What is Vulvodynia?

Vulvodynia is a condition characterized by chronic vulvar pain. The vulva is the exterior region of the female genitalia that protects the sexual organs. There is no specific cause of the pain and discomfort and it may vary in location, severity and frequency between patients. Some women only feel pain in one part of the vulva, while others feel it in more than one area.

Unlike other conditions that may cause similar painful or uncomfortable symptoms, vulvodynia is not an infection and it is not a sexually transmitted disease. Physicians have not defined a specific cause, but according to the National Vulvodynia Association, research shows that vulvodynia may be caused by underlying inflammatory disorders or inconsistent nerve signals within the vulva. But there is still plenty of research to conduct. An estimated 16 percent of women all over the world experience vulvodynia at some point in their lives, which is a significant statistic.

Types of Vulvodynia

There are two main types of vulvodynia, which can occur on their own or at the same time: localized and generalized vulvodynia.

Localized Vulvodynia (Provoked)

The majority of women only feel pain in one area of the vulva. There are subcategories of localized vulvodynia based on where the patient feels pain, including vestibulodynia and clitordynia.

Vestibulodynia

Women with vestibulodynia, formerly called vestibulitis syndrome, feel pain in the vestibule, which is the tissue that surrounds the opening of the vagina. The pain develops from pressure to the vestibule from:

• Sexual intercourse
• Gynecologic exam
• Tampon use
• Wearing fitted pants
• Prolonged sitting

There are two more classes dividing vestibulodynia: primary and secondary. Women with primary vestibulodynia begin to feel pain at the first attempt of sexual intercourse, while women with secondary vestibulodynia have painless intercourse before they develop pain.

Clitorodynia

This is a rare type of localized vulvodynia. Patients feel pain in the clitoris, which is an extremely sensitive organ in front of the vagina, so it can be very painful.

Generalized Vulvodynia

In generalized vulvodynia, the patient feels constant sudden pain. Unprovoked generalized vulvodynia causes pain without any touch or pressure. The patient may experience periods during which the symptoms subside. Sexual intercourse, prolonged sitting or wearing pants may put pressure on the vulva and make the symptoms even worse. The pain may occur in one or multiple areas.

Symptoms of Vulvodynia

Vulvodynia often lasts for at least three months and may even last for years. The condition is not life-threatening, but it usually starts suddenly and the pain may interfere with daily activities. It may also take a toll on the patient’s mental health and potentially cause stress, anxiety and depression.

The main symptom is pain. It may affect a specific location or a wider area. Aside from just the genital region, the patient may even feel pain in the upper legs and inner thighs. Patients with vulvodynia may also feel an irritating, burning, stinging or itching feeling in the tissue of the vulva. Sometimes the tissue is also inflamed. The vulva may feel raw and sore, or it may throb or swell.

Neuropathic Pain

Specifically, vulvodynia causes neuropathic pain. This usually means there is tissue injury in the body, specifically damaged or dysfunctional nerve fibers that send the wrong pain signals. In vulvodynia, the hypersensitive nerve fibers in the vulva and the area surrounding it send unusual signals to the brain.

Vulvodynia pain may be immediate, delayed, intermittent, persistent or constant in timing. The symptoms may be more serious during or after walking, sitting, sexual intercourse, exercise, tampon insertion or any other activity that puts pressure on the vulva.

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Risk Factors for Vulvodynia

Researchers have not discovered the exact cause of vulvodynia. Patients often receive a diagnosis after doctors eliminate all other conditions that may also cause vulvar pain, like infections or skin conditions. However, there are several factors that researchers suspect may contribute to vulvodynia.

Genetic Factors

Studies suggest that there may be a genetic predisposition, including alterations in inflammatory response, strong pain sensitivity and susceptibility to persistent inflammation.

Nerve Damage

Because the pain is neuropathic, it develops when the nerve fibers in the vulva become damaged or irritated. Then they are unable to send correct signals to other areas of the body.

The density of the nerve fibers in the vulvar vestibule may increase, making the areas more sensitive. The hormone receptor activity in the vulva’s tissue may also change.

Inflammatory Malfunction

The vulva may contract high levels of inflammatory materials in its tissue. In some cases, the cells in the vulva may react abnormally to this inflammation, as well as other environmental factors, such as physical trauma or injury to the vulva. The vulva may also endure localized ultra-sensitivity to infections or organisms in the vulva and vagina, such as Candida albicans, a species of the Candida genus and the most common type of yeast infection.

Weak Pelvic Muscles

The condition may also be a result of muscle spasms, weakness or instability in the pelvic floor. There are three categories: the superficial muscles, the middle layer and the deep pelvic floor muscles. The muscles support urinary, bowel and sexual function and when they weaken, it can cause side effects, such as pain in the vulva.

Treatment for Vulvodynia 

Vulvodynia is not life-threatening, but it can cause extreme pain and discomfort. Since there is no single cause for vulvodynia, treatment focuses on easing symptoms and providing pain relief. Doctors tailor treatment plans to each patient and they may require more than one method to find a successful solution.

Topical Medications

Patients can apply topical ointments and creams with nerve-stabilizing medication or anesthetics to the area around the vulva. For example, physicians may prescribe hormonal medications with estrogen or testosterone or compounded formulations, such as an antidepressant or anticonvulsant.

