Vulvodynia: The stinging-burning-raw sex pain
Vulvodynia, previously known as Vulvar Vestibulitis Syndrome, is a condition of pain in the vulvar area and can present differently for every woman. It is often characterised by stinging, burning, irritation, rawness and pain with sex and can vary in severity.
Vulvodynia has long been misunderstood until quite recently with research only emerging over the last 25 years. Finally, there are now some answers for women who have been suffering with this pain for many years, having seen numerous doctors and specialists and trialled many different treatments and medications without success.
Yes it can happen in the absence of infection, virus or any visible symptoms.
NO it is not 'just in your head'!
Firstly, a quick anatomy and latin lesson: The vulva is the external female genitalia and comprises of the labia and clitoris. The vestibule is
the area within the labia minora and includes the introitus or opening of the vagina. The vagina is the internal organ and cannot be seen from the outside. The suffix ‘dynia’ means pain (the 'itis' in vestibulitis means inflammation, however it is not always present so the name has been changed).
What is it?
Vulvodynia is a result of hypersensitivity of the nerves supplying the vulva and vestibule. The cause of this increased sensitivity is still mostly unknown, however there are several theories:
- Chronic spasm and tightness of the pelvic floor muscles compressing the nerves that pass through them
- Previous infection or virus that has since healed but has left the nerves flared up and irritated
- Ongoing stretching of the nerves with extra movement in the joints of the pelvis
- Direct injury to the nerve more centrally near the spinal cord or along its path to the pelvis
It can be present from the very first sexual experience, gradually develop over time, following menopause or after a particular event such as surgery or pregnancy. It can also occur in conjunction with Vaginismus or be related to a traumatic experience, however this is generally not the case.
Here are several sub-classifications of Vulvodynia:
Vulvodynia (VVD)
Often a more diffuse, broad area of pain. It can encompass the labia, and also the area of the inner thighs and upper legs, around the clitoris, anus and also the urethra (where you pass urine). May or may not cause pain with intercourse.
Vestibulodynia (VBD) Most common
A more localised form, Vestibulodynia refers to pain only within the vestibule and around the opening of the vagina. Provoked pain more frequently occurs with penetration of the vagina including tampon use, digital palpation (finger insertion) and intercourse.
Clitorodynia
Again localised, specifically pain in or around the clitoris. May be provoked or unprovoked.
Within these classifications, the severity of the condition can determine the possibility and enjoyment that one can have from sexual intercourse. For some women it can prevent intercourse completely, while some may be able to tolerate it enough to have penetration.
How is it diagnosed?
History taking with symptoms as described above.
The Q-tip test. This is a simple test that can be done by your family doctor or Pelvic Health Physio to determine the irritability and sensitivity of the vulva and vestibule. It involves lightly touching the area with a Q-tip or cotton bud to see if the sensation is painful.
Observation may or may not show any redness or visible signs of soreness.
Differential Diagnosis. Additional tests may be conducted to rule out any infection or virus, skin conditions or systemic diseases.
What can be done about it?
Prevention: Optimise your pelvic health to prevent dysfunction of the pelvic floor muscles! (See Too Short, Too Long or Just Right). Avoid using chemical irritants around the vulva and vagina (See Vulvar Skin Care post).
Diet: Research suggests that these foods do not necessarily trigger the condition. However if you have vulvodynia, food highest in oxalate can make it worse and may be worth trying to decrease or avoid (See List of High Oxalate Foods).
Pelvic Health Physiotherapy: The safest (and often most effective!!) form of treatment for vulvodynia is Pelvic Health Physiotherapy. Treatment involves desensitizing and retraining the nerves of the vulvovaginal area, releasing the muscles of the pelvic floor and optimising their function with often very good results and a complete cure of the condition.
Medication: Some medications such as tricyclic anti-depressants have been shown to help manage the pain. However there are side-effects associated with any medication and they can take a long time to wean off.
Surgery: Generally a last resort as it is not guaranteed to work and can make the condition worse. Surgery for vestibulodynia involves removal of the skin of the vestibule and some of the irritated nerves. All surgeries have associated risks.
Often a more diffuse, broad area of pain. It can encompass the labia, and also the area of the inner thighs and upper legs, around the clitoris, anus and also the urethra (where you pass urine). May or may not cause pain with intercourse.
- Unprovoked the negative sensation can be present constantly, regardless of touch or contact to the skin
- Provoked painful sensations are only present when provoked. This can be any kind of physical contact such as tight clothing, wiping after bowel or bladder emptying, manual touch by yourself or another person.
Vestibulodynia (VBD) Most common
A more localised form, Vestibulodynia refers to pain only within the vestibule and around the opening of the vagina. Provoked pain more frequently occurs with penetration of the vagina including tampon use, digital palpation (finger insertion) and intercourse.
Clitorodynia
Again localised, specifically pain in or around the clitoris. May be provoked or unprovoked.
Within these classifications, the severity of the condition can determine the possibility and enjoyment that one can have from sexual intercourse. For some women it can prevent intercourse completely, while some may be able to tolerate it enough to have penetration.
How is it diagnosed?
History taking with symptoms as described above.
The Q-tip test. This is a simple test that can be done by your family doctor or Pelvic Health Physio to determine the irritability and sensitivity of the vulva and vestibule. It involves lightly touching the area with a Q-tip or cotton bud to see if the sensation is painful.
Observation may or may not show any redness or visible signs of soreness.
Differential Diagnosis. Additional tests may be conducted to rule out any infection or virus, skin conditions or systemic diseases.
What can be done about it?
Prevention: Optimise your pelvic health to prevent dysfunction of the pelvic floor muscles! (See Too Short, Too Long or Just Right). Avoid using chemical irritants around the vulva and vagina (See Vulvar Skin Care post).
Diet: Research suggests that these foods do not necessarily trigger the condition. However if you have vulvodynia, food highest in oxalate can make it worse and may be worth trying to decrease or avoid (See List of High Oxalate Foods).
Pelvic Health Physiotherapy: The safest (and often most effective!!) form of treatment for vulvodynia is Pelvic Health Physiotherapy. Treatment involves desensitizing and retraining the nerves of the vulvovaginal area, releasing the muscles of the pelvic floor and optimising their function with often very good results and a complete cure of the condition.
See Find a Pelvic Health Physio (you generally do not need a Dr's referral to see a physiotherapist unless required by your extended or private health insurance for reimbursement)
Medication: Some medications such as tricyclic anti-depressants have been shown to help manage the pain. However there are side-effects associated with any medication and they can take a long time to wean off.
Surgery: Generally a last resort as it is not guaranteed to work and can make the condition worse. Surgery for vestibulodynia involves removal of the skin of the vestibule and some of the irritated nerves. All surgeries have associated risks.
