Vulval pain

What is Vulvodynia?

Vulvodynia is a term to describe pain arising in the area around the vaginal opening (vulva) for which there is no identifiable cause.

The pain, burning or irritation associated with vulvodynia may make sitting for prolonged periods or having sex quite uncomfortable.

It is common in sexually active women between 20 and 40 years of age.

What are the symptoms?

Pain in the genital area, which can manifest as:

  • Burning
  • Soreness
  • Stinging
  • Rawness
  • Painful intercourse (dyspareunia)
  • Throbbing
  • Itching

The pain may be constant or intermittent and chronic or short lasting in duration.

It may be brought on by touch, insertion of tampon or during penetrative sex.

Pain can occur passing urine or after physical activity such as bike riding

What Causes vulvodynia?

The exact cause is unknown but it reflects hypersensitive nerves in the affected skin.

It may be triggered by:

  • Injury or irritation of the nerves due to childbirth, sexual abuse and vaginal surgery.
  • Chronic thrush and herpes infections
  • Allergies or sensitive skin
  • Emotional Factors
  • Hormone changes at menopause

How is Vulvodynia diagnosed?

The diagnosis is made from the description of the pain at the vaginal opening

Pelvic exam may reveal normal looking tissues with tight pelvic muscles and pain on touching with a cotton swab.

What treatment options are available?

  • Local anesthetics. Medications, such as lidocaine ointment, can provide temporary symptom relief. Application of lidocaine 30 minutes before sexual intercourse may reduce discomfort.
  • Pelvic floor therapy. Women with vulvodynia have tightness in the muscles of the pelvic floor, which supports the uterus, bladder and bowel. Pelvic floor exercise helps to relax the muscles and may relieve pain. Biofeedback can help to relax the pelvic muscles, which contract in anticipation of experiencing pain.
  • Antidepressants such as amitriptyline and anticonvulsants like gabapentin and pregabalin may alleviate symptoms
  • Nerve blocks. Long-standing pain unresponsive to other treatments may benefit from local anaesthetic and steroid injections.
  • Surgery. Excision of the affected skin and tissue (vestibulectomy) may relieve pain in some women.

Your individual management will be discussed during the consultation.

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