Oral Medications

Doctors may prescribe oral medications, such as opioids or antidepressants. These are pain-blocking medications to relieve nerve pain.

Biofeedback

This treatment helps the patient learn how to relax the pelvic muscles, which may help reduce vulvar pain.

Physical Therapy

Similar to biofeedback, physical therapy aims to relax pelvic muscles. However, its purpose is myofascial release rather than strengthening the muscles.

Dietary Modifications

Research suggests that diets high in oxalate salts may contribute to vulvodynia. Consult a doctor about dietary modifications and confirm any allergies and get medical advice about eliminating food that may be affecting the condition. In a study, a vulvodynia patient took calcium citrate along with a low-oxalate diet, resolving her symptoms.

Track your diet and record the results in a food diary. You might start to notice a link between certain foods and the frequency or severity of their symptoms. Patients with interstitial cystitis may also find this useful.

Counseling

Vulvodynia can restrict routine activities, interfere with intimate and interpersonal relationships and lower the quality of life. Patients who experience chronic vulvar pain may also develop low self-esteem and depression. Regardless of the other approaches that a patient uses to control vulvar pain, they may also benefit from psychological counseling. It may help them develop coping mechanisms and sort through problems with sexual intimacy.

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Vestibulectomy

Some patients with localized vulvodynia may need surgery to ease their pain if other treatments have failed. Vestibulectomy gets rid of the affected tissues and skin around the opening of the vagina.

Home Remedies for Vulvodynia

Other remedies that don’t require a doctor or surgeon may be helpful, just simple lifestyle changes. For example, avoid products that may dry or irritate the skin. Keep irritants away by ditching soaps, detergents and shampoos with scents or dyes. Avoid bubble baths, fabric softeners, vaginal wipes and douching. The vagina cleans itself naturally, so it doesn’t need anything drastic to keep it functioning properly.

Wear cotton underwear and loose clothing. Avoid materials that hold moisture, such as nylon. Gently pat the vulva dry after urinating and avoid wearing sweaty workout gear or wet bathing suits for too long. Prevent painful sex with lubricants without irritating scents or cooling or warming effects. Cool ice packs may help relieve pain in the vulva.

Supplements for Vulvodynia

Vulvodynia patients may lack vital nutrients and may not receive enough vitamins for the pelvic, vaginal and vulvar tissues to function optimally. Magnesium, Vitamin D, omega-3 fatty acids and antioxidant deficiencies may contribute to vulvodynia. Therefore, these supplements may help maintain overall health as well as support optimal vulvovaginal health.

Magnesium

This mineral plays an essential role in supporting nerve health. Magnesium maintains normal muscle and nerve function. A magnesium deficiency can increase the risk of inflammation, which can then lead to health problems like vulvodynia. Take ½ to 1 tsp of magnesium citrate powder daily mixed into a liquid, unless a doctor advises against it.

Vitamin D3

Not only does it support healthy blood pressure levels and healthy bones, but studies also link Vitamin D deficiency to neuropathic pain. A study concluded that 80 percent of its female subjects with neuropathic pain were deficient in Vitamin D. As a dietary supplement, take vitamin D3 (cholecalciferol) in 50 mg doses daily, or following a physician’s instructions.

Omega-3-6-9

Fatty acids like omega-3-6-9 are important for healthy neurotransmitter and brain cell function. Physicians believe that they may support healthy blood pressure and cholesterol levels and promote brain health. They also control nerve damage by enhancing signal transmission and nerve density. Take three omega-3-6-9 softgels one or two times a day, or as recommended by a doctor.

Beta Carotene 

A pigment found in plants, beta-carotene is an antioxidant credited with promoting healthy aging and a healthy immune system. It has antioxidant properties that help fight nerve-damaging free radicals. Take 1,300 mg of beta-carotene powder per day, or as instructed by a physician.

Saw Palmetto Extract Powder

Derived from a palm tree plant, saw palmetto extract is used to help treat prostate disorders in men. However, it may also benefit women’s health by regulating hormonal imbalances. As a dietary supplement, take 500 mg of saw palmetto extract powder daily after confirming the dosage with a doctor.

The Bottom Line

Vulvodynia is persistent pain in the vulva, the part around the vagina’s opening. The vulva protects the female sexual organs. The main vulvodynia symptom is pain and sometimes it’s sharp , dull, throbbing, stinging or sore. Other times, it’s burning pain and the vulva may be swollen or inflamed. Vulvodynia pain may be mild or so severe that it makes it difficult for the patient to carry out daily functions, but it is not life-threatening.

Doctors have not identified a singular cause for vulvodynia. However, there are many different risk factors that may contribute. Research associates the condition with inflammatory malfunction, damage to nerves in the vulvar area (neuropathic issues), genetic factors, environmental factors, hormonal factors and musculoskeletal issues.

Different treatments can work for different vulvodynia cases. Some people may need to make lifestyle or dietary changes, while others may find relief with medications, anesthetic creams or physical therapy. Because there is no identifiable cause, treatment options aim to relieve the symptoms and increase quality of life. Patients also have the option to use more natural treatment methods, such as supplements to maintain proper nerve function. It is always best to consult with a physician before starting a supplement regimen. Remember that supplements are not a treatment for any medical condition, even though they may maintain general health.