Vaginal Pain and Vulvodynia

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Vaginal pain and vulvodynia facts

  • Vulvodynia refers to pain in the area of the vulva and vaginal opening for which no cause can be identified.
  • Vulvodynia is not related to sexually-transmitted diseases (STDs).
  • The exact cause of vulvodynia is not known.
  • Symptoms include a burning, throbbing, or aching pain that can be localized to one area of the vulva or more widespread.
  • Vaginal itching may be associated with vulvodynia.
  • Vulvodynia can be treated with medications and/or self-care (home remedy) measures. No one treatment is effective for all women.
  • Local anesthetics, local estrogen creams, antidepressants, and anticonvulsive drugs are examples of medical treatments for vulvodynia.
  • Biofeedback, exercises, and nerve blocks may benefit other women.
  • Vulvodynia is not associated with cancer or serious medical conditions, but it can be a source of long-term physical and emotional discomfort.

What is vaginal pain (vulvodynia)?

Vulvodynia refers to pain in the area of the vulva and vaginal opening. Vulvodynia is considered to be pain for which there is no known cause. It is different from pain that is located deep in the pelvis or internally in the vagina. This article focuses on pain in the vulvar region and at the opening (introitus) of the vagina. Deeper vaginal pain can also occur due to infections, tumors and conditions that cause more generalized pain in the pelvic organs.

Vaginal pain can be chronic and can last for years in some women. The degree of severity varies among women. It often occurs in the absence of physical signs or visible abnormalities. It can be severe and can interfere with sexual activity and cause painful intercourse (dyspareunia). However, there are a number of other causes of vaginal pain during or after sex.

What causes vaginal pain and/or vulvodynia?

It is unclear why some women develop vulvodynia. It is not thought to be related to sexually-transmitted diseases (STDs), although some women with vulvodynia have had multiple STDs. Some theories suggest that vulvodynia may be related to

  • damage or irritation of nerves,
  • abnormal responses to irritation or inflammation,
  • allergic reactions,
  • muscle spasms,
  • a history of sexual abuse, or
  • frequent use of antibiotics.

Familial or genetic factors also have been suggested to play a role in vulvodynia. Unfortunately, the exact cause has not been determined and most women have no known contributing factors.

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Vaginal Pain Symptoms

Pain in the vagina or the female external genital organs (the vulva, which includes the labia, clitoris, and entrance to the vagina) most commonly is a result of infection. Vaginal pain during sexual intercourse is referred to as dyspareunia. Infection of the vagina is referred to as vaginitis.

What about vaginal pain during pregnancy?

Vaginal pain may occur during the third trimester of pregnancy due to an increase in pressure on the cervix. Women who experienced vulvodynia before pregnancy may continue to experience this symptom during pregnancy.

What symptoms are characteristic of vaginal pain and vulvodynia?

Symptoms of vulvodynia can include:

  • Burning or stinging pain in the vulva or vaginal opening
  • Sharp, aching, or throbbing pain in the vagina or vulva
  • itching may be associated with the pain
  • The pain may be constant or it may come and go
  • Pain that occurs during sex or exercise
  • Some women report pain that is localized to one side or one area of the vulva, while others have more generalized and widespread pain.
  • There usually are no physical signs or changes that accompany vulvodynia, but sometimes there is evidence of inflamed skin.

What are risk factors for vaginal pain and vulvodynia?

Since the cause is poorly understood, it is difficult to predict who is at risk for vulvodynia. It can affect women of all ages and races. It can begin as early as adolescence and can occur both before and after menopause. It may occur during the menstrual period or independent of the menstrual period.

How is vaginal pain and vulvodynia diagnosed?

There are no specific tests that confirm vulvodynia, and the diagnosis is made based upon the characteristic symptoms. However, since vulvar and vaginal infections (yeast infection, bacterial vaginosis, vaginitis) are sometimes associated with burning and itching, cultures or other diagnostic tests to rule out infections may be ordered.

What is the treatment for vaginal pain and vulvodynia?

Vulvodynia can be managed both by medical treatments and self-care (home remedies). Not all treatments will be effective for every woman, and a woman may have to try different treatments to find the most effective option for her.

Medications and other medical therapies for vaginal pain and vulvodynia

Some of the medications that have been useful include:

Other medical therapies for women with severe vulvodynia include:

  • Injections of interferon or nerve blocks, in which medications are injected to reduce signaling from nerves in the affected areas
  • Biofeedback training and pelvic floor exercises have been helpful for some women.
  • Surgical removal of affected tissue can be of benefit in women with vulvodynia due to vulvar vestibulitis syndrome, a particular type of vulvodynia that is located at the area of the hymenal ring.

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Home remedies for vaginal pain and vulvodynia

Home remedies and self-care measures for vulvodynia can bring relief for many women. Some self-care measures to relieve the pain of vulvodynia include:

  • Rinsing the area with cool water, particularly after urination and sexual activity
  • Soaking in cool or warm sitz baths
  • Using topical ice packs wrapped in a towel
  • Heating pad use, in contrast, may help some women
  • Using mild, unscented soaps and detergent
  • Using white, unscented toilet tissue
  • Wearing white cotton underwear
  • Wearing loose-fitting clothing and avoiding stockings or pantyhose
  • Avoiding pools or hot tubs with chlorinated water
  • Using a water-soluble lubricant during sexual intercourse
  • Avoiding activities such as bicycling, that put pressure on the vulvar area
  • Keeping the vulvar area dry and clean
  • Avoiding food that can make the urine more irritating to the skin of the genital area. These foods include beans, berries, nuts, and chocolate
  • Over-the-counter antihistamines can help reduce itching, particularly at night

What are the complications of vaginal pain and vulvodynia?

The pain of vulvodynia can be debilitating and interfere with daily activities and sexual intercourse. It can make women feel a loss of control their bodies, causing profound emotional and physical discomfort.

What is the outlook (prognosis) for vaginal pain and vulvodynia?

Vulvodynia is a chronic condition, meaning that it may persist for months to years. In other women it may come and go. While it is not associated with cancer or with any serious medical diseases, it may be a source of chronic pain and emotional discomfort.

Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES: Gunther, E. S. "Clinical manifestations and diagnosis of generalized vulvodynia." UpToDate. Updated Jan 30, 2015.

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Reviewed on 10/7/2016
References
Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES: Gunther, E. S. "Clinical manifestations and diagnosis of generalized vulvodynia." UpToDate. Updated Jan 30, 2015.

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