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Vulvodynia causes chronic pain in the vulva, the outer parts of the female genitals. Treatment includes a combination of oral and topical medication, physical therapy, and other procedures if needed.
What is vulvodynia?
Vulvodynia is a chronic condition that causes pain in the vulva, the outer parts of female genitals. The pain can feel like itching, burning, stinging, or rawness. It can range from mild to severe and be triggered by something like inserting a tampon, or happen for no reason.
It’s very common, affecting about 16% of women of all ages and races. It typically appears between the ages of 18 and 25, according to the National Vulvodynia Association.
Although it’s not understood what causes it, some theories suggest that it may be from inflammation, nerve injury or irritation, hormonal or muscular problems, or genetics. Often, women with vulvodynia have other chronic pain syndromes, including irritable bowel syndrome, painful bladder syndrome, and fibromyalgia.
Treatment of vulvodynia often includes a combination of oral medication, topical medication, and physical therapy.
There is a long list of treatment options. If the first few don’t work, there are so many more to try. Often a combination of them are needed. Don’t get discouraged! —Dr. Katz
Symptoms of vulvodynia
Vulvodynia causes pain in the labia, clitoris, or vaginal opening. There are two main types. Localized vulvodynia is pain in one area of the vulva, usually the opening. It often happens after prolonged pressure on the area, such as during sexual intercourse, inserting a tampon, or sitting for long periods of time.
General vulvodynia is when the pain is in different areas of the vulva. There is usually constant pain that worsens when the vulva is under pressure for some time, like from wearing tight pants. The pain is also in the perineum (the area between the vulva and anus) and inner thighs.
- Sharp, stabbing pain
- Burning or stinging
- Throbbing or aching
These symptoms can be from other conditions, like urinary tract infections and vaginal infections. It’s important to see a doctor to get the right diagnosis.
There is no exact cause. It is not a quick fix. It is not from an infection or STD —Dr. Jessica Katz
Although the exact cause of vulvodynia is not yet known, there are several theories. These include:
- Irritation or injury of the nerves that control vulvar sensation
- Genetic factors that make the vulva overreact to chronic inflammation
- Being over sensitive to yeast infections
- Muscle spasms or weakness of the pelvic floor muscle
- Allergy or irritation caused by certain chemicals
- Hormonal changes
- Frequent antibiotic use
Risk factors include:
- Post-traumatic stress disorder
- History of sexual abuse
- Having other chronic pain syndromes, such as fibromyalgia, migraines, irritable bowel syndrome, and painful bladder syndrome
Ask your doctor: Do you have experience treating vulvodynia? If not, where can I go to see someone who is specialized in this area? —Dr. Katz
While there isn’t any cure for vulvodynia, there are treatments for the pain. But it can take time to find the right combination of therapies. Some treatments take longer to work, and women may respond differently to each treatment.
Basic vulvar care
- Wear cotton underwear during the day (and no underwear at night).
- Avoid tight-fitting clothing.
- Don’t use scented tampons and pads.
- Don’t douche.
- Try to clean the vulvar area only with water (no soaps), and pat it dry instead of rubbing after showering and urinating.
- Apply a preservative-free oil or jelly to the area after you shower to keep moisture in and protect the skin.
- If intercourse is painful, use a water-soluble lubricant to lessen discomfort.
- Topical anesthetic ointments. These provide fast but temporary pain relief and can be applied before sexual activity or throughout the day as needed.
- Topical estrogens. Your doctor may prescribe these if you have low estrogen. It can take 1–2 months to notice an improvement.
- Tricyclic antidepressants. This type of antidepressant has pain-blocking properties. It may be several weeks before they take effect.
- Gabapentin. This is an anti-seizure medication that is also effective for pain. It may be several weeks before you notice an improvement.
- Nerve blocks. Injections of lidocaine with or without a steroid can block nerves and provide temporary and sometimes long-term relief.
- Spinal infusion pump. This implanted device continuously delivers a small dose of medication to the spinal cord and nerve roots to help dull pain. It may be recommended if other treatments have not helped.
Spasms or weakness of the pelvic floor muscles may contribute to vulvar pain or be caused by the pain. Physical therapy treatments include exercise, education, massage, ultrasound, and electrical stimulation.
An important part of physical therapy is biofeedback. This teaches you how to control the contraction and relaxation of your pelvic muscles, which may reduce pain. This is especially helpful during sex, where you can learn to consciously relax the pelvic muscles.
Relaxation and breathing techniques may be recommended for the same reason.
Sex therapy and psychological counseling
Your doctor may suggest these treatments if vulvodynia is hurting your self-image, making you feel depressed or anxious, or affecting your relationship with your partner.
Eliminating some foods from your diet may be helpful. Keep a food diary to determine whether eating certain foods increases pain.
Neurostimulation may be recommended when other treatments have failed or your pain is severe. An electronic device is implanted and delivers electrical stimulation to a targeted nerve or in the spinal cord. The goal is to make the pain feel more like a tingle.
In hard-to-treat cases, your doctor may suggest a vestibulectomy. In this procedure, the painful tissue in the opening of the vulva is removed. It can help women who have localized vulvodynia. It takes about 8–12 weeks to recover. You may need physical therapy and to use vaginal dilators to gradually relax and stretch vaginal muscles.
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Since the cause of vulvodynia is not known, it’s also not known how to prevent it. Some helpful tips you can try include:
- Follow basic vulvar skin care. See the suggestions under Treating Vulvodynia.
- Identify your pain triggers. When you have pain, think about what you were doing before it started. Were you sitting down for a while? Did you switch to a new soap or laundry detergent? Is it worse when you wear a specific kind of underwear or pants? Keep a symptoms journal to help identify triggers.
- See your ob-gyn annually. Yearly pelvic exams are an important part of good vulvar health. So is going to your ob-gyn to discuss any pain or other symptoms and get treated for it. If treatments don’t help, your doctor can refer you to a vulvar disease specialist.
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