
Vulvodynia: Pain Down There
Many women complain of pain around their labia, vagina and genital region, a common condition known as vulvodynia. While it can be challenging to treat, there are treatment options available.
Oct 14, 2019
Your BodyPracticing Nurse Practitioner
Author
San Francisco, CA
Barbara Dehn RN, MS, NP is a practicing Nurse Practitioner and a television health expert, who's known as Nurse Barb. She is passionate about health education, whether it's 1 on 1 with a patient, in a lecture hall at Stanford or with millions of people watching on television. Her warm and engaging personality puts everyone at ease as they learn more about health.
Nurse Barb is the award winning author of the Personal Guides to Health used by over 5 million women in the US, with titles ranging from fertility and pregnancy to menopause and breastfeeding. Active in Social Media, she contributes content to HealthyWomen, Huffington Post, NurseBarb, KevinMD and The Patch and amplifies her reach with an active and engaged Facebook following and 34,000 Twitter followers.
She is the author of The Hot Guide to a Cool Sexy Menopause, Nurse Barb's Guide to Breastfeeding and Nurse Barb's Guide to Pregnancy.
Barb earned a masters degree from UCSF and a BS from Boston College. She is certified by the North American Menopause Society and is a Fellow in the American Association of Nurse Practitioners. Over the last 2 years, she has been an active participant in Global Health Initiatives at FAME Hospital in Karatu, Tanzania. Barb lives in the San Francisco Bay area.
Full BioLearn about our editorial policies
Many women come to me complaining of pain around their labia, vagina and genital region, a very challenging condition known as vulvodynia. The highest incidence is seen in women ages 18 to 25, but it can occur at any age.
These extremely distressing symptoms can make having sex out of the question, and some women find that even their clothing, no matter how loose, will trigger pain. Also, many times there are no visible signs or symptoms, such as a rash or redness, which can further delay diagnosis and treatment—not to mention making a woman feel crazy.
Classifications of Vulvodynia
There are many reasons for vulvar and genital pain. The way we providers classify them is whether the pain occurs all the time and is in not a response to something (unprovoked), or it occurs only as a response and therefore is provoked.
Provoked Vulvodynia
With provoked vulvodynia, the pain occurs when something touches the outer area of the genitals surrounding the vaginal opening, including the labia minora, labia majora, clitoral hood, urethra or the vaginal opening itself.
Possible triggers are:
Unprovoked Vulvodynia
Unprovoked (generalized) vulvodynia is not caused by a particular trigger and some women experience pain all the time. Others have episodes of pain in different spots, with periods of relief.
Women report various kinds of pain:
Causes and Diagnosis: The Q-tip Test
Though we don't always know the cause of vulvodynia, here's what we think is happening. The nerves under the skin may have become sensitized by a previous trauma, infection or irritation. They continue to produce chemical proteins (chemokines and cytokines) that further the cycle of inflammation and irritation by directly activating pain-sensitivity neurons. This heightened sensitivity is called hyperalgesia, where the nerves are overreacting to even a light touch.
Nerve-type (neuropathic) pain is difficult to trace to a specific cause and is also hard to treat.
The Q-tip Test
We use a cotton swab to diagnose vulvodynia and to find the areas that are painful. Many providers also use magnifying glasses or a vulvoscopy to further inspect the area. Once the area has been identified, we can start to formulate a plan for treatment.
A Real Patient Story
I saw a woman recently, Alexa (not her real name), who had seen four providers over two years for recurrent vaginal infections and pain around the vaginal opening that wasn't getting any better. She had not been able to have penetrative intercourse with her long-term partner without debilitating pain for a year. Even getting aroused from oral and manual stimulation started her pain cycle.
Read more about What Happens When You Want to Have Sex, But It Hurts?
During her exam, I noted that she had a slight amount of redness at the lower part of the vaginal opening, and a Q-tip test revealed two areas that were extremely tender. She described them as an 8 out of 10 on the pain scale. She also had bacterial vaginosis (BV) at the time.
We treated the BV and I provided her a range of "tools" to help reduce her symptoms. We talked about research from the National Vulvodynia Association that shows treatment can take three to six months.
I advised her to choose whichever treatments suited her day-to-day situation. They included:
This was Alexa's specific and unique treatment toolbox. Yours might be different.
After six months, Alexa was able to have intercourse, and her pain levels went from an eight to a one or two depending on the day. She sometimes has flares and, when she does, she only needs a day or two of treatment to quiet her symptoms.
If you're experiencing vulvar and vaginal pain, known as vulvodynia, look for a women's health provider who has experience treating vulvodynia or talk with your provider about the treatment plans mentioned at NVA.org.
Click here for help finding a pelvic floor physical therapist.
Here are more resources for help keeping your pelvic floor healthy:
This blog originally appeared on Nurse Barb. Barb Dehn is a women's health nurse practitioner, award-winning author and nationally recognized health expert. She practices with Women Physicians in the Silicon Valley of California.