What is vulvodynia (vulval pain)?
Vulvodynia is a chronic pain condition defined as vulval pain lasting for more than three months without an identifiable cause, such as an infection or skin condition. It affects the vulva, including the external genitalia such as the labia, clitoris, and vaginal opening. Women with vulvodynia may experience persistent pain, burning, or discomfort that interferes with daily activities like sitting, exercising, or sexual intercourse. The pain can vary from mild to severe, may occur without a clear trigger, and can be challenging to diagnose and treat. Seeking specialist gynaecological care is essential for effective management. The pain may be:
- Generalised: Affecting the entire vulval area.
- Localised: Concentrated in a specific spot, such as the vaginal opening (vestibulodynia).
Vulvodynia can also be classified as provoked (triggered by touch or pressure) or unprovoked (occurring spontaneously). Women of all ages can experience vulvodynia, and it often requires a personalised approach to treatment to manage symptoms effectively.
Symptoms of vulvodynia
The symptoms of vulvodynia can differ between individuals but commonly include:
- Burning, stinging, or throbbing pain in the vulval area.
- Discomfort during sexual intercourse (dyspareunia).
- Itching or soreness that doesn’t improve with typical treatments.
- Rawness or irritation, particularly around the vaginal opening.
- Pain when sitting or performing physical activities, such as cycling.
These symptoms may be constant or come and go. If you experience vulval pain for more than three months, it is recommended to consult a gynaecologist for evaluation.
Causes of vulvodynia
The exact cause of vulvodynia is often unknown, and it is likely influenced by several factors. Potential causes and contributing factors include:
- Nerve damage or irritation: Nerve inflammation or injury around the vulva can lead to heightened sensitivity and chronic pain.
- Hormonal changes: Menopause, birth control, or other hormonal shifts can cause thinning of the vulval skin, making it more prone to discomfort.
- Chronic infections: Recurrent yeast or bacterial infections can lead to lingering pain or irritation in the vulval area.
- Skin conditions: Conditions like lichen sclerosus or eczema can irritate the vulva and contribute to chronic pain.
- Pelvic floor muscle issues: Tight or weak pelvic floor muscles can put pressure on the vulva, leading to pain, especially during activities like sitting or intercourse.
- Psychological factors: Emotional factors such as stress, anxiety, and depression can increase pain perception, and the experience of chronic pain can further impact mental health.
Diagnosis of vulvodynia
Diagnosing vulvodynia involves a thorough examination by a gynaecologist, who will take a detailed medical history and may perform the following tests:
- Visual examination: The doctor will closely inspect the vulva for any signs of infection, inflammation, or skin abnormalities.
- Cotton swab test: This test involves pressing a cotton swab on different areas of the vulva to determine pain location and severity.
- Swab tests: These may be taken to rule out infections, such as yeast or bacterial infections, which could be causing the symptoms.
- Pelvic floor assessment: Your doctor may examine the pelvic floor muscles for tightness or dysfunction, which could contribute to vulval pain.
Treatment options for vulvodynia
Vulvodynia treatment is often tailored to the individual, as it may involve a combination of approaches to effectively manage symptoms. Treatment options include:
- Medications: Topical anaesthetics like lidocaine can numb the area temporarily, while oral medications such as tricyclic antidepressants or anticonvulsants can reduce nerve-related pain.
- Pelvic floor physiotherapy: Physical therapy can help relax or strengthen the pelvic floor muscles; alleviating pain caused by muscle tension.
- Lifestyle changes: Using unscented, hypoallergenic products, wearing cotton underwear, and adopting gentle hygiene practices can help prevent irritation.
- Counselling or cognitive behavioural therapy (CBT): Psychological support, including CBT, can help manage the emotional effects of chronic pain and reduce stress, which may contribute to pain.
- Nerve blocks: In some cases, nerve block injections may be used to temporarily reduce pain by blocking the nerve pathways.
- Surgery: Surgery is rarely needed but may be considered for persistent, localised pain when other treatments have not been effective.
Self-care and prevention
Although vulvodynia may not always be preventable, certain self-care practices can help manage symptoms and improve comfort:
- Practice gentle hygiene: Avoid using scented products on the vulva and opt for unscented, hypoallergenic options.
- Reduce stress: Relaxation techniques such as meditation or yoga can help manage stress and improve overall wellbeing.
- Use lubricants: Water-based lubricants can help reduce friction during intercourse, making it more comfortable.
- Attend regular check-ups: Routine gynaecological exams can monitor symptoms and help address any changes in vulval health.
Why choose Birmingham Gynaecology Clinic
Birmingham Gynaecology Clinic provides specialised, compassionate care for women experiencing vulvodynia. Our experienced team uses the latest diagnostic methods and offers personalised treatment plans to help you manage pain and enhance your quality of life. We are committed to supporting you in a comfortable and caring environment.
If you’re experiencing vulval pain, please contact Birmingham Gynaecology Clinic to book a consultation. Our team is here to provide expert guidance and tailored care.