Vulvodynia (vulval pain)

Symptoms of vulvodynia

The main symptom of vulvodynia is persistent pain in and around the vulva. The vulva usually looks normal.

The pain may be:

• a burning, stinging or sore sensation
• triggered by touch, such as during sex or when inserting a tampon
• constantly in the background and can be worse when sitting
• limited to part of the vulva, such as the opening of the vagina
• more widespread – sometimes it can spread to the buttocks and inner thighs

Some women also have problems such as:

• vaginismus (where the muscles around the vagina tighten involuntarily)
• interstitial cystitis (a painful bladder condition)
• painful periods
• irritable bowel syndrome (IBS)

Having chronic pain can also:

• affect relationships
• reduce sex drive
• cause low mood and depression

Pain in the genital area is often difficult to talk about with friends and it's not uncommon to feel isolated.

When to get medical advice

See your GP or visit your local genitourinary medicine (GUM) clinic if you have persistent vulval pain.

Vulvodynia is unlikely to get better on its own and some of the treatments are only available on prescription. There are also a number of other causes of vulval pain that need to be ruled out.

Your doctor will ask about your symptoms and may examine you or check for conditions such as infections.

Many people with vulval pain can have the condition for many years before a diagnosis is made and proper management started.

The British Society for the Study of Vulval Disease has a map of vulval clinics and services in the UK that you can use to search for services near you. You can't self-refer to these services, but you could discuss a referral with your GP.

Treatments for vulvodynia

A combination of some of the following lifestyle changes and treatments can often help relieve symptoms of vulvodynia and reduce its impact on your life.

Lifestyle tips you can try to help reduce symptoms of vulvodynia include:

• wearing 100 per cent cotton underwear and loose-fitting skirts or trousers
• avoiding scented hygiene products such as feminine wipes, bubble bath and soap – an emollient is a good substitute for soap
• applying cool gel packs to your vulva to soothe the pain
• using petroleum jelly before swimming to provide protection from chlorine
• trying not to avoid sex or touching your vulva completely, as this may make your vulva more sensitive
• trying to reduce stress, as it can increase the pain of vulvodynia – read some relaxation tips to relieve stress
• for pain when sitting, try using a doughnut-shaped cushion

Potential treatments that can help reduce the symptoms of vulvodynia include:

• over-the-counter gels and lubricants
• prescription medication
• physiotherapy
• therapy and counselling

In very rare cases, surgery to remove part of the vulva may be an option. Pain, however, can recur and it's usually not recommended. You should speak to your GP about the possibility of surgery.

Possible causes of vulvodynia

The exact cause of vulvodynia is unknown. It's thought it may be the result of a problem with the nerves supplying the vulva, although it's not clear what causes this.

Possible triggers that have been suggested include:

• damage due to previous surgery or childbirth
• trapped nerves
• a history of severe vaginal thrush

Vulvodynia isn’t contagious. It has nothing to do with personal hygiene and isn't a sign of cancer.

Other causes of vulval pain

Pain in the vulva isn't always vulvodynia. It can have a number of other causes, such as:

• persistent vaginal thrush or other vaginal infections
• sensitivity to something touching the vulva, such as soap, bubble bath or medicated creams (known as irritant contact dermatitis)
• a drop in the hormone oestrogen causing dryness of the vulva, particularly during the menopause
• a recurrent herpes infection
• lichen sclerosus or lichen planus (skin conditions that can cause intense irritation and soreness of the vulva)
• in rare cases, Behçet's disease or Sjögren's syndrome

Your doctor may want to rule out these conditions before treating you for vulvodynia. Some women can have a combination of problems, for example, recurrent thrush and vulvodynia, with both needing proper treatment to reduce pain.

Support and more information

Living with a long-term painful condition such as vulvodynia can be frustrating and stressful. You may find it useful to contact a support group for more information and advice or to get in touch with other women who have vulvodynia.

Two of the main support groups are:

• the Vulval Pain Society 
• the Pelvic Pain Support Network

More useful links

• How to use your health services