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What Is Vulvodynia?

Vulvodynia is unexplained pain in your vulva, the external female genital area. There’s no apparent reason for the pain, which can last for months or years. This condition makes sex, wearing tampons, sitting for long periods or wearing tight-fitting pants uncomfortable. 

For women who haven’t gone through menopause, vulvodynia is the leading cause of painful sex. You may find it embarrassing to talk about, but discussing your symptoms with a health care provider is important. Treatment for vulvodynia is available and can significantly improve your quality of life and emotional health. 

Our women’s health providers and gynecologic surgeons at University of Utah Health are experts at treating this complex condition. Our surgeons have treated more than 500 patients with a 90% cure rate. 

Types of Vulvodynia

There are several types of vulvodynia. Most women have pain in the same spot, which is called localized vulvodynia. Pain in multiple areas or moving from spot to spot is called generalized vulvodynia. Both types can occur anywhere in your vulva, including the:

  • clitoris, the sensitive nub of flesh at the top of your vaginal opening,  
  • inner thigh,
  • labia, the folds of skin around your vaginal opening, and 
  • perineum, the area between your vaginal opening and anus. 

Touch or pressure may provoke (or cause) vulvodynia. Or it can occur spontaneously without any external stimulation.

Vulvar Vestibulitis Syndrome

Vulvar vestibulitis syndrome, or vestibulodynia, is the most common type of localized vulvodynia. It occurs in the tissues around the vaginal opening called the vestibule. 

Vulvodynia Symptoms

Pain in your vulva is the primary symptom of vulvodynia. The pain may be constant, or it may only happen occasionally. 
Many women say the pain feels like a burning sensation. It could also feel like:

  • itching,
  • painful intercourse (dyspareunia),
  • rawness,
  • soreness,
  • stabbing, 
  • stinging, or 
  • throbbing.

Can Vulvodynia Feel Like a UTI?

A urinary tract infection (UTI) occurs when bacteria grow in the urinary tract. A UTI causes pelvic pain and pressure, burning with urination, and needing to urinate frequently and urgently.

You may confuse vulvodynia with a UTI since urine may cause a burning sensation on the vulva with either condition. However, with vulvodynia, you won’t have the frequency and urgency to urinate of a UTI.

Vulvodynia Causes

Doctors don’t know exactly why the condition happens. However, viruses and sexually transmitted infections (STIs) do not cause it. 

Possible causes include: 

  • allergies or skin sensitivities,
  • hormonal imbalances,
  • injuries or trauma to the vulvar area,
  • muscle spasms,
  • past vaginal infections, or
  • weakness or tightness in the pelvic floor muscles that support the bladder, uterus, and ovaries.

Can Birth Control Cause Vulvodynia?

Oral birth control can cause vulvodynia when pills alter hormone levels in the vulva, making the tissues dry and painful. As a result, you may feel pain during sex. Changing the type or dosage of pills may reduce symptoms.

Can Endometriosis Cause Vulvodynia?

The lining of the uterus, or womb, is called the endometrium. If the lining grows outside the uterus, it’s called endometriosis. This condition causes heavy periods, muscle pain, and pain during urination. 

Endometriosis doesn’t cause vulvodynia. However, it can make your pelvic muscles hurt, which causes pain in your vulva.

How Long Does Vulvodynia Last?

Vulvodynia is a chronic condition, which means the pain lasts for at least three months. However, some women experience symptoms for longer—even years. 

Can Vulvodynia Go Away?

Vulvodynia may go away without treatment, but you should see a health care provider if you’re experiencing pain. It’s important to identify and treat the source of the pain. 

What Causes Vulvodynia to Flare Up?

Pain in your vulva can occur for many reasons, including:

  • douching or cleaning out the inside of your vagina with water or another solution,
  • exercise, especially bike riding,
  • inserting tampons,
  • scented soaps or bath products,
  • sex,
  • sitting for too long, especially in damp exercise clothes or swimwear, or
  • wearing synthetic underwear like nylon or polyester.

