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Treatment Options
Treatments for vulvodynia aim to relieve symptoms and restore a woman's quality of life. No single treatment works for every woman, and you may find that a combination of drug and nondrug therapies works best for you. Commonly recommended treatment options include:
Medications. Low-dose tricyclic antidepressants, such as amitriptyline and desipramine, and a newer class of antidepressants, known as SSNRIs, are often used to treat vulvodynia. These drugs appear to block pain signals to the brain and can help relieve any associated depression. When using antidepressants keep in mind that it can take up to six to eight weeks for symptoms to improve, and you may not achieve complete relief, which is why a combination of therapies is often used. Local anesthetics. Lidocaine ointment can provide temporary relief from the pain. Your health care professional may recommend applying lidocaine overnight or 15 to 30 minutes before sexual intercourse to reduce your discomfort and numb the area. Other topical creams. Creams that contain estrogen may be recommended to lessen the pain. Creams are also formulated that include antidepressants, anesthetics and/or other medications and are being used with success.
Physical therapy and biofeedback. Many women with vulvodynia have associated pelvic floor muscle spasm or weakness. Specialized physical therapy techniques and/or biofeedback training can help you strengthen or relax your pelvic muscles, which can improve vulvar pain. Finding a physical therapist or biofeedback specialist with experience in vulvar pain may be helpful. Diet Modifications. Talk with your provider about the pros and cons of eliminating certain types of foods from your diet, such as those high in oxalate content, acid or sugar. Seeds, nuts, leafy plants, like spinach and other dark greens, and chocolate are high in oxalates, and even though they don't cause vulvodynia, they may irritate vulvar skin upon urination. Daily calcium supplements also help neutralize oxalates in the urine. It's also very important to drink plenty of water to reduce the acidity of your urine. Relaxation and breathing techniques. Learning specialized relaxation and breathing techniques helps to reduce stress and anxiety, which can worsen pain sensations. Psychotherapy. Vulvodynia can limit daily activities and quality of life. It is not uncommon for women who suffer with chronic vulvar pain to experience depression and feelings of low self-worth, especially related to their sexuality. Psychotherapy that focuses on coping strategies and sexual intimacy issues has benefited many women. Surgery. Some women with severe localized vulvodynia in the vestibule may benefit from surgery (vestibulectomy) to remove the painful tissue of the vulvar vestibule; however, this is usually reserved for those who have not responded to more conservative therapies. Other options. Therapies recommended to promote general health may also be recommended along with traditional medical approaches for people in chronic pain. These therapies include acupuncture, hypnosis, massage therapy and cognitive behavioral therapy. Discuss these options with your health care professional or ask for a referral to a health care provider who has experience with one or more of these approaches.
Self-Care Tips
Pay attention to basic vulvar skin care.
There are simple steps you can take to manage pain symptoms. Here are some tips:
- Wear cotton-only underwear.
- Avoid tight-fitting pants and pantyhose, which can restrict airflow to your genital area, trapping moisture and heat.
- Use unscented cotton pads and tampons.
- Keep harsh soaps and shampoos away from the vulvar area.
- Do not use douches, vaginal wipes, contraceptive creams or spermicides.
- Pat the vulvar area dry after rinsing and urination.
- Apply plain petroleum (Vaseline) after cleansing to hold moisture in the skin.
- Use plenty of (water-soluble) lubrication during all sexual activity.
- Pay attention to things that aggravate the pain and avoid them. These may include hot tubs, irritating soaps, clothing dyes and scented toilet paper, creams and bath products.
- Limit exercises that create a lot of friction in the vulvar area; try yoga, stretching or low-impact walking instead.
- Don't sit for too long; use a foam rubber doughnut if you need to.
- Apply cold compresses or use a sitz bath periodically (warm water or saline solution that only covers your hips and buttock).
Pain relief doesn't happen overnight. It may take several weeks for you to notice a difference in your pain.
The good news is that the NIH and other groups are funding research to learn more about vulvodynia and find more effective ways to diagnose and treat it. Following the self-care tips above and finding a health care provider who is knowledgeable about vulvodynia will help you cope and manage your diagnosis.
Self-Help Tips for Coping with Chronic Vulvar Pain
There are simple steps you can take to reduce vulvar irritation. Here are a few tips:
- Wear only cotton underwear.
- Avoid wearing tight-fitting pants and pantyhose.
- Use plenty of water-soluble lubricant during all sexual activity.
- Steer clear of perfumed creams or soaps, pads or tampons, and contraceptive creams or spermicides.
