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Vulvodynia is persistent, unexplained pain of the vulva, the skin surrounding the vagina. There is usually no obvious cause, but much can be done to help relieve the pain so that it no longer causes problems.
The pain of vulvodynia is often described as a burning, stinging or raw sensation. Some women describe a feeling of a needle being stuck in their genitals.
Vulvodynia can be:
The pain can also be limited to the vulva (localised) or may be more widespread (generalised), spreading to the urinary tract, the bottom or the inside of the tops of the thighs.
It can be made worse by activities such as cycling or horse riding, which put prolonged pressure on the vulva.
The following information and advice about vulvodynia covers:
Vulvodynia affects women of all ages, from 20 to 60, but often starts in women younger than 25. It can be very distressing, significantly affecting quality of life.
Women with vulvodynia are usually otherwise healthy, with no history of sexually transmitted infections. However, some women with vulvodynia also have vaginismus, when the muscles around their vagina tighten involuntarily whenever penetration is attempted.
If you have persistent vulval pain, see your doctor or visit your local genitourinary medicine (GUM) clinic.
Your doctor may touch your vulva lightly with the tip of a cotton bud to see if this causes pain. A diagnosis of vulvodynia is made based on your symptoms.
The cause of vulvodynia is not understood. It's possible that it is caused by:
Your doctor will want to rule out other conditions that can cause some similar symptoms to vulvodynia, such as:
A combination of some of the following treatments can help relieve symptoms of vulvodynia and reduce its impact on your life. Discuss these options with your doctor.
The antidepressant amitriptyline has been found to relieve the pain of vulvodynia for some women. However, possible side effects are drowsiness, weight gain and dry mouth.
The anti-epilepsy medicines gabapentin and pregabalin can also help control pain. Make sure you talk to your doctor about the side effects, and how you should take the medication.
Your doctor will probably recommend that you start on a low dose of amitriptyline, and gradually increase the dose until your pain subsides. This may take several weeks and you may need to take the medication for three to six months.
Some women with vulvodynia find that applying the anaesthetic gel lidocaine to their vulva 15–20 minutes before sex may make intercourse possible, although lidocaine can sometimes irritate the area.
A tube of 5% lidocaine can be bought over the counter from a pharmacy.
Vaginal lubricants and aqueous cream (also available over the counter) may soothe the area and help moisturise the vulva if it is dry.
Speak to your pharmacist about these treatments.
Your doctor may refer you to a physiotherapist if you also have vaginismus.
The physiotherapist may teach you some pelvic floor exercises (such as squeezing and releasing your pelvic floor muscles) to help relax the muscles around your vagina.
Another technique to relax the muscles in the vagina involves using a set of vaginal trainers. These are four smooth, penis-shaped cones of gradually increasing size and length, which can be used in the privacy of your own home.
The smallest one is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size, and so on. It is important to go at your own pace and it does not matter how long it takes, whether it is days or months.
When you can tolerate the larger cones without feeling anxious or any pain, you and your partner may want to try having sexual intercourse.
Read more about the treatment of vaginismus.
Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act. It can often help women cope with the impact that vulvodynia has on their life.
CBT focuses on the problems and difficulties you have now, and looks for practical ways you can improve your state of mind on a daily basis.
Talk to your doctor about whether CBT may benefit you, and whether you can be referred to a therapist for this.
The following lifestyle changes may help:
Further advice and support can be found by visiting the following websites:
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.