Updated: 9/21/23
As women, we often take our body for granted, and when it comes to the female reproductive system, we’re often hesitant to talk about it. One such condition that many women don’t know much about is Vulvodynia. If you’re experiencing unexplained vulvar pain, dryness, or itching, then it could be Vulvodynia. Don’t worry; you’re not alone. In this blog, we’ll explain everything you need to know about this misunderstood condition, its symptoms, causes, and treatments.
What is Vulvodynia?
Vulvodynia is a genital pain condition that affects the vulva or the outer part of the female genitalia. It can vary in intensity from mild discomfort to severe pain, and the symptoms can be continuous or intermittent. This pain is unique to Vulvodynia and cannot be attributed to any other specific illness. The pain can make it challenging to sit, stand, or exercise, and it can be difficult to have intimate relations, leading to dysfunction. Some women only feel pain in one part of the vulva, while others feel it in more than one area.
Unlike other conditions that may cause similar painful or uncomfortable symptoms, vulvodynia is not an infection and it is not a sexually transmitted disease. Physicians have not defined a specific cause, but according to the National Vulvodynia Association, research shows that vulvodynia may be caused by underlying inflammatory disorders or inconsistent nerve signals within the vulva. But there is still plenty of research to conduct. An estimated 16 percent of women all over the world experience vulvodynia at some point in their lives, which is a significant statistic.
Types of Vulvodynia
There are two main types of vulvodynia, which can occur on their own or at the same time: localized and generalized vulvodynia.
Localized Vulvodynia (Provoked)
The majority of women only feel pain in one area of the vulva. There are subcategories of localized vulvodynia based on where the patient feels pain, including vestibulodynia and clitordynia.
Vestibulodynia
Women with vestibulodynia, formerly called vestibulitis syndrome, feel pain in the vestibule, which is the tissue that surrounds the opening of the vagina. The pain develops from pressure to the vestibule from:
- Intercourse
- Gynecologic exam
- Tampon use
- Wearing fitted pants
- Prolonged sitting
There are two more classes dividing vestibulodynia: primary and secondary. Women with primary vestibulodynia begin to feel pain at the first attempt of intercourse, while women with secondary vestibulodynia have painless intercourse before they develop pain.
Clitorodynia
This is a rare type of localized vulvodynia. Patients feel pain in the clitoris, which is an extremely sensitive organ in front of the vagina, so it can be very painful.
Generalized Vulvodynia
In generalized vulvodynia, the patient feels constant sudden pain. Unprovoked generalized vulvodynia causes pain without any touch or pressure. The patient may experience periods during which the symptoms subside. Intercourse, prolonged sitting or wearing pants may put pressure on the vulva and make the symptoms even worse. The pain may occur in one or multiple areas.
What Does Vulvodynia Feel Like?
Vulvodynia often lasts for at least three months and may even last for years. The condition is not life-threatening, but it usually starts suddenly and the pain may interfere with daily activities. It may also take a toll on the patient’s mental health and potentially cause stress, anxiety and depression.
The main symptom is pain. It may affect a specific location or a wider area. Aside from just the genital region, the patient may even feel pain in the upper legs and inner thighs. Patients with vulvodynia may also feel an irritating, burning, stinging or itching feeling in the tissue of the vulva. Sometimes the tissue is also inflamed. The vulva may feel raw and sore, or it may throb or swell.
Neuropathic Pain
Specifically, vulvodynia causes neuropathic pain. This usually means there is tissue injury in the body, specifically damaged or dysfunctional nerve fibers that send the wrong pain signals. In vulvodynia, the hypersensitive nerve fibers in the vulva and the area surrounding it send unusual signals to the brain.
Vulvodynia pain may be immediate, delayed, intermittent, persistent or constant in timing. The symptoms may be more serious during or after walking, sitting, intercourse, exercise, tampon insertion or any other activity that puts pressure on the vulva.
Risk Factors for Vulvodynia
The actual cause of Vulvodynia is unknown, but certain hormonal changes, infections, inflammation, and nerve damage may play a role. Often this condition is associated with an imbalance of hormones or neurotransmitters, which can lead to nerve damage or irritation in the vulvar region. Some medical conditions associated with Vulvodynia include Candida, herpes, and bacterial vaginosis. However, there are several factors that researchers suspect may contribute to vulvodynia.
Genetic Factors
Studies suggest that there may be a genetic predisposition, including alterations in inflammatory response, strong pain sensitivity and susceptibility to persistent inflammation.
Nerve Damage
Because the pain is neuropathic, it develops when the nerve fibers in the vulva become damaged or irritated. Then they are unable to send correct signals to other areas of the body.
The density of the nerve fibers in the vulvar vestibule may increase, making the areas more sensitive. The hormone receptor activity in the vulva’s tissue may also change.
Inflammatory Malfunction
The vulva may contract high levels of inflammatory materials in its tissue. In some cases, the cells in the vulva may react abnormally to this inflammation, as well as other environmental factors, such as physical trauma or injury to the vulva. The vulva may also endure localized ultra-sensitivity to infections or organisms in the vulva and vagina, such as Candida albicans, a species of the Candida genus and the most common type of yeast infection.