- Wash the vulva with cool to lukewarm water only and be sure to rinse away shampoos or other soapy residue.
- Don't use douches or vaginal wipes.
- Do not stay in damp bathing suits or exercise clothes.
- Refrain from exercises that are likely to place added pressure to the vulva, such as bicycling or horseback riding.
- Apply plain petroleum (Vaseline) after cleansing to hold moisture in the skin.
Identify pain triggers using a journal.
Whether your vulvar pain is constant or triggered by certain activities, consider starting a journal to keep track of your pain. Jot down detailed information about your pain, such as when it occurs, for how long, how it feels (use descriptive language, such as "burning," "stabbing," "stinging") and things that you notice make it better or worse. You should also note how it impacts your day-to-day life—your exercise, sexual activity and work—as well as your response to various treatments over time, including improvements in sexual function. This can provide important clues about what worsens your pain and will help your health care team find the best ways to treat your pain.
Be honest with your partner; remain confident if you're single.
Few things are more personal than vulvar health. Vulvodynia can make it difficult, if not impossible, to have sexual intercourse. Not surprisingly, many women feel isolated by their condition and are plagued with worry about how their romantic partner will react. While you may be embarrassed to broach the subject, it's important to communicate openly about your pain and its impact on your sex life. Educate your partner about vulvodynia to allay concerns that it could be a sexually transmitted disease, "all in your head" or a convenient excuse to avoid intimacy. Remind your partner how much you miss having sex, and be creative—there are still lots of sexual activities you can enjoy without inciting your pain.
If you do not currently have a sexual partner because of vulvodynia, remember that you have as much right to love and intimacy as anyone else. While vulvodynia presents a challenge to sexual relations, it doesn't mean that you should give up. Take your time and get to know your partner before explaining your condition. When you do discuss your pain, be honest and open about how you feel, steps you are taking to alleviate the pain and ways you can be supported.
Stress management therapies can help.
Managing stress and learning specialized relaxation techniques are important parts of any pain relief program. Prolonged psychological stress can initiate inflammatory responses in the body and lead to increased pain sensitivity and greater susceptibility to chronic pain conditions. Consistent with this, many women who suffer with vulvodynia have higher levels of inflammatory markers (e.g., interleukin-1 and TNF alpha) and lower pain thresholds.
There are many relaxation techniques you can easily learn and practice at home, including focusing (what women in labor are advised to do), meditation, deep breathing exercises and progressive muscle relaxation. Learning biofeedback techniques takes much more training but is often recommended for women with vulvodynia to learn how to strengthen or ease spasms in their pelvic muscles.
Get the emotional help you need.
Many women with vulvodynia benefit from psychological and/or sex counseling. Chronic vulvar pain can be debilitating and often interferes with daily activities and sexual functioning. The anxiety that comes with anticipating the next pain flare-up can be highly stressful. Talking openly with a licensed therapist about how the pain is affecting your sexual life, overall mood and coping skills can be helpful. Try not to let the pain overshadow you. Continue to engage in activities you enjoy, even if you need to cut back some days. If you feel sad for several weeks at a time and think you might be depressed, seek treatment.
Keep up with your annual gynecologic exams.
Routine pelvic exams—once a year for women age 18 and older—are important to ensure early intervention for problems, including chronic pelvic and vulvar pain. Annual gynecologic appointments also include breast exams, Pap tests and other important preventive screenings, such as cholesterol screening and thyroid tests. These visits give you the opportunity to discuss any gynecological concerns or symptoms with your provider. Of course, if you experience vulvar pain in between visits, don't wait. Make an appointment to discuss your symptoms with your health care professional.
Stay fit and healthy.
Regular exercise improves circulation and increases the production of natural pain-relieving substances (endorphins) in your body. By staying active, you will also reduce your chances of increasing pain due to tight muscles. Be sure to talk with your doctor about which exercises are best for you. You may need to stay away from bicycling, rowing or other forms of exercise that place pressure on the vulva. Good nutrition and getting enough rest also may help you manage pain better. Talk with your health care provider about changes to your diet because some foods can make your urine more irritating. He or she may want you to cut out highly acidic or sugary foods or those that have high oxalate content, such as greens, beans, berries, chocolate or nuts. A low-oxalate diet with calcium citrate supplementation may neutralize acid in the urine and may lessen vulvar irritation.
This content was produced with support from the Office of Research on Women's Health, National Institutes of Health, as part of the Vulvodynia Awareness Campaign.
Create Date: 10/24/07
Date Last Updated: 10/24/07
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