Pain in the vulva, the external genital area, is common. Often it has a clear cause, such as a yeast infection, a skin irritation or friction. But for some people the pain lingers for months with no obvious explanation. Tests come back normal. Treatments for infections do not help. It can be exhausting to explain, and many people wait a long time before getting a diagnosis.

That kind of persistent pain has a name: vulvodynia.. It is a real condition, it is not in your head, and it can be treated.

What is vulvodynia?

ACOG defines vulvodynia as vulvar pain that lasts for 3 months or longer and is not caused by an infection, skin disorder or other medical condition.

The definition matters. Vulvodynia is not a catch all label for any vulvar pain. It is used after other causes have been looked for and ruled out. That is why diagnosis can take time.

You may also see older or more specific names. NICHD notes that terms such as vulvar vestibulitis syndrome, vestibulitis and vestibulodynia have been used, often for pain centered in the vestibule, the area around the vaginal opening.

What does it feel like?

ACOG says vulvodynia is most commonly described as burning, stinging, irritation and rawness. Some people also feel aching, soreness, throbbing or swelling.

The pain can affect the whole vulva or be centered in one area. It can be constant or come and go. It can start and stop without warning, or happen only when the area is touched, for example during sex, inserting a tampon, sitting for a long time or wearing tight clothing.

What causes it?

There is no single known cause. ACOG says vulvodynia is likely caused by many factors working together, which may include:

  • Damage or irritation of the nerves of the vulva
  • Inflammation of the vulva
  • Long term reactions to certain infections
  • Certain genetic disorders
  • Sensitivity to certain foods
  • Dysfunction of the pelvic floor muscles
  • Conditions affecting nearby muscles or bones

Vulvodynia is not a sexually transmitted infection, it is not contagious and it is not caused by poor hygiene.

How is it diagnosed?

Because vulvodynia is diagnosed after ruling out other causes, the evaluation starts by looking for the more common reasons for vulvar pain. ACOG says your gynecologist or other health care professional may:

  • Ask about your symptoms, sexual history and medical and surgical history
  • Ask when symptoms happen, what treatments you have tried and whether you have allergies, chronic infections or skin problems
  • Carefully examine the vulva and vagina
  • Take a sample of vaginal discharge to check for infection
  • Gently touch areas of the vulva with a cotton swab to find where the pain is and how severe it is
  • Sometimes take a small biopsy of vulvar skin

The cotton swab test may sound simple, but it helps map the pain, which guides treatment.

If you find it hard to raise the topic, it may help to write down your symptoms beforehand and bring the list to your appointment.

How is it treated?

ACOG is candid that many treatments are available and no single method works for everyone. It can take a few months before any relief is noticed, and more than one treatment may be needed. ACOG suggests keeping a pain diary to track symptoms and how they respond to each approach. Some people are referred to a pain specialist.

Gentle vulvar care

ACOG recommends gentle care of the vulva and avoiding irritants. Its suggestions include:

  • Wear 100 percent cotton underwear, and do not wear underwear while sleeping
  • Avoid douching
  • Avoid irritants such as perfumes, dyes, shampoos, detergents and deodorants
  • Clean the vulva with water only
  • Switch to 100 percent cotton pads if regular pads are irritating
  • Use lubricant during sex, but avoid flavored, cooling or warming lubricants
  • Rinse and pat the vulva dry after urinating
  • After bathing, apply a thin layer of preservative free oil or petroleum jelly to hold in moisture
  • Avoid using a hair dryer on the vulvar area
  • Use cool gel packs on the vulva

These steps will not cure vulvodynia for everyone, but they reduce irritation and can make other treatments work better.

Medications

ACOG lists several kinds of medicine that have helped people with vulvodynia. They can be taken by mouth, injected into the affected area or applied to the skin.

  • Local anesthetics applied to the skin can provide short term relief, for example before sex, or be used for longer periods.
  • Antidepressants and antiseizure drugs can help with nerve related pain. They are used here for pain, not because the pain is "in your head." They may take a few weeks to work, and some antidepressants can be made into a cream.
  • Hormone creams, such as estrogen cream applied to the vulva, may help in some cases.

Physical therapy

ACOG notes that physical therapy can relax tissues in the pelvic floor and release tension in muscles and joints. Biofeedback, a form of physical therapy, trains you to work with the pelvic floor muscles. Trigger point therapy, a form of massage therapy, targets specific tight spots. A pelvic floor physical therapist is often a key part of care. Our guide to Kegel exercises explains pelvic floor basics, but if you have pain, check with your clinician or therapist first, since some people need to relax these muscles rather than strengthen them.

Other options

For pain centered in the vestibule that does not respond to other treatments, some people are offered surgery to remove the affected tissue. NICHD lists surgical treatment among the options, usually after other approaches have been tried.

Vulvodynia, sex and relationships

Pain during sex is one of the most common and distressing parts of vulvodynia. It can lead to avoiding intimacy, worry about a partner's feelings and a cycle where anticipating pain makes muscles tense, which can make pain worse. Talking openly with a partner, using lubricant, exploring forms of intimacy that do not cause pain and working with a clinician or sex therapist can all help.

When to see a doctor

See a gynecologist or other health care professional if you have vulvar pain that lasts for weeks, returns again and again, or makes sex, sitting or daily activities painful. It is also worth going back if treatments for infection have not helped. Persistent pain deserves a proper evaluation.

The takeaway

Vulvodynia is long lasting vulvar pain without another identifiable cause. It is real, it is not your fault, and it can be treated. Relief often takes time and a combination of approaches: gentle care, medicines, physical therapy and support. A pain diary and a clinician who takes your symptoms seriously make a big difference.

This article is for general information and is not a substitute for medical advice.

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