What is vulvodynia?
Pain before, during and after intercourse is more common than you might think, and it can be caused by a variety of conditions. Vulvodynia is a type of long-term pain or discomfort of at least three months or longer around the outer part of the female genitals, called the vulva[i]. This pain may or may not be triggered by touch and may be felt in one area or across the whole vulva. The pain, burning or irritation linked with vulvodynia can make you so uncomfortable that sitting for a long time or having sex becomes unthinkable[ii].
Despite its prevalence, vulvodynia is frequently misunderstood or misdiagnosed, leaving many women feeling isolated and frustrated. Remember, you are not alone, and there are effective treatments and strategies available to help you regain comfort and confidence.
What is the difference between vulvodynia and vestibulodynia?
A subtype of vulvodynia, vestibulodynia, causes pain in the entrance to the vagina (vestibule). This condition is often provoked by pressure on the vulva during activities like sex, tampon insertion, or pelvic exams [iii].
Types of vulvodynia
Symptoms of vulvodynia can vary for different people, sometimes making it hard to identify. Additionally, there are two main types of the condition, each with subtle differences:
· Generalised vulvodynia is pain in different areas of the vulva at different times. Vulvar pain may be constant or happen every once in a while. Touch or pressure may or may not cause it, but it may make the pain worse[iv].
· Localised vulvodynia is pain in one area of the vulva. Often a burning sensation, this type of vulvar pain usually results from touch or pressure, like sex or prolonged sittingii. Vestibulodynia related to pressure (provoked) is the most common form of localised vulvodynia.
Vulvodynia could be provoked and unprovoked. In provoked vulvodyni a, you feel pain with touch or activity. With unprovoked vulvodynia, you feel pain without these factors[v].
What causes vulvodynia and vestibulodynia?
The causes of both vulvodynia and vestibulodynia have been disputed between experts, and it is difficult to know exactly what causes the condition due to the number of potential physical, social and psychological factors. Don’t panic though, just because the causes are not finite, it does not mean that there are no treatment options available which can help.
Researchers in the pelvic health space are understanding more about the pelvic conditions each day, and research has revealed that these factors might play a role:
· Physical or sexual trauma – Childbirth, sexual abuse, or sex without enough vaginal lubrication can cause vulvar nerve endings to be injured. Activities that put pressure on the vaginal region, such as cycling or horseback riding, can also harm nerve endings and tissue.
· Allergies - Soaps, gels, and feminine deodorant products can cause an allergic reaction in the vulvar region in some women. That can lead to irritation, inflammation, and pain[vi].
· Recurrent yeast infections – Recurrent yeast infections can significantly heighten the risk of developing vulvar pain. The repeated occurrences of yeast infections introduce symptoms such as vulvar soreness and irritation, which not only cause immediate discomfort but also can lead to longer-term sensitivity in the vulvar region[vii]. Managing yeast infections promptly and effectively is crucial to prevent the transition from acute infection-related pain to chronic vulvodynia.
· Hormone changes – Research has led experts to theorise that excessive hormone changes and imbalances can lead to women in their 20s especially, and older, developing vulvodynia. A link has been found between women undergoing hormone therapy and vulvodynia[viii]. Birth control pills for example can lower the amount of estrogen and testosterone in the vulvar area, leading to dryness and pain.
· Hypertonic pelvic floor – Tight pelvic floor muscles can be another cause that leads to vulvodynia[ix]. A hypertonic pelvic floor is a condition where the muscles in your lower pelvis are in a spasm or state of constant contraction. Doctors will check the tone of a patient's pelvic floor muscles to determine whether this is a factor in vulvar pain.
How do I treat vulvodynia?
As with any health condition you may be experiencing, the first step is always talking to a healthcare professional if you need advice on how to treat it.
Due to the varying causes of vulvodynia, the treatment options that can help are equally varied, meaning it’s important that you do what is right for your personal experience.
Treatments which can help vulvodynia include:
· Topical creams - These are creams that are applied to the affected area. Creams that contain estrogen can be helpful if a patient's low estrogen levels are causing vulvodyniavi.
