About Vulvodynia and Vulvar Vestibulitis
What Is Vulvodynia?
Vulvodynia is a painful condition ("dynia" = pain) characterized by discomfort or pain (stinging, burning, irritation) of the vulva. While the cause of vulvodynia is not known, some possible causes may include genetic abnormalities, immune or hormonal factors, inflammation, infection or post-infection syndromes, or neurologic changes.
Vulvodynia is often classified by the location of symptoms (diffuse or localized to a specific area) and whether they are caused by pressure or touch (provoked) or occur even without the area being touched (unprovoked). The pain may occur in different areas and may be constant or intermittent, but is always 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. The term "vestibulitis" is used to describe pain or irritation that occurs in the vestibule, or the area of the female 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. Although we prefer the term “vulvar vestibulitis,” the names of different types of vulvodynia have been changing, and vulvar vestibulitis is now known as “localized provoked vulvodynia.”
Symptoms of Vulvar Vestibulitis
Patients who have vestibulitis have pain with any kind of pressure or touch at the vestibule. Intercourse, tampon use, tight clothes, bicycle-riding and sometimes just sitting or standing for long periods can be painful Often, there is redness on the skin where the pain is located.
Diagnosing Vulvar Vestibulitis
Vestibulitis can be diagnosed during a pelvic exam. A cotton swab is used to locate areas of tenderness during the exam. In diagnosing it, it is crucial to rule out other causes of vulvar pain such as infections or skin abnormalities.
Treating Vulvar Vestibulitis
Because women with vestibulitis have different symptoms that may be due to different (and perhaps unknown) 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 a relief of symptoms.
The first treatment for vestibulitis is to identify and treat any infections or skin conditions that may be present, for example 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 as a first therapy for chronic inflammation. Other possible treatments include medications for neuropathic pain (including amitriptyline, a tricyclic antidepressant medication) and gabapentin, an anti-seizure drug. We usually start with a cream that contains gabapentin, amitriptyline and a muscle relaxant (baclofen), but can switch to oral treatment when necessary. Vestibulitis 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 to the site of the pain may be effective. For women who have pain that is localized to a specific area of the vestibule, a surgical procedure called partial vestibulectomy can greatly improve or eliminate pain.
It may not always be possible to completely cure vestibulitis, but it is possible to control symptoms so that they no longer interfere with daily activities or cause sexual activity to be unenjoyable.
Lessening the Symptoms of Vulvodynia/Vestibulitis
Because there are many personal care products that can worsen vulvar symptoms, it is important to use only those products that are least likely to be irritating to skin in the genital area. For example, we recommend:
- Minimal use of soap on the vulva or the use of a mild soap such a Neutrogena.
- Elimination of any deodorized sanitary products.
- Avoiding tight clothing, especially those containing spandex, lycra and other synthetics.
Avoid use of all over-the-counter creams and yeast products unless they are recommended by a clinician. For comfort, petroleum jelly and vegetable shortening 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, and the National Vulvodynia Association website is a great place to find information on vulvodynia, current research, conferences and publications. We also recommend a YouTube video, "Understanding Pain in 5 Minutes," which gives a great explanation about neurpathic pain.
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.