Vulvodynia: A Vaginal Chronic Illness No One's Talking About

Some chronic ailments, such as vaginitis, chronic yeast infections, or chronic urinary tract infections, can impact the vagina, some of which are treatable and some of which are not. Many individuals have voiced their struggles with some of these conditions, which are relatively common. One chronic vaginal illness that you may not have heard of, though, is called vulvodynia. For those of us who may lack knowledge regarding the female anatomy, the external female genital area is called the vulva. It’s common for vagina owners to experience pain in the vulva region, but such pain becomes an issue if it lasts longer than three months. If you find yourself experiencing pain in the vulva region for an extended period of time, it’s worth researching on your own and asking your doctor about vulvodynia. The condition is most commonly described as burning, stinging, irritation, and rawness. Aching, soreness, throbbing, and swelling also may be felt. The entire vulva may be painful, or pain may be centered in a specific area. Symptoms of vulvodynia may be constant, or they may come and go.

Vulvodynia, simply put, is chronic vulvar pain without an identifiable cause. The location, constancy, and severity of the pain vary among sufferers. Some vulva-owners experience pain in only one area of the vulva, while others experience pain in multiple areas. One woman reported her pain felt like “acid being poured on [their] skin,” while another described it as “constant knife-like pain.” There are two main subtypes:  localized and generalized vulvodynia, which sometimes co-exist. Localized vulvodynia is when the pain occurs on one side or specific part of the vulvar region. This type of pain is typically brought on by touch or after any sort of pressure is applied to the area. Local vulvodynia pain can be brought on by sexual intercourse, tampon insertion, or by tight fitting pants. General vulvodynia is when pain occurs spontaneously without any true known trigger. The pain itself is relatively constant, but it’s possible that there can be some periods of relief. Activities that apply pressure to the area, such as sitting for a prolonged period of time or having sexual intercourse, can exacerbate symptoms. 

Causes and Treatment Options

If you find yourself experiencing vulva pain, it’s best to visit your gynecologist so they can help you determine the culprit behind your discomfort. The doctor will most likely ask you a series of questions regarding your sexual history and vaginal health. They will also perform tests to rule out any possible causes of vulva pain or discomfort, which may include a vaginal swab or biopsy of the vulvar skin. During the test, gentle pressure is applied to various vulvar sites, and you’re asked to rate the severity of the pain. If your doctor is unable to find any sort of infection or other ailments that explains your vulvar pain, they may diagnose you with vulvodynia. Next, your gyno will most likely explain to you the possible factors that can contribute to the development of vulvodynia and what steps you can take to treat your condition and manage the pain associated with it. Vulvodynia is likely caused by many factors working together. Some of these factors include the following:

• Damage or irritation of the nerves of the vulva

• Inflammation of the vulva

• Long-term reactions to certain infections

• Certain genetic disorders

• Sensitivity to certain foods

• Dysfunction of the muscles of the pelvic floor

• Conditions that affect nearby muscles or bones

Once a doctor diagnoses you with Vulvodynia, the next step will be to discuss possible treatment options. Since the condition is not a simple gynecological condition, most providers will utilize a multi-disciplinary approach when attempting to treat the symptoms. Vulvodynia treatment may involve visiting a: gynecologist or vulvovaginal specialist, dermatologist, neurologist, pain management specialist, urogynecologist, and/or physical therapist. You may also want to seek out the guidance of a couples or sex therapist as vulvodynia pain can impact your sex life and may lead to struggles with intimacy. If you want to figure out ways to enhance intimacy that won’t exacerbate your vulvodynia pain, a sex therapist can help you.  It may seem daunting to have to visit so many different types of doctors, but each one specializes in a different medical field that has the potential to help alleviate symptoms of vulvodynia. Because doctors don’t know exactly what causes vulvodynia, treatments are directed toward alleviating symptoms and usually provide moderate pain relief. Some women experience relief with a particular treatment, while others do not respond or experience unacceptable side effects. In this sense, vulvodynia treatment is specific to each patient and it may take some trial and error to find what specific treatment works for you. Current vulvodynia treatments include:

• Discontinuation of Irritants

• Oral “Pain-Blocking” Medications

  • Tricyclic Antidepressants

  • Serotonin-Norepinephrine Reuptake Inhibitors

  • Anticonvulsants

  • Opioids

• Topical Medications

  • Topical Hormonal Creams (e.g., estrogen, testosterone)

  • Topical Anesthetics (e.g., lidocaine)

  • Topical Compounded Formulations (e.g., anticonvulsant, antidepressant)

• Pelvic Floor Muscle Therapy

• Nerve Blocks

• Neurostimulation and Spinal Infusion Pump

• Surgery

• Complimentary or Alternative Medicine

Overall, the vulvodynia treatment is, unfortunately, not a one-size-fits-all prescription. You may have to make individual lifestyle changes, such as avoiding inflammatory substances and using specific medications to manage your condition. 

