What is it?

This condition is a cause of vulval burning and soreness. It usually affects women from their mid-forties onwards. Nerve fibres in the skin detect a number of sensations such as touch, pressure, temperature and pain.

What it involves

The pain described by women with unprovoked vulvodynia is often a burning or aching sensation. The intensity of pain can vary from mild discomfort to severe constant pain which can even prevent sitting down comfortably. The pain is usually continuous and can interfere with sleep.

The pain in unprovoked vulvodynia is not always restricted to the vulval area (area of skin on the outside of the vagina), and some women get pain elsewhere. This can be around the inside of the thighs, upper legs and even around the anus (back passage) and urethra (where you pass urine). Some women also have pain when they empty their bowels. Unprovoked vulvodynia can have an effect on sexual activity and is associated with pain during foreplay and penetration.

In some women with unprovoked vulvodynia, the burning sensation can be generalised over the whole genital area. Alternatively, it can be localised to just the clitoris or just one side of the vulva.

This condition is not contagious and is not related to cancer.

Symptoms

• Spontaneous pain, itching, burning, stinging or throbbing
• Constantly in the background
• Worse when sitting
• Limited to part of the vulva such as the opening of the vagina, or one side
• Sometimes it can spread over the whole genital area and the anus
• Pain with light touch, e.g., tampon use or sexual intercourse

Causes

Vulvodynia may be caused by a problem with the nerves supplying the vulva. This nerve damage could be caused by:

• previous surgery
• childbirth
• trapped nerves
• a history of severe vaginal thrush

Vulvodynia is not contagious. It has nothing to do with personal hygiene and is not a sign of cancer. Sometimes the exact cause of vulvodynia is never found.

Treatments

Vulvodynia is unlikely to get better on its own and some treatments are only available on prescription.

The consultant will ask about your symptoms and may touch your vulva lightly with the tip of a cotton bud to see if this causes pain.
A swab may also be taken to check for other health problems such as infections. Women with vulval pain can often have it for many years before they get a diagnosis and treatment.

Painkillers such as paracetamol will not usually relieve the pain of vulvodynia, but several prescription medicines may help, including:

• Amitriptyline and nortriptyline – possible side effects include drowsiness, weight gain and dry mouth
• Anti-epileptic medications such as gabapentin and pregabalin – possible side effects include dizziness, drowsiness and weight gain

The consultant will initially start you on a low dose and gradually increase it until your pain subsides. Medication may need to be taken for several months. If you have pain in a specific area of the vulva, injections of local anaesthetic and steroids into a nearby nerve may provide temporary pain relief.