Many women experience vulvar pain at some stage during their life. For most, the pain is temporary and resolved by treating an underlying infection or skin irritation.
When vulvar pain persists for more than three months, however, and the cause is unknown, a condition known as vulvodynia is typically diagnosed. Read on for more understanding of vulvar pain, the symptoms, what causes it, and the most effective treatment options.
What is the Vulva & Where is It?
The vulva is the exterior portion of the female genitals and includes the outer lips (labia majora), inner lips (labia minora), clitoris, and vaginal opening. In addition to being the center of female sexual pleasure, the vulva also acts as the entrance to the womb and protects the inner genitals.
Symptoms of Vulvar Pain
While most women suffering from vulvar pain describe the sensation as a burning, stinging, or throbbing ache, the severity of pain can differ from woman to woman depending on the cause.
For example, some women experience persistent vulvar pain, and others feel the pain only when the vulva is touched or extra pressure is added. The vulva can also become inflamed for some, however, many women often report no physical changes to the vulva despite feeling persistent pain.
Additional symptoms of vulvar pain include:
- Itching around the vulva and vagina
- Pain during sex
- Pain while urinating
- Pain when inserting a tampon
- Vaginal dryness
- Vulvar discomfort when sitting
What Causes Vulvar Pain?
Several factors have been proven to cause temporary vulvar pain, and although the exact cause of constant vulvar pain is unknown, scientists have pinpointed influences that are believed to contribute to its development. Below, we’ve outlined the most common factors associated with the cause of both short-term and long-term vulvar pain.
Causes of Temporary Vulvar Pain
Vaginal infections are the most common cause of temporary vulvar pain, particularly yeast infections, which are typically accompanied by vulvar itching, a burning sensation when peeing, and a lumpy cottage cheese-like vaginal discharge with a foul odor. Bacterial vaginosis (BV), although symptomless for many is another cause of vulvar pain, as is herpes.
Allergic reactions to fragranced detergents, scented soaps or tampons, sperm, latex condoms, and spermicides can often be at the root of short-term vulvar pain, especially when additional symptoms include itching, irritation, redness, and vulvar inflammation.
Vaginal Dryness is typically associated with menopause, however, it can also happen due to hormone fluctuations during pregnancy and breastfeeding. Also referred to as vaginal atrophy, vaginal dryness can result in painful sex, vulvar pain, as well as itching, and irritation. In addition to hormonal fluctuations, vaginal dryness is known to occur because of douching, taking antidepressants, after cancer treatment, or post-hysterectomy.
Causes of Vulvodynia – Persistent Vulvar Pain
Even though medical researchers have not yet concluded a definitive cause, it is believed that vulvodynia is more than likely a multifactorial disorder, meaning that the development of pain is caused by a combination of factors, rather than an isolated incident. For example, hormonal changes and long-term use of hormonal contraceptives are thought to play a role, in addition to the possibilities mentioned below.
Chronic pain conditions such as irritable bowel syndrome (IBS), interstitial cystitis, and fibromyalgia are thought to increase the risk of vulvodynia, or constant vulvar pain, by up to 30%.
Genetics and genetic disorders have recently been the subject of many studies surrounding vulvodynia and it was found that Caucasian women, as well as women with a history of dyspareunia (painful sex), could be at higher risk of persistent vulvar pain.
Physical or sexual trauma can result in damage to vulvar nerve endings and result in a heightened susceptibility to pain. Childbirth, for example, regular bike riding or horseriding can cause physical injury to the vulva, while sexual abuse, or painful sex due to vaginal dryness can result in sexual trauma that resonates as vulvar pain.
Recurring yeast infections are thought to contribute to vulvodynia by increasing the production of nerve fibers in the vulvar skin, making it hypersensitive and susceptible to chronic pain.
Overactive (too tight) pelvic floor muscles or pelvic muscle spasms not only lead to bladder and bowel issues but can also compress the nerves and lead to irritation, or an “itch” or burning sensation.
