Vulvodynia (vul-voe-DIN-e-uh) is chronic pain or discomfort around the opening of your vagina (vulva) for which there's no identifiable cause and which lasts at least three months. The pain, burning or irritation associated with vulvodynia can make you so uncomfortable that sitting for long periods or having sex becomes unthinkable. The condition can last for months to years.
If you have vulvodynia, don't let the absence of visible signs or embarrassment about discussing the symptoms keep you from seeking help. Treatment options are available to lessen your discomfort. And your doctor might be able to determine a cause for your vulvar pain, so it's important to have an examination.
The main vulvodynia symptom is pain in your genital area, which can be characterized as:
Painful intercourse (dyspareunia)
Your pain might be constant or occasional. It might occur only when the sensitive area is touched (provoked). You might feel the pain in your entire vulvar area (generalized), or the pain might be localized to a certain area, such as the opening of your vagina (vestibule).
Vulvar tissue might look slightly inflamed or swollen. More often, your vulva appears normal.
A similar condition, vestibulodynia, causes pain only when pressure is applied to the area surrounding the entrance to your vagina.
When to see a doctor
Although women often don't mention vulvodynia to their doctors, the condition is fairly common.
If you have pain in your genital area, discuss it with your doctor or ask for a referral to a gynecologist. It's important to have your doctor rule out more easily treatable causes of vulvar pain â€” for instance, yeast or bacterial infections, herpes, precancerous skin conditions, genitourinary syndrome of menopause, and medical problems such as diabetes.
It's also important not to repeatedly use over-the-counter treatments for yeast infections without seeing your doctor. Once your doctor has evaluated your symptoms, he or she can recommend treatments or ways to help you manage your pain.
Vulvodynia treatments focus on relieving symptoms. No one treatment works for every woman. For many, a combination of treatments works best. It can take time to find the right treatments, and it can take time after starting a treatment before you notice relief.
Treatment options include:
Medications. Steroids, tricyclic antidepressants or anticonvulsants can help lessen chronic pain. Antihistamines might reduce itching.
Biofeedback therapy. This therapy can help reduce pain by teaching you how to relax your pelvic muscles and control how your body responds to the symptoms.
Local anesthetics. Medications, such as lidocaine ointment, can provide temporary symptom relief. Your doctor might recommend applying lidocaine 30 minutes before sexual intercourse to reduce your discomfort. Using lidocaine ointment can cause your partner to have temporary numbness after sexual contact.
Nerve blocks. Women who have long-standing pain that doesn't respond to other treatments might benefit from local nerve block injections.
Pelvic floor therapy. Many women with vulvodynia have tension in the muscles of the pelvic floor, which supports the uterus, bladder and bowel. Exercises to relax those muscles can help relieve vulvodynia pain.
Surgery. In cases of localized vulvodynia or vestibulodynia, surgery to remove the affected skin and tissue (vestibulectomy) relieves pain in some women.
Doctors don't know what causes vulvodynia, but possible contributing factors include:
Injury to or irritation of the nerves surrounding your vulvar region
Past vaginal infections
Allergies or sensitive skin
Muscle spasm or weakness in the pelvic floor, which supports the uterus, bladder and bowel
Because it can be painful and frustrating and can keep you from wanting sex, vulvodynia can cause emotional problems. For example, fear of having sex can cause spasms in the muscles around your vagina (vaginismus). Other complications might include: