One of the most frustrating things about vaginal health is the lack of available answers and treatments. This is especially true when it comes to a condition known as vulvodynia, which affects 16% of people with vulvas.
Often described as a stinging or burning sensation, vulvodynia pain can be severe or even debilitating, and can be felt in just one or in multiple parts of the vulva.
Science doesn’t know what causes vulvodynia—it is a diagnosis of exclusion, given when vulvar pain has lasted for more than three months and when no other cause of the pain can be identified.
There’s no known cure, but the good news is that there are ways to treat and manage the pain.
Even though there’s plenty we don’t know about vulvodynia, it’s important to be clued up on the things that we do, so that you know when it’s time to get checked out by a doctor and feel empowered to learn how to manage your pain.
What is vulvodynia?
Vulvodynia is a blanket term used to describe chronic pain in the vulva for which there is no other identifiable cause. In case you didn’t learn enough about female anatomy in sex-ed (*cough* thanks, gender health gap), the vulva is the external part of the genitalia assigned as female, and includes the labia (the folds of skin or “lips” that enclose the opening of the vagina), the vaginal opening, and the clitoris.
The Vulvodynia Lowdown
Vulvodynia can be described in more specific terms depending on where the pain is felt and whether it is triggered by any sort of activity, such as sex or inserting a tampon:
- Generalized vulvodynia describes pain felt in the entire vulvar area, rather than in one specific place
- Localized vulvodynia describes pain felt in only one place on the vulva
- Provoked vulvodynia describes pain that is triggered by an activity or contact made with the vulva
- Unprovoked vulvodynia is when the pain isn’t triggered by any known factor. This is sometimes also called “spontaneous vulvodynia.”
There is also a common type of vulvodynia called vestibulodynia, which is when pain is provoked in a specific part of the vulva.
What is vestibulodynia?
As you may have guessed from the name, vestibulodynia describes chronic pain in the vestibule, which is the area between the labia minora (inner lips of the labia) that contains the opening to both the urethra and the vagina.
Because the vestibule contains the vaginal opening, pain is usually triggered by vaginal penetration. Pain can occur in a variety of ways, and has been described as burning, stinging, itching, stabbing, and more. However this is usually only felt when touch or pressure is applied to the area. So, if sex is always painful or inserting a tampon hurts too much, it may be worth paying your doctor a visit
It’s also possible to experience more than one of the above types of pain, for example, if it hurts both when you use a tampon and randomly when there’s nothing touching your vulva. In this case, your vulvodynia may be referred to as “mixed”.
Sometimes, vulvodynia can develop following another condition, for example, a yeast infection, though most research is necessary to fully understand the connection. When this happens, the pain is referred to as “secondary”. Primary vulvodynia is when there is no identifiable or known cause for the pain at all.
Symptoms of vulvodynia
You may have already clocked that the defining symptom of vulvodynia is vulvar pain. Whether the pain is burning, stinging, throbbing, or something else, it’s classified as vulvodynia if it’s been going on for more than three months and no cause can be identified.
Who is at risk for vulvodynia?
Because we know so little about vulvodynia it’s hard to say for sure who is more likely to get it. One study found that people who had poorer sleep quality, other chronic pain conditions, PTSD, a history of vulvodynia, and other urogenital symptoms were more likely to get vulvodynia than people who weren’t affected by those factors. But, again, more research is needed.
How is vulvodynia diagnosed?
To diagnose vulvodynia, your doctor will first need to exclude other causes of your vulvar pain. First, they will ask you questions about how long the pain has been going on, your medical and sexual history, allergies, and for details on any previous treatments you’ve had.
Then, your doctor will use a cotton swab test to identify where the pain is and to determine whether the pain is local (in one spot) or generalized (all over).
Different tests are then used to exclude other causes, which could include checking your vaginal pH or checking to see if the vulvar pain is actually coming from another part of the body, such as referred pain from your back or hips.
If no other cause of the pain can be identified, you’re likely to be diagnosed with vulvodynia.
Causes of vulvodynia
Trying to figure out the cause of vulvodynia can be tricky because vulvodynia is a diagnosis of exclusion — if you know what’s causing your pain, then it isn’t vulvodynia.
But while we don’t know exactly what causes the condition, the mechanism that brings on the pain is thought to be when nerve endings in the skin of the vulva become over-sensitive.
According to one theory, there could be a primary trigger that causes inflammation or direct trauma to the vulva that then would stimulate the pain receptors. Possible triggers could be genetic or immune factors, infection, or damage to the nervous system.
