Vulva pain conditions
About vulva pain conditions
Vulvodynia and Vestibulodynia are both conditions where pain is experienced in the female genital area, the vulva. This pain is experienced when other possible causes of pain such as thrush or skin conditions have been excluded. Sometimes the symptoms have been present for a very long time before a diagnosis is made.
The sensation of burning and soreness can be continuous, or can be provoked by gentle light touch. Pain and hypersensitivity can be felt in different areas and are identified by their location: vulvodynia being pain in the vulva area, and vestibulodynia describes pain at the entrance to the vagina known as the vestibule (see diagram below).
If the pain arises from the entrance to the vagina, it makes sexual intercourse or inserting tampons painful and often impossible. There is sometimes no obvious visible cause for the pain and the skin can often look completely normal.
What causes the pain?
The exact cause of these conditions is not well understood. It is thought that nerve endings in the vulval area appear to become hypervigilant, meaning pain is experienced instead of normal sensation. These conditions are not contagious or related to personal hygiene.
Naturally, when pain is present, the muscles around the area try to protect it by tightening up and this is known as vaginismus. There can be several factors that contribute to the symptoms.
Can it be cured?
These conditions can be managed with a combination of treatments, and most patients have a good response over time.
Management options
There are a variety of treatment options that can be tried. The response varies between individuals, so it is worth trying different things to see which will help you and often it is a combination that seems to be useful.
Avoid perfumed soap, bubble baths, shower gels, shampoos, special wipes and deodorants in this area. Instead, wash with a soap substitute which is less likely to cause skin irritation.
A local anaesthetic topical ointment can be used to numb the area, reducing discomfort. Lidocaine ointment (5%) can be bought over the counter from your chemist. This can be applied as and when needed, and for some it is helpful to use prior to sex to make it less painful.
Sometimes oral medication can to be considered if the above steps fail. These include drugs which can modify the nerve pain response, and the dose can be gradually increased as necessary. Such drugs include:
- amitriptyline or nortriptyline
- gabapentin
- pregabalin
Physiotherapy can play an important role in managing these conditions by addressing the soft tissue sensitivity and pelvic muscle behaviour.
There are a variety of different techniques and exercises that can be suggested to help restore the normal function of the area. Some techniques can be taught to do directly to the tissues and others influence the area indirectly.
None of the techniques or exercises are designed to provoke symptoms and the aim is to work towards self-management and normal function.
Experiencing such personal symptoms can have a profound effect on your emotions and relationships. Physiotherapists understand this and the focus of physiotherapy is about empowering you.
If sexual intercourse is painful this can have emotional and psychological effects on your relationships. It is important to recognise this, and to communicate fully with your partner, discovering techniques that are comfortable and suit you both.
Psychosexual counselling can be helpful. Some patients may also benefit from other types of therapy including cognitive behavioural therapy or compassion focused therapy.
In rare cases, further treatment options may be considered. These include local injections to small areas or nerve block injections. Surgical excision is an option for a small minority of patients.
