About Vulvodynia and Vulvar Vestibulitis
What Is Vulvodynia?
Vulvodynia is a condition characterized by discomfort or pain (stinging, burning, irritation) of the vulva. Vulvodynia is often classified by the location of symptoms and whether they are caused by pressure or touch, or even without any touch. The pain may or may not be constant. It may occur in different places in the genital area: labia minora, labia majora, vestibule, clitoris, mons pubis, perineum, or inner thighs.
What Is Vulvar Vestibulitis?
Vulvar vestibulitis is a very common type of vulvodynia. Vestibulitis is pain or irritation that occurs in the vestibule, the area of the vulva that surrounds the opening of the vagina. Vestibulitis can occur in women of all ages, whether or not they have ever been sexually active. "Vulvar vestibulitis" is also referred to as "localized provoked vulvodynia," because it is provoked by pressure or touch.
What Causes Vulvodynia/Vestibulitis?
While the cause of vulvodynia is not known, some possible causes include genetic abnormalities, immune or hormonal factors, inflammation, infection or post infection syndromes, or neurologic changes.
Symptoms of Vulvodynia/Vestibulitis
The symptoms of vulvodynia include stinging, burning, or irritation of the vulva. Patients who have vestibulitis have pain with any kind of pressure or touch at the vestibule. Intercourse, tampon use, tight pants, bicycle-riding, and sometimes just sitting or standing for long periods of time can be painful. Often, there is redness on the skin where the pain is located.
Vulvodynia/vestibulitis can be diagnosed during a pelvic exam. A cotton swab is used to locate areas of tenderness during the exam. In diagnosing vestibulitis, it is crucial to rule out other causes of vulvar pain such as infections or skin abnormalities that can cause vulvar pain.
Treatment of Vulvodynia/Vestibulitis
Because different women with vulvodynia or vestibulitis have different symptoms, which may have different causes, there are many different methods of treatment, including topical or oral medications, injections, physical therapy, biofeedback, and surgery. It is often necessary to use a combination of treatments, or to try several treatments before one is found that will provide relief of symptoms.
The first treatment for vestibulitis and vulvodynia is to identify and treat any infections or skin conditions that may be present, like vaginal yeast infections. Sometimes this treatment alone will provide some relief of symptoms. Topical corticosteroids (like hydrocortisone but stronger) applied to the vulva are often used first to treat chronic inflammation. Other possible treatments include the use of amitriptyline, a common antidepressant medication, which is often used to treat nerve pain. Amitriptyline comes as a pill to be taken by mouth or in a topical cream (combined with gabapentin, an anti-seizure drug that helps treat pain, and baclofen, a muscle relaxer).
Vestibulitis and vulvodynia may also involve spasm of the pelvic floor muscles, so physical therapy may be prescribed in addition to medication. If these treatments are not helpful, steroid injections at the site of the pain can be effective. If pain is localized to a specific area of the vestibule, a surgical procedure called partial vestibulectomy can greatly improve or eliminate pain for many women.
It may not always be possible to completely cure vestibulitis and vulvodynia, but it is possible to control symptoms so that they do not interfere with daily activities and allow sexual activity to be enjoyable.
Comfort measures during treatment include:
- Minimal use of soap on the vulva and only mild soaps such as Neutrogena
- Elimination of any deodorized sanitary products and sprays
- Avoiding tight clothing, especially garments containing spandex, lycra, and other synthetics
Over-the-counter creams and anti-yeast products should not be used unless they are recommended by a doctor. Vaseline, A & D ointment, and ordinary Crisco are very soothing and help to keep skin moist without causing additional irritation. A review of recommended personal hygiene products and practices is available at the Drexel Vaginitis Center.
Resources for Patients with Vulvodynia/Vestibulitis
There is ongoing research into the cause and treatment of vulvodynia/vestibulitis, as well as the emotional toll of chronic vulvar pain and the additional distress for women who are unable to enjoy some forms of sexual activity.
Continuing to be intimate with a partner during treatment in ways that are comfortable for both people is important. Counseling can be a great help to women and their partners as they work through issues related to sexuality and relationships. There are support groups available.
The National Vulvodynia Association website is a great place to find information on vulvodynia, current research, conferences, and publications.
The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.
The images being used are for illustrative purposes only; any person depicted is a model.