Weak Pelvic Muscles
The condition may also be a result of muscle spasms, weakness or instability in the pelvic floor. There are three categories: the superficial muscles, the middle layer and the deep pelvic floor muscles. The muscles support urinary, bowel and function and when they weaken, it can cause side effects, such as pain in the vulva.
Is Vulvodynia Curable?
Unfortunately, there is no definitive cure for vulvodynia. Furthermore, the treatment choices for vulvodynia are focused mainly on decreasing discomfort rather than attempting to cure the condition entirely. Nevertheless, there are various treatment methods that alleviate the symptoms of vulvodynia, making it more bearable.
Treatment for Vulvodynia
Vulvodynia is not life-threatening, but it can cause extreme pain and discomfort. Since there is no single cause for vulvodynia, treatment focuses on easing symptoms and providing pain relief. Doctors tailor treatment plans to each patient and they may require more than one method to find a successful solution.
Topical Medications
Patients can apply topical ointments and creams with nerve-stabilizing medication or anesthetics to the area around the vulva. For example, physicians may prescribe hormonal medications or compounded formulations, such as an antidepressant or anticonvulsant.
Oral Medications
There is no cure yet for Vulvodynia, but several available treatments can help manage this distressing and frustrating condition. Medical professionals can prescribe oral medications that include anticonvulsants, antidepressants, and nerve blocks. For instance, Tricyclic antidepressants, such as Amitriptyline or Nortriptyline, can assist manage pain, improve mood, and quality of sleep. Anticonvulsants, like Gabapentin or Pregabalin, work by suppressing overactive nerves, potentially reducing chronic pain. These are pain-blocking medications to relieve nerve pain.
Biofeedback
Biofeedback is a technique that focuses on teaching you how to control bodily functions like muscle tension, heart rate, and breathing rate. It is useful for treating Vulvodynia because it helps you focus your attention on relaxing the muscles associated with pain. Biofeedback involves the use of electronic instruments, like sensors and monitors, to measure bodily functions.
During biofeedback therapy, a therapist will attach sensors near the vaginal area to monitor the muscle tension around that area. The therapist will then teach you relaxation techniques like deep breathing and visualization to help you relax those muscles. You can see the results of your muscle relaxation on a monitor. The goal is to train you to relax the muscles without the need for biofeedback so that you can manage your pain on your own.
Biofeedback therapy is often done in conjunction with other treatments like medications and physical therapy. It can help you learn relaxation techniques that can reduce the pain and discomfort associated with Vulvodynia. It may take several sessions to feel improvement, but with persistence and patience, biofeedback can be a helpful tool.
This treatment helps the patient learn how to relax the pelvic muscles, which may help reduce vulvar pain.
Physical Therapy
Though the exact cause of vulvodynia is not clear, physical therapy can offer some relief for many women who experience it. Physical therapists have been successful in using techniques such as manual therapy, pelvic floor muscle relaxation, pain education, and biofeedback to help women manage their symptoms.
Manual therapy involves gentle manipulation of the muscles and tissues in the pelvic floor and vulval area to improve blood flow and reduce tension. Pelvic floor muscle relaxation can help patients learn to release the tension in their muscles, which can also improve blood flow and reduce pain. Pain education is an important component of physical therapy for vulvodynia patients, as it helps them understand how pain works and how to manage it.
Similar to biofeedback, physical therapy aims to relax pelvic muscles. However, its purpose is myofascial release rather than strengthening the muscles.
Dietary Modifications
Research suggests that diets high in oxalate salts may contribute to vulvodynia. Consult a doctor about dietary modifications and confirm any allergies and get medical advice about eliminating food that may be affecting the condition. In a study, a vulvodynia patient took calcium citrate along with a low-oxalate diet, resolving her symptoms.
Track your diet and record the results in a food diary. You might start to notice a link between certain foods and the frequency or severity of their symptoms. Patients with interstitial cystitis may also find this useful.
Counseling
Vulvodynia can restrict routine activities, interfere with intimate and interpersonal relationships and lower the quality of life. Patients who experience chronic vulvar pain may also develop low self-esteem and depression. Regardless of the other approaches that a patient uses to control vulvar pain, they may also benefit from psychological counseling. Cognitive-behavioral therapy can be useful in managing anxiety and depression caused by this distressing condition. It may help them develop coping mechanisms and sort through problems with intimacy.
Vestibulectomy
One of the most effective treatments for vulvodynia is vestibulectomy. Vestibulectomy is a surgical procedure that involves the excision of the vulvar vestibule, which is the area surrounding the hymeneal ring in the vagina. Vestibulectomy reduces the number of pain receptors in the vulvar vestibule, resulting in a reduction in pain intensity. The procedure is usually performed under local or general anesthesia, and patients can go home the same day. Recovery time after the surgery is approximately two to three weeks. Some patients with localized vulvodynia may need surgery to ease their pain if other treatments have failed. Vestibulectomy gets rid of the affected tissues and skin around the opening of the vagina.