Emotional and psychosocial factors, such as the state of your relationships, can also influence your physical and sexual health. While these are recognized as being related to vulvodynia, there isn’t really a clear understanding of how these factors are associated.
Vulvodynia pain can also be associated with changes in hormone levels—from taking birth control pills or entering menopause, for example. As with so many aspects of vaginal and gynecological health, so much more research is needed to better understand our bodies!
Treatment options for vulvodynia
Because vulvodynia can present in so many different ways and we don’t know for sure what causes it, there isn’t really a “gold standard” for how the condition is treated. Instead, there are multiple different pathways that your doctors may suggest based on your specific experiences, including your vulvar pain, your medical history, and more.
Your doctor might suggest taking medication, physical and/or psychological therapy, topical treatments, or even surgery in some cases.
Topical medications for vulvodynia
Numbing cream (local anesthetic)
Numbing creams do what they say on the tin: help to numb the area and, therefore, reduce pain. The most commonly used topical treatment for vulvodynia is a local anesthetic cream called lidocaine ointment, which can be used 30 minutes before sex or as a way to relieve vulvar pain.
However, it doesn’t always work for everyone. While it has been reported to reduce pain in some people, one study found that lidocaine cream was less effective than a topical placebo.
Did you know that antidepressants are sometimes used to treat nerve pain, and can be helpful in treating vulvodynia? Amitriptyline is often used as a first-line treatment here but doesn’t always work, or work as well, for everyone.
In one study of 150 patients, just over half (56%) responded positively to the use of amitriptyline cream applied topically onto their vulva—with 10% reporting that they were completely pain-free following treatment.
Estrogen is one of the MVPs when it comes to maintaining gyno health. Among other things, it helps to prevent the tissues of the vulva becoming thin and dry—which may cause pain, especially on contact or during sex.
Topical estrogen is then sometimes used to treat vulvar pain but with mixed results. One small study found that applying estrogen cream improved vulvodynia pain compared to those in the placebo group, while another slightly larger one found that both estrogen cream and placebo caused an improvement in pain. Again, more research is needed.
Certain types of physical therapy can also be useful in relieving pain. This includes pelvic floor training, techniques that work with soft tissue, and joints, and using vaginal dilators.
The approach taken here will be unique to you and the specific nature of the pain you’re feeling. For example, an overactive pelvic floor muscle can cause pain because it’s too tense and unable to relax. Dilation can work to “retrain” these muscles, while other therapies might focus on specific pressure points or areas of tissue.
Therapy can help in getting to the root of any psychological reasons behind your pain, including processing any past trauma or dealing with relationship issues. It can also help you to manage the mental health impacts of being in chronic pain and experiencing pain during sex.
Cognitive behaviour therapy (CBT) has been shown to improve pain and sexual function when delivered one-on-one or in a group format, while long-term effects of CBT were found to be comparable to surgery in terms of pain relief.
It’s easy to understand why people seek out home remedies—they’re usually inexpensive and may feel more safe because they’re positioned as being “natural”. But be wary when considering home remedies for vulvodynia as these aren’t often backed up by evidence.
For example, there has been some hype around the low oxalate diet—avoiding foods high in oxalates, aka oxalic acid, a natural compound in plants—as a means of relieving vulvodynia pain. It’s also sometimes called the kidney stone diet.
But there simply isn’t enough evidence to back this up and, in fact, more recent studies have shown that there is no association between consumption of oxalates and vulvodynia.
Coconut oil is generally considered safe enough to use on skin as a moisturizer, but there is limited evidence that it can specifically help with vulvodynia pain.
However, if the coconut oil is free from preservatives, then it can be applied to the vulva after bathing to reduce the risk of irritation. This can also help to hold moisture in the skin and improve its protective function as a barrier against outside threats. Make sure you pat the area dry before applying the oil and remember that coconut oil damages condoms!
There are some simple ways you can show your vulva some TLC that can reduce your risk of irritation.
- Wearing breathable, cotton underwear
- Avoiding irritants such as shampoos, dyes, and douching (douching is never a good idea!)
- Avoid cleaning the vulva with anything other than water
- Avoiding use of hair dryers on the vulvar area
- Using lube when having sex
- Applying cool gel packs to the vulvar area
- Applying preservative-free emollients (i.e. coconut oil, plain petrolatum) to the skin after bathing and the area has been patted dry
- Rinse and pat the vulva dry after you pee
There may be plenty of unknowns when it comes to vulvodynia, but at Evvy, we’re big believers in focusing on what we do know so that we can better understand our bodies. Our Vaginal Health Test can help you to monitor changes within your vaginal microbiome, which may shed some light on any recurrent symptoms you’re facing.