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Vulvar Pain (Vulvodynia)Vulvar pain, or vulvodynia, can have many origins. Most common are temporary irritation from yeast or other vaginal infections. If vulvar pain or irritation persists for months it is considered chronic. Vulvar pain may be burning, or may be sharp and stabbing. Sometimes the cause can be determined and treated, but many times a cause may not be found.
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Infection, such as a yeast infection |
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Irritation, such as from soap or other products, or from rubbing on clothing |
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Treatment of conditions such as genital warts (condyloma) |
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Skin conditions, such as eczema or psoriasis, which can also occur on the vulva |
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Pre-cancerous conditions, vulvar cancer, and other vulvar skin disorders |
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Trauma or surgical scars; injury to the nerves supplying the area |
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Muscle tension in the surrounding muscles |
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Anxiety and fear |
The diagnosis of vulvar pain and/or irritation requires a careful history by a gynecologist familiar with vulvar problems. The vulva is examined with the aid of a colposcope — an instrument similar to binoculars with an excellent light. The vulva is gently touched with a Q-tip to see if there are specific areas of tenderness. The muscles surrounding the vulva and vagina are checked for tenderness and tension. Any vaginal discharge is checked under a microscope, and cultures may be taken.
Treatment can be simple or complex. One of the most common causes of irritation is frequent washing of the area with soap. As a general rule, do not use anything on the vulva that you wouldn't put in your eye! Even soaps and products claiming to be gentle and non-allergenic can be irritating. Rinse with plain water, blot dry, and then blow dry with a hair dryer on low heat. An over the counter mild cortisone cream can be applied for a few days, but if the irritation persists a gynecologist should be consulted.
Vaginal pain is most commonly caused by infection. Sometimes scar tissue can occur after childbirth, surgery or trauma. In endometriosis tissue that normally lines the uterus can grow in the vagina and be painful. Muscle tension or spasm is a common cause of vaginal pain, and may respond to physical therapy and psychotherapy. Inflammation of the bladder from infection or interstitial cystitis (a sterile inflammation of the bladder) can also cause vaginal pain.
The treatment of vulvodynia and other conditions requires great patience both on the part of the doctor and of the patient. Most often symptoms will improve, but it can take months of treatment. It is not surprising that vulvar pain can interfere with relationships, and cause a great deal of emotional distress. In addition, tenderness in that area can lead to spasm of the pelvic muscles, which in turn can aggravate the pain.
Many times there are simple medical treatments that relieve these symptoms. But when long term treatment is necessary, a psychotherapist specializing in sex therapy and sexual pain management can help minimize the impact the pain has on a woman's life. When muscle tension or spasm appears to be a factor, a physical therapist, through gentle massage, biofeedback, or other techniques can help restore normal muscle balance. For many women a multidisciplinary approach is clearly more effective than any single treatment.
This website was created by:
Denise Alberto, MPT, Mary Buxton, LCSW, Maia Chakerian, M.D., Annemarie Cosby, MPT, Paul D. Indman, M.D., Linda R. Janowitz, Ph.D., and Diane Morrissette, Ph.D.
Each person is an individual practitioner practicing independently of the others. We work cooperatively, with our client's permission, to enhance treatment. ©2001
Anatomy
of the Vulva from a Pain Perspective