Many women who experience chronic unexplained genital pain are not aware that there is a name for this "devastating condition," as one paper described it. It is vulvodynia and it often goes undiagnosed—and thus untreated—in part because women may not feel comfortable talking to their doctors about it. And even if they do, they are frequently misdiagnosed, with yeast infections or estrogen deficiency, for example. Sometimes women are told the pain is all in their head.
Though estimates vary widely, vulvodynia may affect up to 25 percent of women at some point in their lives, young and old alike. The pain, often described as burning, is sometimes accompanied by irritation and tenderness in the vulva (the external part of the female genitalia, which includes the labia and vaginal opening), though there are no visible signs of disease. Pain is usually provoked by pressure on the vulva such as during intercourse or with tampon use, but may also occur for no apparent reason. Like other chronic pain disorders, it can affect quality of life and cause stress and depression. It can make sitting for long stretches difficult and, needless to say, have a negative impact on a woman’s sex life.
It’s not clear what causes vulvodynia, but several factors may play a role. According to a 2009 review in Obstetrics, Gynaecology, and Reproductive Medicine, there may be changes in the nerves in the vaginal area, which causes increased pain sensitivity, and an alteration in the local immune system, which increases inflammatory processes.
From sitz baths to surgery
Few randomized controlled studies have been conducted to determine the effectiveness of various treatments, and those done show a big placebo effect. Still, some doctors prescribe medications such as gabapentin (used for various types of nerve pain), antidepressants and topical lidocaine. If you are past menopause, your doctor may prescribe topical estrogen to see if your symptoms are due to an estrogen deficiency. If spasms in the pelvic floor muscles play a role, as some researchers think, biofeedback and pelvic floor exercises called Kegels may help. For more severe cases, nerve blocks (injections of nerve-numbing substances) are an option. A last resort is surgery to remove sensitive tissue—but be sure to get a second opinion beforehand.
Self-help steps include taking lukewarm or cool sitz baths and applying cold compresses to the genital area. Don’t douche or take hot baths. Use mild unscented soap or no soap at all on the vulva and a lubricant for intercourse. Avoid bicycling and other activities that put pressure on the vulva.
Bottom line: If you have genital pain that doesn’t go away, talk to your doctor. You may want to ask about vulvodynia if there are no visible signs of disease. No single treatment works for all women, and it may take a combination to get relief. Psychological counseling to learn pain-coping skills and address psychosocial issues may also be advisable.
The National Vulvodynia Association provides a list of professionals who treat the condition. You can also contact the association if you want to participate in the National Vulvodynia Treatment Outcomes Registry, which is evaluating the efficacy of various treatments.