Down There: Facts & Fixes About Vulvodynia

How to treat chronic pain and discomfort of the vulva 

by The North American Menopause Society

FACT: Vulvodynia is a term used to describe chronic pain and discomfort of the vulva (the external parts of the female genitals) when the cause can’t be clearly identified. There are usually no signs like unusual discharge, vaginal odors, abnormal bleeding, or visible physical signs other than erythema (a redness of the skin) and occasionally erosions resembling “paper cuts” in the skin. Women describe a variety of symptoms, such as vulvar burning, stinging, irritation, rawness, or knifelike pain. Pain with intercourse may last from minutes to days.

FIX: Vulvar symptoms can be related to a number of conditions, which must be excluded before a diagnosis of vulvodynia is made. Examination by a healthcare provider can help rule out the following:

  • Inflammation caused by aggressive scrubbing or irritants such as soap, pantyliners, synthetic underwear, moistened wipes, deodorants, douches, lubricants, spermicides, excessive vaginal discharge, urine, and feces
  • Allergic reactions from sanitary napkins, colored or recycled toilet paper, vaginal sprays, laundry detergents, bubble baths, fragrances, and topical medications
  • Infections such as candidiasis (yeast), herpes, HPV (human papillomavirus), and bacterial vaginosis
  • Skin conditions such as lichen sclerosus or lichen planus
  • Precancerous and cancerous conditions
  • Varying degrees of vaginal dryness and inflammation caused by low estrogen levels after menopause

FACT: Vulvodynia was thought to be a rare condition, but studies suggest that about 3% to 15% of women may be affected. Many suffer in silence, pain, and frustration for years until an accurate diagnosis is made. What can you do?

FIX: Don’t wait to get help if you are suffering from vulvovaginal pain. If the diagnosis is vulvodynia, there are treatments available to lessen your discomfort and pain.

  • Prescription medications such as antidepressants or anticonvulsants may help “turn down” the central pain center in the brain.
  • Local anesthetic gel applied to the painful area may provide relief.
  • Biofeedback and physical therapy can help relax muscles in spasm.
  • Some healthcare providers advocate topical steroids on the vaginal opening or injections within lesions to decrease possible inflammation.
  • Surgical removal of the painful tissue is sometimes recommended when no response is achieved with other treatments.

Vulvodynia is poorly understood and it may take several office visits and tests to be diagnosed. Treatments that work for one woman may show little benefit for the next. Many cases improve over time with or without treatment. The goal is to achieve symptom relief as opposed to a “cure.”

You can find more resources at from the North American Menopause Society and the National Vulvodynia Association.

Next: When You Can't Hold It: Tips to Treat Incontinence

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