· Dilator therapy - In this therapy, you use your fingers or introduce vaginal dilators to gradually become more comfortable with touching around the vagina, as you begin to understand what feels comfortable[x]. Vaginal dilators, like our ones found here, are designed to help you familiarise yourself with your body and build your confidence until you feel able to progress to natural penetration with your partner. The various sizes allow you to start small and gradually move up the range at a pace that is comfortable and safe for you.
· Psychosexual therapy - The psychological causes of vulvodynia must also be considered as effective treatment can only be achieved through addressing them as well. The NHS advises that this can be done through psychosexual therapy, a type of talking therapy that aims to help you understand and change your feelings about your body and sex, nurturing a positive body image and sexual confidence[xi].
· Pelvic floor exercises – Pelvic floor relaxation training can be done in the comfort of your own home and can aid in treating vulvodynia by promoting relaxation and reducing tension in the pelvic floor muscles. These exercises involve deep, diaphragmatic breathing that encourages the pelvic floor to relax with each exhalation, thereby alleviating chronic muscle tightness that often contributes to vulvodynia pain.
No single treatment works for everyone, and you may need to try several treatments to find out what works best for you.
Remember, you are not alone. Whichever treatment route you take, we are here to support you.
[i] Koray Gorkem Sacinti, Hosna Razeghian, Yaseen Awad-Igbaria, Lima-Silva, J., Eilam Palzur, Vieira-Baptista, P., Verstraelen, H. and Bornstein, J. (2023). Is Vulvodynia Associated With an Altered Vaginal Microbiota?: A Systematic Review. Journal of lower genital tract disease, 28(1), pp.64–72. doi:https://doi.org/10.1097/lgt.0000000000000780.
[ii] Vulvodynia (2023) Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-20353423 (Accessed: 19 September 2023).
[iii] Cleveland Clinic. (n.d.). Vestibulodynia: Causes, Symptoms & Treatment. [online] Available at: https://my.clevelandclinic.org/health/diseases/23514-vestibulodynia.
[iv] Contributors, W.E. (n.d.). Vulvodynia: Causes, Symptoms, and Treatments. [online] WebMD. Available at: https://www.webmd.com/women/vulvodynia [Accessed 7 Jun. 2024].
[v] Cleveland Clinic. (n.d.). Vulvodynia; Causes, Symptoms, Management & Treatment. [online] Available at: https://my.clevelandclinic.org/health/diseases/17878-vulvodynia.
[vi] Healthline. (2017). Vulvar Pain: Causes, Treatments, and More. [online] Available at: https://www.healthline.com/health/womens-health/vulvar-pain#causes [Accessed 10 Jun. 2024].
[vii] Sobel , J. (2023). Patient education: Vaginal yeast infection (Beyond the Basics). [online] UpToDate . Available at: https://www.uptodate.com/contents/vaginal-yeast-infection-beyond-the-basics/print#:~:text=Most%20vaginal%20yeast%20infections%20are,Candida%20glabrata%20or%20Candida%20krusei. [Accessed: June 26, 2024]
[viii] Mitro, S.D., Harlow, S.D., Randolph, J.F. and Reed, B.D. (2016). Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia? Women’s Midlife Health, 2(1). doi:https://doi.org/10.1186/s40695-016-0017-z.
[ix] Doctors at Kaiser Permanente in MD, VA, DC. (n.d.). Blogs & News. [online] Available at: https://mydoctor.kaiserpermanente.org/mas/news/vulvodynia-how-to-recognize-and-treat-this-chronic-pain-of-the-vulva-2012598 [Accessed 10 Jun. 2024].
[x] National Health Service (UK) (2021) Vaginismus, NHS choices. NHS. Available at: https://www.nhs.uk/conditions/vaginismus/ (Accessed: February 8, 2024).
[xi] nhs.uk. (2017). Vulvodynia (vulval pain). [online] Available at: https://www.nhs.uk/conditions/vulvodynia/. Accessed: February 8, 2024).
