I have pain down below, what can I do?
Vulvodynia is defined as pain or discomfort of the vulva that lasts longer than three months. The vulva is the external genital area of a female. About 16% of women in the United States have vulvodynia. It affects ethnic and racial groups equally. Some women with vulvodynia will experience pain in one area of the vulva while others will experience pain in the entire area.
The types of pain women experience range from mild aching, soreness, and throbbing to more intense pain including burning, stinging, and a feeling of constant, severe irritation. These symptoms may come and go or remain constant. They can start without warning; however, symptoms usually develop after specific activities like intercourse, gynecological exams, insertion of a tampon, tight fitting pants, or sitting for long periods of time.
Sometimes vulvar pain is due to an infection, skin disorder or other medical disease. Pain from these conditions is not considered vulvodynia. The cause of vulvodynia is not known. Some believe the pain develops due to an injury or irritation of the pudendal nerve, a woman’s genetic predisposition, an overactive response to an direct injury, or weakness and spasms of the muscles in the pelvic floor.
If a woman develops vulvar pain, she should see a medical professional who specializes in women’s health. The medical provider will complete a thorough examination to rule out infection or other skin conditions that may be causing the vulvar pain. They may also perform a cotton swab test in which they touch various parts of the vulva to determine the exact location and severity of the pain. Finally, a skin biopsy may be done if there is an area of skin that appears abnormal.
Once vulvodynia has been diagnosed, there are several treatment options. Treatment options focus on relieving pain symptoms and avoiding activities or events that cause pain. Not every treatment will work the same for every patient. In fact, some women will require more than one treatment to control the pain. Women are highly encouraged to keep a pain diary because diaries can help track symptoms, identify activities or events that make the pain worse, and follow responses to treatment.
Treatments for vulvodynia include:
- Physical therapy: Physical therapy helps relax and relieve tension of the pelvic floor muscles. Physical therapy can also improve pelvic floor muscle strength. Improved strength and relaxed muscles can significantly reduce vulvar pain.
- Local anesthetics: A cream or gel, often containing lidocaine, can be applied to the vulva for short-term relief of symptoms. Many women apply the cream or gel before aggravating events, such as intercourse, because the cream can prevent or reduce pain that frequently occurs with these types of activities.
- Hormone cream: Estrogen cream can improve irritation of vulvar skin and may be used in some instances.
- Antidepressants/Antiseizure Medications: These types of medications have been shown to reduce and improve overall vulvar pain. These medications are used to control a woman’s symptoms long-term; however, it is important to remember that it may take several weeks before patients start seeing an improvement in their symptoms.
- Cognitive Behavioral Therapy/Sex Therapy: Because vulvar pain can affect sexual relationships and a woman’s emotional state, counseling with a licensed professional therapist can greatly improve overall symptoms associated with vulvodynia and can help maintain healthy physical and emotional relationships.
In addition to these medical treatment options, women can also help reduce their pain by following these simple suggestions at home:
- Wear 100% cotton underwear to improve airflow to the external genital area. Chronic moisture and reduced airflow can cause significant vulvar irritation and discomfort.
- Do not wear underwear to bed. This allows maximum airflow to the vulva.
- Avoid douching. Douching can remove “good” vaginal flora. This can cause irritation and burning, which leads to worsening vulvar pain.
- Clean the vulva with water only. There is no need to scrub or use harsh, heavily perfumed soaps to clean this area.
- Limit pad use. Pads can be very irritating to the vulvar tissue.
- If pads are needed, use 100% cotton pads that are free of perfumes.
- Certain ointments or creams may be applied to the vulva to reduce rubbing from underwear and pads. These ointments include Aquaphor, Vaseline, Desitin, or non-flavored Crisco.
- Pat the vulva dry after voiding. Avoid hard, repeated wiping.
- Use lubricants before sex. However, do not use lubricants that are scented or that cause heating/cooling sensations.
- Apply cool packs to vulva as needed
Ongoing and regular medical care is very important in helping control vulvodynia symptoms long-term and in preventing symptoms from worsening. If you are experiencing any type of vulvar pain or discomfort, call The Woman’s Center for Pelvic Floor Dysfunction to schedule an appointment for evaluation and discussion of individualized treatment options.
National Vulvodynia Association, 2019
The American College of Obstetricians and Gynecologists, 2017