, the exact cause has not been determined and most women have no known contributing factors.

What if you have vaginal pain during pregnancy?

Vaginal pain may occur during the third trimester of pregnancy due to an increase in pressure on the cervix. Women who experienced vulvodynia before becoming pregnant may continue to experience this symptom during pregnancy.

Since the cause is poorly understood, it is difficult to predict who is at risk for vulvodynia.

• It can affect women of all ages and races.
• It can begin as early as adolescence and can occur both before and after menopause.
• It may occur during the menstrual period or independent of the menstrual period.

No specific tests confirm vulvodynia. Usually, vaginal pain and vulvodynia are diagnosed based on the characteristic symptoms of the condition. However, since vulvar and vaginal infections, (for example, yeast infections, bacterial vaginosis, and vaginitis) are associated with vaginal burning and itching, cultures or other diagnostic tests may be ordered to rule out vaginal infections.

Vulvodynia is a chronic condition (it may last for months to years) in some women; in others, it may come and go. Vulvodynia and vaginal pain can be managed using medical treatments and self-care (home remedies). Not all treatments will be effective for every woman, and a woman may have to try different treatments to find the most effective option for her.

Vulvodynia is not associated with cancer or with any serious medical diseases, but it may be a source of chronic pain and emotional discomfort for some women.

What medications and home therapies can relieve vaginal pain?

Some of the medications that have been useful include:

• Topical estrogen creams
• Topical or local anesthetics
• Tricyclic antidepressants
• Anticonvulsants (anti-seizure medications are sometimes useful in managing chronic pain)

Other medical therapies for women with severe vulvodynia include:

• Injections of interferon or nerve blocks, in which medications are injected to reduce signals from nerves in the affected areas
• Biofeedback training and pelvic floor exercises have been helpful for some women.
• Surgical removal of affected tissue can be of benefit in women with vulvodynia due to vulvar vestibulitis syndrome, a particular type of vulvodynia that is located in the area of the hymenal ring.

What treatments and home remedies help relieve pain?

Home remedies and self-care measures for vulvodynia can bring relief to many women.

Some self-care measures to relieve the pain of vulvodynia include:

1. Rinsing the area with cool water, particularly after urination and sexual activity
2. Soaking in cool or warm sitz baths
3. Using topical ice packs wrapped in a towel
4. Heating pad use, in contrast, may help some women
5. Using mild, unscented soaps and detergent
6. Using white, unscented toilet tissue
7. Wearing white cotton underwear
8. Wearing loose-fitting clothing and avoiding stockings or pantyhose
9. Avoiding pools or hot tubs with chlorinated water
10. Using a water-soluble lubricant during sexual intercourse
11. Avoiding activities such as bicycling, that put pressure on the vulvar area
12. Keeping the vulvar area dry and clean
13. Avoid food that can make the urine more irritating to the skin of the genital area, such as beans, berries, nuts, and chocolate
14. Over-the-counter antihistamines can help reduce itching, particularly at night