Vulvodynia Treatment

Treatment is a trial-and-error process. You may need to try several treatments or a combination, including: 

  • oral or topical medications to stop nerve pain,
  • physical therapy to relax the tissues and muscles in your pelvic floor, or 
  • surgery to remove tissue where you feel pain. 

Vulvodynia Medication

Medicines alleviate vulvodynia symptoms in a variety of ways. 

Topical creams or ointments numb the painful area. You can apply this medicine before sexual intercourse or a pelvic exam. 

Oral medications include antidepressants and anticonvulsants, which can help dull pain.

Hormonal creams and gels applied directly to the vulva improve blood flow and encourage collagen growth. Collagen is a natural protein that supports the elasticity of your skin, tissues, and muscles. 

Vestibulectomy Surgery

If medicines and physical therapy don’t work, you may find pain relief from vestibulectomy surgery. The procedure removes the vestibule tissue where you feel pain. 

The surgery is for women with localized vulvodynia who always feel pain around the vaginal opening. It’s not an option if you feel pain in the clitoris or labia or if the pain moves to different parts of your vulva. 

You’ll be asleep during the surgery, which takes about an hour. First, the surgeon removes the surface layer of your vestibule tissue where nerve endings are concentrated. Next, the surgeon closes the area with sutures (stitches) and applies medicine to prevent infection. 

Vestibulectomy Recovery

After your procedure, you’ll go home the same day. Once you get home, you should: 

  • apply ice to reduce swelling and pain, 
  • soak your vulva in warm water to reduce pain and prevent infection (sitz bath), and
  • take pain relievers to manage pain.

You’ll need to rest for the week after surgery. Then, limit movements for three to five weeks while your body heals. After eight to 12 weeks or when fully healed, you’ll begin physical therapy to strengthen the muscles of your pelvic floor.

Vestibulectomy Complications

While complications can occur with any surgery, vestibulectomy complications are rare. The formation of a Bartholin’s cyst is the most common complication. Bartholin’s glands sit on either side of the vaginal opening and lubricate the vagina during sex. 

Vestibulectomy surgery may block the glands, making them unable to release natural lubricant. If this happens, the glands become large and painful. You can often manage the condition with at-home remedies like sitz baths, but in severe cases, you may need surgery to drain the glands.

Vestibulectomy Success Rate

Surgery for vulvodynia is highly effective. Studies show that vestibulectomy surgery provides significant relief for 78.5 % of women and 89% have pain-free sex after the procedure.

Vulvodynia Home Remedies

You can reduce symptoms at home with these remedies.

  • Apply cold compresses during flare-ups. Wrap ice or gel packs in a towel before applying them to your genitals.
  • Avoid bubble baths or using soap directly on your vulva. Instead, wash gently with cool water and lightly pat dry.
  • Don’t use scented bath or laundry products. Rinse your underwear twice to remove any potential irritants. 
  • Practice yoga and other stretching exercises. Avoid activities, such as cycling or horseback riding, that put pressure on your vulva.
  • Apply a layer of petroleum jelly on your vulva after bathing to serve as a barrier between your clothing and genitals.
  • Rinse your vulva with cool water after urinating or having sex.  
  • Sit on a doughnut-shaped foam pillow to remove pressure from the vulva.
  • Soak in a lukewarm sitz bath twice daily for 5-10 minutes. Epsom salts or oatmeal can help ease symptoms.
  • Use water-based lubricants before sex. Avoid contraceptive creams or lubricants with scents or flavors. 
  • Wear loose-fitting clothing like skirts or baggy pants. 
  • Wear cotton underwear instead of synthetic fabric. 

Why Choose U of U Health?

The experts at U of U Health specialize in treating women with vulvar pain using medical therapy and surgery. Our gynecological surgeons treat more cases of vulvodynia than any other practice in the state and have successfully cured more than 500 patients. Trust our vulvodynia specialists to help you find relief for pain in your vulva, either through medicine, therapy, or surgery. 

Make an Appointment

You can make an appointment to see one of our Women’s Health providers by calling 801-213-2995 or ask your physician to refer you to our program. 

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