Vaginal pain and vulvodynia facts

• Vulvodynia refers to pain in the area of the vulva and vaginal opening for which no cause can be identified.
• Vulvodynia is not related to sexually-transmitted diseases (STDs).
• The exact cause of vulvodynia is not known.
• Symptoms include a burning, throbbing, or aching pain that can be localized to one area of the vulva or more widespread.
• Vaginal itching may be associated with vulvodynia.
• Vulvodynia can be treated with medications and/or self-care (home remedy) measures. No one treatment is effective for all women.
• Local anesthetics, local estrogen creams, antidepressants, and anticonvulsive drugs are examples of medical treatments for vulvodynia.
• Biofeedback, exercises, and nerve blocks may benefit other women.
• Vulvodynia is not associated with cancer or serious medical conditions, but it can be a source of long-term physical and emotional discomfort.

What are vaginal pain and vulvodynia?

Vulvodynia refers to pain in the area of the vulva and vaginal opening. Vulvodynia is considered to be pain for which there is no known cause. It is different from pain that is located deep in the pelvis or internally in the vagina. This article focuses on pain in the vulvar region and at the opening (introitus) of the vagina.

Vulvodynia can be chronic and can last for years in some women. The degree of severity varies among women. It often occurs in the absence of physical signs or visible abnormalities. It can be severe and can interfere with sexual activity and cause painful intercourse ( dyspareunia).

The vulva is the outer part of the female genitalia, including the labia majora, labia minora and clitoris.

The main vulvodynia symptom is pain in your genital area, which can be characterized as:

• Burning
• Soreness
• Stinging
• Rawness
• Painful intercourse (dyspareunia)
• Throbbing
• Itching

Your pain might be constant or occasional. It might occur only when the sensitive area is touched (provoked). You might feel the pain in your entire vulvar area (generalized), or the pain might be localized to a certain area, such as the opening of your vagina (vestibule).

Vulvar tissue might look slightly inflamed or swollen. More often, your vulva appears normal.

A similar condition, vestibulodynia, causes pain only when pressure is applied to the area surrounding the entrance to your vagina.

Doctors don't know what causes vulvodynia, but possible contributing factors include:

• Injury to or irritation of the nerves surrounding your vulvar region
• Past vaginal infections
• Allergies or sensitive skin
• Hormonal changes
• Muscle spasm or weakness in the pelvic floor, which supports the uterus, bladder and bowel

Vulvodynia treatments focus on relieving symptoms. No one treatment works in every case. For many, a combination of treatments works best. It can take time to find the right treatments, and it can take time after starting treatment before you notice relief.

Treatment options include:

• Medications. Steroids, tricyclic antidepressants or anticonvulsants can help lessen chronic pain. Antihistamines might reduce itching.
• Biofeedback therapy. This therapy can help reduce pain by teaching you how to relax your pelvic muscles and control how your body responds to the symptoms.
• Local anesthetics. Medications, such as lidocaine ointment, can provide temporary symptom relief. Your doctor might recommend applying lidocaine 30 minutes before sexual intercourse to reduce your discomfort. Using lidocaine ointment can cause your partner to have temporary numbness after sexual contact.
• Nerve blocks. Women who have long-standing pain that doesn't respond to other treatments might benefit from local nerve block injections.
• Pelvic floor therapy. Many women with vulvodynia have tension in the muscles of the pelvic floor, which supports the uterus, bladder and bowel. Exercises to relax those muscles can help relieve vulvodynia pain.
• Surgery. In cases of localized vulvodynia or vestibulodynia, surgery to remove the affected skin and tissue (vestibulectomy) relieves pain in some women.

Since the cause is poorly understood, it is difficult to predict who is at risk for vulvodynia.

• It can affect women of all ages and races.
• It can begin as early as adolescence and can occur both before and after menopause.
• It may occur during the menstrual period or independent of the menstrual period.

There is no cure for vulvodynia or vaginal pain. However, there are a number of treatments that can help you manage your symptoms of vaginal pain and vulvodynia and get you back to living your best life.

• The first thing you'll want to do is see your doctor to get tested for sexually transmitted infections (STIs) or yeast infections. If those tests come back negative, the next step may be a prescription for an oral medication called duloxetine, which has been shown to help some people with vulvodynia.
• If you have been diagnosed with chronic yeast infections, your doctor may prescribe a cream or suppository that contains clotrimazole or miconazole nitrate to help relieve the pain of a flare-up.
• For some women, these medications don't work well enough on their own; in these cases, doctors may recommend combining them with another treatment like lidocaine injections or nerve blocks (where your doctor injects numbing medicine directly into your skin).
• These options can be effective at reducing the pain of vulvodynia, but they're not perfect—and they often come with side effects like headaches and nausea. That's why it's important to talk with your doctor about which option might be best for you before trying any new treatment options!
• We recommend starting with pelvic floor physical therapy. This type of therapy is designed to strengthen the muscles around your pelvic area, which can help ease symptoms like burning, stabbing pain in your vagina or vulva, or discomfort during sex.
• You can also try topical ointments and creams that contain lidocaine or lidocaine-like drugs. These products are applied directly to the skin on your vulva and may help relieve discomfort temporarily.
• Another option is medications that block nerve signals from reaching the spinal cord. This can be an effective treatment for some people with vulvodynia, although it may take several months before any relief from this type of treatment becomes noticeable.

Symptoms
Painful sex,Pain during urination,Burning or stinging sensation when you pee,Pain during bowel movements (if you have a vulva)
Conditions
Unexplained pain in the vulva
Drugs
Tricyclic antidepressants (amitriptyline, nortriptyline),Anticonvulsants (gabapentin, pregabalin),Opioids (morphine, oxycodone),Local anesthetics (lidocaine)