James Castro & Janet Phoenix, MD, MPH, National Center for Health Research
One of the most common causes of chronic pelvic pain in women is vulvodynia. This is defined as vulvar pain of unknown cause that’s lasted for at least three months.[1,2] This disorder is experienced by an estimated 10% to 28% of reproductive-age women.[1,2] Although less common, it can affect postmenopausal women as well. The pain can sometimes be described as a burning, irritation, stinging, or sharp pain in the vulva, the area outside the vagina. This area includes the labia and the entrance to the vagina. This pain can be brought on by touch, pressure, and vaginal intercourse (attempted or completed). Because of the pain, it can wreak havoc on a patient’s intimate relationships and everyday life. Patients with vulvodynia can experience reduced sexual satisfaction, low self-esteem, a worsened quality of life, and higher rates of depression. Despite how common it is, healthcare providers do not always recognize and treat it. This can lead to patients seeing several physicians before receiving an accurate diagnosis.
Vulvodynia symptoms can occur in a small area or may affect the entire vulvar area. Pain can occur before, during, or after sexual activity, when tampons are inserted, or even when wearing underwear or trousers. The pain can also happen for no apparent reason. Symptoms are reported to be more severe in women who also have major depression, anxiety, and who fear the pain itself[3,5]
The causes of vulvodynia remain unknown. The most recent research indicates that it may occur because of inflammation caused by trauma or yeast infections[1,6]. However, anxiety, depression, and poor body image are also relatively common among women with the condition, perhaps resulting in increased awareness and sensitivity to the pain.[3,5] Despite the role of anxiety and depression, vulvodynia is a real medical condition with physical pain. Unfortunately, awareness of the disorder is not widespread in the medical community, even though it affects women of all ages and ethnic backgrounds. This can lead to much distress for patients as they go from physician to physician without getting a diagnosis. More research and training are needed to increase awareness and understanding of the causes and effective treatments.
Effect on Sexual Activity and Quality of Life
Because sexual activity can often be painful for women with this condition, it can be very isolating for women and their partners. The stress of dealing with a chronic pain condition combined with issues with sexual functioning can lead to a decreased quality of life overall. Additionally, those who suffer from vulvodynia may believe that penetration is the main or only form of sexual pleasure. This belief, combined with pain with sex, can lead to worsened quality of life through increased shame and embarrassment. Organizations like the National Vulvodynia Association (www.nva.org) help educate affected women about the condition, identify support groups, and help guide patients towards holistic management of their condition.
There is no one treatment for vulvodynia that is effective for all women. An individualized approach and finding care with a medical provider aware of the condition is essential. Treatments can include topical and oral medications, talk therapy, pelvic floor therapy, and surgery.
- Talk Therapy can include cognitive behavioral therapy, narrative therapy, and couple’s counseling. These therapies can help reduce feelings of shame and depression and help couples develop strategies that enable them to enjoy intimacy.[5,8,10]
- Pelvic Floor Therapy can involve biofeedback sessions, dilators, electrical stimulation, and education. This type of therapy helps people identify their pelvic floor muscles and helps them learn how to relax them, which can help reduce pain. Research shows that this can be effective.[8,10,11]
- Topical and Oral Medications are medications that work to decrease nerve hypersensitivity and pain around the area. The oral medications typically include anti-depressants and anticonvulsants. Topical treatments generally involve lidocaine, commonly used for its numbing effect. However, studies tend to show that none of these are more effective than a placebo.[8,9,10]
- Surgery – Surgical treatments to remove certain hypersensitive areas are an option but are generally seen as a last resort.[8,11]
Strategies for Coping With the Symptoms
As there is no single effective therapy for vulvodynia, finding an approach that works can take some time. Below are some strategies that may help relieve symptoms in the meantime:
- Avoid hot tubs and chlorinated pools
- Wearing only cotton underwear;
- Avoiding pantyhose;
- Wearing loose-fitting clothing;
- Using only white unbleached toilet tissue;
- Using 100% cotton sanitary products (tampons and pads);
- Application of ice to relieve pain after intercourse
- Avoid the use of creams, soaps, douches, and deodorants on the vulva.
Vulvodynia is a common cause of chronic pelvic pain that can affect women of all ages. Its symptoms can significantly worsen a woman’s quality of life. More research is needed to find the causes of the condition and the most effective treatment options. It should be treated with help from a trusted healthcare provider.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
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- Pukall CF, Goldstein AT, Bergeron S, et al. Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors. J Sex Med. 2016;13(3):291-304. doi:10.1016/j.jsxm.2015.12.021
- Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. Obstet Gynecol. 2016;127(4):745-751. doi:10.1097/AOG.0000000000001359
- Tribó MJ, Canal C, Baños JE, Robleda G. Pain, Anxiety, Depression, and Quality of Life in Patients with Vulvodynia. Dermatology. 2020;236(3):255-261. doi:10.1159/000503321
- Toeima E, Nieto J. Junior doctors’ understanding of vulval pain/vulvodynia: a qualitative survey. Arch Gynecol Obstet. 2011;283 Suppl 1:101-104. doi:10.1007/s00404-010-1513-2
- Chisari C, Monajemi MB, Scott W, Moss‐Morris R, McCracken LM. Psychosocial factors associated with pain and sexual function in women with Vulvodynia: A systematic review. Eur J Pain. 2021;25(1):39-50. doi:10.1002/ejp.1668
- Leusink P, van de Pasch S, Teunissen D, Laan ET, Lagro-Janssen AL. The Relationship Between Vulvovaginal Candidiasis and Provoked Vulvodynia: A Systematic Review. The Journal of Sexual Medicine. 2018;15(9):1310-1321. doi:10.1016/j.jsxm.2018.07.011
- Shallcross R, Dickson JM, Nunns D, Mackenzie C, Kiemle G. Women’s Subjective Experiences of Living with Vulvodynia: A Systematic Review and Meta-Ethnography. Arch Sex Behav. 2018;47(3):577-595. doi:10.1007/s10508-017-1026-1
- Bohm-Starke N, Ramsay KW, Lytsy P, et al. Treatment of Provoked Vulvodynia: A Systematic Review. The Journal of Sexual Medicine. 2022;19(5):789-808. doi:10.1016/j.jsxm.2022.02.008
- Miranda Varella Pereira G, Soriano Marcolino M, Silveira Nogueira Reis Z, Vale de Castro Monteiro M. A systematic review of drug treatment of vulvodynia: evidence of a strong placebo effect. BJOG: Int J Obstet Gy. 2018;125(10):1216-1224. doi:10.1111/1471-0528.15223
- Morin M, Carroll MS, Bergeron S. Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia. Sex Med Rev. 2017;5(3):295-322. doi:10.1016/j.sxmr.2017.02.003
- De Andres J, Sanchis-Lopez N, Asensio-Samper JM, et al. Vulvodynia–An Evidence-Based Literature Review and Proposed Treatment Algorithm. Pain Pract. 2016;16(2):204-236. doi:10.1111/papr.12274