Treatment for Vulvar Pain
Treatment options for vulvar pain exist and are effective once the cause, or lack thereof, is understood and diagnosed by a medical professional.
Vaginal infections are typically treated with over-the-counter anti-fungal medication or antibiotics, in addition to OTC pain medication to treat vulvar pain. Probiotics are also significantly helpful to rebalance the vaginal microbiome after a yeast infection and medical studies have concluded that a full course of Boric Acid Suppositories is highly effective to not only relieve BV symptoms but prevent recurring infections too.
Allergic reactions that cause vulvar pain will normally disappear once the allergen is identified and eliminated.
Vaginal dryness can be soothed with a naturally-made vaginal moisturizer specifically designed to treat atrophy and vaginal/vulvar irritation. Vitex (or Chasteberry) supplements are also powerful to combat symptoms associated with menopause like vaginal dryness, mood swings, and pelvic pain. And to prevent friction, irritation, or pain during sex, use a water-based lubricant abundantly.
Vulvodynia, which is diagnosed when no cause of vulvar pain is determined, can be managed with pelvic physical therapy. Additionally, vaginal dilators which help to relax vaginal and vulvar tissues, reduce pain, and make vaginal penetration, as well as sex, more comfortable. Biofeedback to re-train the pelvic floor muscles and cognitive behavior therapy to help manage pain response are also effective to manage vulvodynia.
Tips to Prevent Vulvar Pain
Preventing vulvar pain is possible by incorporating some of the lifestyle changes below, however, if regular vulvar pain occurs, or it tends to come and go, make an appointment with your doctor to rule out any underlying causes.
- Wear cotton underwear instead of those made from synthetic materials to prevent a build-up of humidity around the genital area that could result in infection
- Avoid wearing pants that are too tight around the groin
- Remove damp workout pants or swimwear as soon as your workout finishes
- Stop douching
- Don’t use fragranced soap or hygiene products to clean the vagina. Warm water and a clean washcloth will suffice
- Avoid bleached tampons or scented sanitary pads that could irritate the vagina & vulva.
- Use a water-based lubricant during sex to avoid vaginal dryness or pain during sex
- Always urinate after intercourse
- Wipe front to back after using the bathroom to avoid spreading anal bacteria to the vagina
- Consider alternatives to hormonal birth control
Besides being uncomfortable, vulvar pain can adversely affect a woman’s lifestyle, stress levels, and intimacy with their partner. Treatment options exist, however, and the sooner you speak with your doctor about your symptoms, the quicker the pain can be resolved.
Many cases of vulvar pain are cured by treating vaginal dryness, irritants, or underlying vaginal infections, and with pelvic physical therapy symptoms can be successfully managed with vaginal dilators, biofeedback, and sometimes pain medication.
If you are suffering from vulvar pain, don’t be embarrassed to speak with your doctor and start treatment as soon as possible.
Medical News - What is the Vulva https://www.news-medical.net/health/What-is-the-Vulva.aspx
Mayo Clinic – Vulvodynia - https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-20353423
The American College of Obstetricians & Gynecologists - Disorders of the Vulva: Common Causes of Vulvar Pain, Burning, and Itching - https://www.acog.org/womens-health/faqs/disorders-of-the-vulva-common-causes-of-vulvar-pain-burning-and-itching
National Library of Medicine - Repeated Vulvovaginal Fungal Infections Cause Persistent Pain in a Mouse Model of Vulvodynia - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243907/
National Library of Medicine - Vulvodynia—It Is Time to Accept a New Understanding from a Neurobiological Perspective - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296499/
Cleveland Clinic – Boric Acid Vaginal Suppository - https://my.clevelandclinic.org/health/drugs/19641-boric-acid-vaginal-suppository
National Library of Medicine - The Role of Probiotics in Vaginal Health - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366906/
National Library of Medicine - Low Dose, High Frequency Movement Based Dilator Therapy for Dyspareunia: Retrospective Analysis of 26 Cases - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240346/
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.