Vulvodynia and Genital Pain

Janet Phoenix, MD, MPH

First published in October 2007 this article is still an excellent summary in August 2010.

Vulvodynia is a burning, irritation, stinging, or sharp pain that occurs in the vulva, the area outside the vagina. This area includes the labia and the entrance to the vagina. Such pain can last for short periods of time or be persistent, but vulvodynia is usually defined as lasting at least three months. The term vulvodynia was coined in 1983; before that, there was little recognition of this disorder in the medical literature. The National Institutes of Health estimates that 10% of the women in the United States will have vulvodynia at some point in their lives.

Symptoms

The symptoms of vulvodynia can occur in a small area or may affect the entire vulvar area. Pain can occur before, during, or after sexual activity, when tampons are inserted, or even when wearing underwear or trousers. The pain can also occur for no apparent reason. Symptoms are reported as more severe in women who also have major depression.

Causes

The exact causes of vulvodynia are not yet known. Some studies suggest that it is caused by psychological problems (somatization), but other studies suggest that yeast infections may increase the risk, or that the cause may be similar to the cause of some kinds of kidney stones. Awareness of the disorder is not very widespread in the medical provider community, although it affects women of all ages and ethnic backgrounds. More studies are needed to determine the causes and effective treatments.

Effect on Sexual Activity

Because sexual activity can often be painful for women with this condition, it has an impact on intimate partners as well. Organizations like the National Vulvodynia Association (www.nva.org) have information about lubricants and other ways to help women with vulvodynia to engage in sexual activity with less discomfort.

Treatments

Treatments include topical and oral medications, biofeedback, and surgery. Medications to decrease nerve hypersensitivity, such as antidepressants or anticonvulsants, can be effective, as can topical anesthetics such as lidocaine. Antifungal medications may also decrease symptoms. Calcium citrate has been used with other treatments to lower the risk of crystal deposits similar to those causing kidney stones. Surgical treatments can remove hypersensitive areas. Cognitive behavioral therapy has also been used to reduce symptoms. No single treatment seems to be effective for all women, and a combination of treatments seems the best approach to improve quality of life.

Strategies for Coping with the Symptoms

Several strategies have been recommended to relieve symptoms:

  • Wearing only cotton underwear;
  • Avoiding pantyhose;
  • Wearing loose fitting clothing;
  • Using only white unbleached toilet tissue;
  • Using 100% cotton sanitary products (tampons and pads);
  • Frequent washing of the genitals;
  • Application of ice;
  • Avoiding the use of creams, soaps, douches and deodorants on the vulva.

Patient information sources

The National Institute of Health’s Office of Women’s Health Research has an information pamphlet entitled Vulvodynia, Understanding Vulvodynia and Planning for future research (http://orwh.od.nih.gov/health/vulvodynia.html).

Vulvodynia: What You Should Know is an information booklet published by the American Academy of Family Physicians in American Family Physician (http://www.aafp.org/afp/20060401/1239ph.html).

References

1. Bachmann GA, Rosen R, Pinn VW et al. (2006). Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management. Journal of Reproductive Medicine 51 (6):447-56.

2. Mascherpa F, Bogliatto F, Lynch PJ, et al (2007). Vulvodynia as a possible somatization disorder. More than just a notion. Journal of Reproductive Medicine 52(2):107-10.

3. Pagano R, (2007). Value of colposcopy in the diagnosis of candidiasis inpatients with vulvodynia. Journal of Reproductive Medicine 52(1):31-4.

4. Reed BD, (2006). Vulvodynia: diagnosis and management. American Family Physician 73(7):1231-8.