Vulvodynia

Understanding Vulvodynia

Vulvodynia is a condition that causes long-lasting pain in the vulva, which is the external part of a woman’s genitals. This pain can happen without any clear reason and can feel different for each woman. While many describe it as a burning sensation, others might say it feels like “acid being poured on my skin” or “constant knife-like pain.”There are two main types of vulvodynia: localised vulvodynia and generalised vulvodynia, which can sometimes occur together.

Localised Vulvodynia

Localised vulvodynia usually affects just one specific area of the vulva. The most common type is called provoked vestibulodynia (PVD), where pain occurs when pressure is applied to the vestibule, the area around the vaginal opening. This pressure can come from activities like:

Having sex
Inserting a tampon
Going for a gynecological exam
Sitting for long periods
Wearing tight clothing

Most women with localised vulvodynia feel pain in just one spot, but some may also experience pain in the clitoris (this is known as clitorodynia). Types of Provoked Vestibulodynia PVD can be divided into two categories:

Primary PVD: Pain has been present since the first attempt at vaginal penetration.
Secondary PVD: Pain develops after having previously pain-free sexual experiences.

Generalised Vulvodynia

Generalised vulvodynia is different; it involves pain that happens spontaneously across various areas of the vulva and is often more constant. While there may be some times when the pain eases, activities that put pressure on the vulva—like sitting for long periods or having sex—usually make the symptoms worse.

image illustrating location of the dorsal, ischial spine, pudendal, perineal and inferior rectal nerves

Symptoms of Vulvodynia

Women with vulvodynia may experience a range of symptoms, including:

Burning or stinging sensations
Throbbing or aching discomfort
Itching or rawness in the vulvar area

The pain can be persistent or only occur during certain activities, but it’s important to note that the appearance of the vulva often looks normal despite significant discomfort.

Causes and Risk Factors

The exact cause of vulvodynia isn’t fully understood, but several factors might contribute to it:

Nerve Injury or Irritation: Damage to nerves in the vulvar area can lead to increased sensitivity and pain.
Hormonal Changes: Fluctuations in hormones might trigger or worsen symptoms.
Chronic Inflammation: Ongoing issues like repeated yeast infections or skin irritations can lead to inflammation.
Genetic Factors: Some women may be more sensitive due to their genetics.
Physical Trauma: Past trauma from childbirth or sexual abuse can result in long-term nerve damage.

Diagnosis and Treatment

To diagnose vulvodynia, healthcare providers will typically take a detailed medical history and perform a physical examination. There are no specific tests for vulvodynia; instead, diagnosis often includes:

A pelvic exam to check for signs of infection or inflammation.
A cotton swab test to see if certain areas are sensitive.

Treatment for vulvodynia varies and often involves multiple approaches. Some common options include:

Physical Therapy: To strengthen pelvic floor muscles and reduce muscle tension.
Medications: Certain medications can help lessen nerve sensitivity.
Cognitive Behavioral Therapy (CBT): This helps address emotional aspects related to chronic pain.
Lifestyle Changes: Avoiding irritants and practicing relaxation techniques can also help.

In some cases, if other treatments don’t work, surgery may be considered to remove painful tissue.

Vulvodynia is a challenging condition that affects many women. Understanding what it is, its symptoms, potential causes, and treatment options is crucial for managing this condition effectively. If you or someone you know is experiencing symptoms of vulvodynia, reaching out to healthcare professionals who specialise in this area can provide support and relief.

FAQs

Vulvodynia, simply put, is chronic vulvar pain without an identifiable cause. The location, constancy and severity of the pain vary among sufferers. Some women experience pain in only one area of the vulva, while others experience pain in multiple areas. The most commonly reported symptom is burning, but women’s descriptions of the pain vary. One woman reported her pain felt like “acid being poured on my skin,” while another described it as “constant knife-like pain.”
There are two main sub-types localised and generalized vulvodynia, which sometimes co-exist.

Most women have pain at only one vulvar site. If the pain is in the vestibule, the tissue surrounding the vaginal opening, the diagnosis is vestibulodynia (formerly known as vulvar vestibulitis syndrome (VVS)).
The majority of women with localised vulvodynia have Provoked Vestibulodynia (PVD), in which pain occurs during or after pressure is applied to the vestibule, e.g., with:
sexual intercourse
tampon insertion
a gynecologic examination
prolonged sitting, and/or
wearing fitted pants
A less common form of localised vulvodynia, known as clitorodynia (pain in the clitoris), can be very painful. PVD is further classified as primary or secondary.
Women with primary PVD have experienced vestibular pain since the first attempt at vaginal penetration.
Women with secondary PVD have experienced pain-free sexual intercourse prior to the development of vulvar pain.

For women with generalised vulvodynia (GV), pain occurs spontaneously and is relatively constant, but there can be some periods of symptom relief.
Activities that apply pressure to the vulva, such as prolonged sitting or sexual intercourse, typically exacerbate symptoms.