What is vulvodynia?

Vulvodynia is pain in and around the vulvar/vaginal area - either constantly or with intercourse. It is sometimes brought on by touch or contact, but may also occur as a constant discomfort even without any touching. Vulvodynia seems to fall into several subgroups:

Neuropathic - This is pain from a nerve injury and will often feel stinging, burning or electric shock-like. The pelvic exam is usually normal in these cases.

Inflammatory - This sometimes is associated with a small ring of redness around the inner vulva and may be associated with some unknown infection or other inflammatory process in that tissue. For this subset, some physicians are recommending surgical incision of a small strip of tissue in a circle around the vulva. I would not do surgery until other approaches have been tried unless the pain is totally localized to that small ring of tissue.

Muscular - This comes again from pain in the pelvic muscles. Sometimes one can find the muscle which feels like a tight band and can reproduce the pain by pressing on that muscle. It also can sometimes come from multiple muscles deep in the pelvic area and be referred to the vaginal/vulvar area.

If your vulvodynia is associated with fatigue and insomnia, you likely also have a related fibromyalgia process. The good news is that fibromyalgia is now very treatable, and the pelvic pain (along with many other problems) often improves with the fibromyalgia treatment as well!

Vulvodynia is chronic pain in the vulvar area. The cause may be unknown or it may be related to an infection or disease.

Vulvodynia may be a burning or stinging pain in part or all of the vulvar area. There may also be itching, swelling, or pain with sex.

Treatment includes gentle cleaning of the vulvar area, wearing cotton underwear, avoiding feminine products that can irritate the skin, and using ice for swelling and pain.

If vulvodynia continues after trying home treatment, an appointment with a doctor is needed.

Itching, burning, stinging, rawness, or pain in the vulva in the absence of any known cause is called vulvodynia. Symptoms may occur in one site on the vulva or may be experienced all over the vulva; they may last for days, weeks, or even years, then disappear for a time. Tight clothes and sitting often increase the discomfort; sexual intercourse may or may not be painful. The cause of vulvodynia is unknown, but it affects about eight percent of women. It can be hard to get a proper diagnosis; if your vulva hurts, it is important to find a health care provider who is familiar with vulvodynia.

Vulvodynia describes pain or other uncomfortable symptoms such as burning, stinging or irritation, located in the skin of the female genitals, also called the vulva.

Treatment depends on its cause. Two categories are used to classify the causes of vulvodynia:

• Pain caused by a specific disorder
• Pain without a specific recognizable cause

Specific conditions that cause vulvar pain include:

• Infection (for example, herpes simplex virus)
• Inflammatory conditions
• Menopause
• Cancer (though this is rare)

Your doctor will ask about your health history and examine the vulvar skin to try to identify a specific cause. Treatment to eliminate the cause of the pain will be prescribed.

Many women with vulvar pain do not have an obvious condition to explain their pain. In some cases, the pain is over the entire vulva. In other cases, the pain is limited to one spot. Some women with vulvodynia have pain nearly all the time. In others, the pain may only occur with physical contact.

Vulvodynia not associated with a specific disorder affects about 5% of women. While the cause of pain is not known, doctors suspect that in many cases it is a form of "neuropathic" pain. This means the nerves in the vulvar skin send inappropriate signals of pain.

There is no single best treatment for vulvodynia if no specific underlying disorder is identified. Good vulvar care is always essential. Avoid irritants such as scented pads and tight fitting clothes. Cool packs applied to the skin may be helpful. Your doctor may recommend physical therapy to relax muscle spasms in the pelvis.

To help quiet overactive pain nerves, your doctor may prescribe a medication that treats "neuropathic pain," such as gabapentin.