Self-Care Tips

If you’ve recently been diagnosed with vulvodynia, there are some tips that can help you manage your condition and limit its impact on your sexual life. These tips can be used as a preventative measure for when you have your symptoms under control or can be used as a means of alleviating pain when your symptoms flare up. Firstly, pay careful attention to the clothes that you choose to wear and also how you choose to do laundry, especially when washing your intimates. You should try to wear all-white cotton underwear and avoid wearing pantyhose, tight-fitting pants, and skirts. Remember to promptly remove wet bathing suits and exercise clothing, as the excess moisture in these garments can irritate your vulva and exacerbate symptoms. When it comes to washing your clothes, get to know the ingredients in your detergent and perhaps try a detergent that is free of irritants and dermatologically approved, like Purex or Clear. Try to refrain from using fabric softener on undergarments as it typically contains irritants.

There are also tips you can take when it comes to your personal hygiene habits. It’s important to pay special attention to how you take care of your vulva and vaginal region if you suffer from vulvodynia. Use soft, white, unscented toilet paper. If you’re experiencing irritation, you can use a lukewarm or cool sitz bath to relieve any burning or discomfort. If you’re taking a bath, refrain from using a bubble bath or any other perfumed creams or soaps in your bath, as this can cause irritation. When showering, avoid getting shampoo on the area and stay away from any feminine hygiene products, especially those that are perfumed. Also, try to limit the number of times you have to sit for an extended period during the day. If you have a job that requires you to sit for an extended period of time use a foam rubber donut sitting on to limit the amount of pressure that is applied to your vulvar area while you sit. There are also some guidelines you can follow pertaining to going to the bathroom. Try to urinate before your bladder is completely full, and rinse the vulvar area after urination. Try to drink eight glasses of water daily in order to flush your system regularly. When it comes to periods, try to use 100% cotton menstrual pads and tampons without any added irritants such as perfumes to minimize irritation to the vulvar area. 

There are also some tips you can follow when you want to engage in sex. Intercourse can be very painful for individuals who suffer from vulvodynia. Be sure to take things slow and only engage in activities that are comfortable for you. If sex is too painful for you, remember that intercourse is not the only way you can be intimate in a relationship. If you are wanting to try to have sex, there are some steps you can take to make the process more comfortable and enjoyable. Lube is most definitely a must when it comes to sex, whether or not you suffer from a chronic vaginal condition such as vulvodynia. Remember to use a water-based lubricant and look for one that is natural without any added irritants like perfumes or spermicide. Another great option is a lube that contains cannabis or CBD. THC or CBD-infused lube can decrease inflammation and increase pleasurable sensations when applied to the vulva. You can also try a topical anesthetic to try to numb the painful aspects of intercourse, but never use any sort of anesthetic on the anal region, only the vaginal. One topical you should avoid on the area is any type of contraceptive gel or spermicide because these creams can cause irritation in the vaginal area. Another tip is to apply ice or a frozen pack to your genital area after engaging in sex to minimize any pain or irritation from the act. Rinsing the vulva with cool water after sex can also help relieve any pain or irritation, and urinating after to cleanse the area from any irritants that may have entered during sex. 

Sex can be challenging for individals with vulvodynia, but the condition does not have to mean the end of your sex life. Remember that a sex or couples therapist can guide you through other ways to experience intimacy within your life. Start with expanding your definition of sex to include more than just penetration. Remember that your genitals are not the only parts of your body that allow you to feel pleasure. You may want to investigate nipple and anal play and incorporate that into your sex life. No matter what, remember that you are not alone if you have been diagnosed with vulvodynia and that there are things you can do to make your condition more manageable. 

By Alyssa Morterud