Vulval pain syndromes occur when vulval pain exists and there is no infection or skin disease causing the pain. For some women however, previous infections and skin problems can trigger the pain, even when those problems have been successfully treated.
The vulva is the skin around the outside of the vagina. It includes the labia majora (the hair bearing lips of skin) and the inner, smaller labia minora.
How do I talk about this problem?
It can be embarrassing to talk about vulval pain, but this is not an uncommon problem…it just doesn’t get discussed among women very often.
Don’t just try to ‘put up with it’ There is a great deal that can be done!
There are different names to describe different types of vulval pain syndromes:
- Vestibulodynia or vestibulitis – pain at the entrance to the vagina. The pain usually comes on after touch or pressure during sex, medical examinations or inserting tampons. For some women, it can last for hours after sex.
- Vulvodynia – pain in the outside skin of the female genitals. The pain can be present all the time, or it can come and go. The pain may be felt all over the vulva, or just on one side, or one or two spots. Touch does not usually trigger the pain, but it can make it worse.
- Clitorodynia – pain around the clitoris, often brought on by touch or sexual arousal.
Women with vulval pain use words like:
- burning, tearing, splitting, stabbing, feeling raw, and sometimes itchiness or stinging.
Why do I have this problem?
The exact cause of vulval pain syndromes are unknown, but researches believe that pain can occur as a result of:
- chronic inflammation from recurrent thrush infections or chronic skin conditions, such as Lichen sclerosus and Irritant Contact Dermatitis,
- hormonal changes e.g., at menopause, during breastfeeding,
- abnormal inflammatory responses to trauma,
- overactive pelvic floor muscles in the setting of chronic pelvic pain conditions such as endometriosis,
- misfiring of the vulval nerves to send a message to the brain of pain, when they should be sending messages of touch, pressure, heat or stretch.
Will my vulval look abnormal?
Some women with vestibulodynia will have redness at the vaginal opening, but this not a reliable sign as every woman’s vulva looks different. In most cases of vulval pain, the vulva looks completely normal.
How is it diagnosed?
There is no single test that diagnoses vestibulodynia or vulvodynia. To being with, your doctor will need to talk to you about your symptoms and your medical history in detail. The ‘Q-tip test’ can be used to map areas of pain – this involves touching a cotton bud to vestibule. It is important to exclude other causes for vulval pain so your doctor may need to take swabs from inside the vagina to test for infections and perform a vulval biopsy to test for skin conditions. A women’s health physiotherapist can assess for over-activity of the pelvic floor muscles by performing an internal exam.
What can I do to make it better?
Avoid irritating the sensitive skin of the vulva and vagina by:
- washing the vulva only with water,
- use a soap alternative such as QV, Cetaphil or Dermaveen for the body,
- don’t use feminine hygiene sprays, wipes or powders,
- use unscented toilet paper, pads and tampons,
- wear comfortable cotton underwear – try to minimise wearing G-strings, tight jeans and pantyhose,
- use water-based lubricants, or coconut or almond oil for sex,
- don’t wax, shave or laser the hair on the labia – limit hair removal to the ‘bikini-line’.
What are some of the treatments available?
Treatment for vulval pain syndromes often involves multiple strategies, and a little bit of time and adjustment to find the regimen that suits you best. Because the pain often has more than one cause, successful treatment often involves more than one approach. For example, a combination of appropriate genital skin care, medication to reduce nerve pain and physiotherapy to relax the pelvic floor muscles is the starting point for most women.
We sometimes also get help from psychologists, sex therapists and gynaecologists for Nerve blocks & Dysport (Botox) injections.
Don’t despair if your pain comes back after a period of improvement – these problems can wax and wane. With time, these flares will last for shorter periods of time and you’ll get on top of them more quickly. Improvement can take weeks and sometimes months, so be patient and kind to yourself and your body.
For more information go to:
- The International Society for Vulval Disorders http://www.issvd.org
- For information on other skin conditions that can affect the vulva or Lichen Sclerosus
Dr Tonia Mezzini is a member of the Australian and New Zealand Vulvovaginal Society and has been teaching other doctors how to help patients with vulval pain for years. If you have vulval concerns, make an appointment today to see Dr Tonia Mezzini.
Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with:
- Vulval pain syndromes and vulval skin conditions
- Low libido and pain with intercourse
- Polycystic Ovarian Syndrome
- Gender-affirming hormone therapy
- Complex contraceptive choices
- Sexually transmitted infections such as recurrent genital herpes
- Recurrent bacterial vaginosis
- Recurrent thrush
- Menopause and hormonal concerns
- Chronic pelvic pain in men and women
- Painful periods and endometriosis
- Information about sexual health
- Women's Health after cancer treatment
- Androgen deficiency in men