Home Remedies for Vulvodynia
Other remedies that don’t require a doctor or surgeon may be helpful, just simple lifestyle changes. For example, avoid products that may dry or irritate the skin. Keep irritants away by ditching soaps, detergents and shampoos with scents or dyes. Avoid bubble baths, fabric softeners, vaginal wipes and douching. The vagina cleans itself naturally, so it doesn’t need anything drastic to keep it functioning properly.
Wear cotton underwear and loose clothing. Avoid materials that hold moisture, such as nylon. Gently pat the vulva dry after urinating and avoid wearing sweaty workout gear or wet bathing suits for too long. Prevent painful intimacy with lubricants without irritating scents or cooling or warming effects. Cool ice packs may help relieve pain in the vulva.
Exercises for Vulvodynia
Pelvic Floor Exercises
The pelvic floor muscles are responsible for supporting the bladder, uterus, and rectum. Strengthening these muscles can help reduce the pressure on the vulva, thus reducing the pain of vulvodynia. Kegel exercises are one way to strengthen these muscles. To get started, contract your pelvic floor muscles (as if you were stopping urine flow) for five seconds, then relax for five seconds. Repeat 10-15 times.
Stretching Exercises
Stretching exercises can help relieve tightness and tension in the pelvic floor muscles, which can exacerbate pain in women with vulvodynia. Yoga has been shown to be particularly helpful in reducing vulvodynia symptoms. Try the Reclining Bound Angle Pose, also known as Supta Baddha Konasana. First, lie on your back, then bring the soles of your feet together and let your knees drop out to the sides. Hold for 10-15 deep breaths.
Aerobic Exercises
Aerobic exercise, such as walking or swimming, can promote circulation, reduce stress, and build endurance in the body. Try low-impact exercises that won’t put too much pressure on the vulva or pelvic floor muscles. Start with a few minutes of aerobic exercise per day, then gradually increase until you can do 30 minutes or more. Exercise can also help you manage the endocrine system that controls stress hormones.
Supplements for Vulvodynia
Vulvodynia patients may lack vital nutrients and may not receive enough vitamins for the pelvic, vaginal and vulvar tissues to function optimally. Magnesium, Vitamin D, omega-3 fatty acids and antioxidant deficiencies may contribute to vulvodynia. Therefore, these supplements may help maintain overall health as well as support optimal vulvovaginal health.
Magnesium
This mineral plays an essential role in supporting nerve health. Magnesium maintains normal muscle and nerve function. A magnesium deficiency can increase the risk of inflammation, which can then lead to health problems like vulvodynia. Take ½ to 1 tsp of magnesium citrate powder daily mixed into a liquid, unless a doctor advises against it.
Vitamin D3
Not only does it support healthy blood pressure levels and healthy bones, but studies also link Vitamin D deficiency to neuropathic pain. A study concluded that 80 percent of its female subjects with neuropathic pain were deficient in Vitamin D. As a dietary supplement, take vitamin D3 (cholecalciferol) in 50 mg doses daily, or following a physician’s instructions.
Omega-3-6-9
Fatty acids like omega-3-6-9 are important for healthy neurotransmitter and brain cell function (x). Physicians believe that they may support healthy blood pressure and cholesterol levels and promote brain health. They also control nerve damage by enhancing signal transmission and nerve density. Take three omega-3-6-9 softgels one or two times a day, or as recommended by a doctor.
Beta Carotene
A pigment found in plants, beta-carotene is an antioxidant credited with promoting healthy aging and a healthy immune system. It has antioxidant properties that help fight nerve-damaging free radicals. Take 1,300 mg of beta-carotene powder per day, or as instructed by a physician.
Saw Palmetto Extract Powder
Derived from a palm tree plant, saw palmetto extract is used to help treat prostate disorders in men. However, it may also benefit women’s health by regulating hormonal imbalances. As a dietary supplement, take 500 mg of saw palmetto extract powder daily after confirming the dosage with a doctor.
The Bottom Line
Vulvodynia is persistent pain in the vulva, the part around the vagina’s opening. The vulva protects the female sexual organs. The main vulvodynia symptom is pain and sometimes it’s sharp , dull, throbbing, stinging or sore. Other times, it’s burning pain and the vulva may be swollen or inflamed. Vulvodynia pain may be mild or so severe that it makes it difficult for the patient to carry out daily functions, but it is not life-threatening.
Doctors have not identified a singular cause for vulvodynia. However, there are many different risk factors that may contribute. Research associates the condition with inflammatory malfunction, damage to nerves in the vulvar area (neuropathic issues), genetic factors, environmental factors, hormonal factors and musculoskeletal issues.
Living with vulvodynia can be challenging, but it is essential to remember that you are not alone. By understanding the causes and symptoms of this condition and implementing healthy lifestyle changes, you can manage the pain and enjoy a fulfilling life. Remember to listen to your body, seek professional help when necessary, and prioritize self-care. Let’s break the silence around vulvodynia and promote awareness and understanding of this chronic pain condition.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease