The vulva (derived from Latin; wrapper or covering) includes the pubic region (Mons pubis ); labia ( labia majora and minora ); clitoris and the vaginal opening. And pain and discomfort experienced anywhere in this region is called vulvar pain; also medically known as vulvodynia.
It is said that each year; 2% of women develop vulvar pain. The pain, burning, or irritation associated with vulvodynia can make you so uncomfortable that sitting for long periods or having sex becomes unthinkable. The condition can last for months to years.
The age range at which vulvar pain happens varies from children (rarely) to elderly women, but most women with this disorder are between 20 and 50 years of age. However, it may be seen as late as 80 years of age.
Types of Vulvar Pain
- Generalised vulvar pain: It starts spontaneously. It causes general vulvar pain which can last for months or years. It pains all over the vulva.
- Localised vulvar pain: As the name suggests; it happens around a certain are on the vulva like in skin folds or the labia. It often appears and disappears.
- Cyclic vulvar pain ; This vulvar pain comes and goes away with a woman s menstrual cycle. This pain may start just before the menstruation starts.
- Vestibular pain: This type of pain occurs at the vestibule or the opening of the vagina.
Symptoms of Vulvar Pain
The symptoms of vulvar pain may be:
Burning ; stinging or throbbing discomfort around the vagina.
This type of pain may be felt when there is pressure on the area like with sex; inserting a tampon; sitting or wearing tight clothes .
Causes of Vulvar Pain
- Recurrent yeast infections; bacterial vaginosis; HPV or HSV infections.
- Genetic disorders that cause the cells to overreact to inflammation; so the vulvar tissues get swollen and give pain e.g. lupus erythematosus and lichen sclerosis
- Physical or sexual trauma; physical trauma due to bicycling or horseback riding can cause vulvar pain. It can also result from surgery like labiaplasty. Traumatic sexual intercourse can harm nerve endings and tissues and can cause vulvar pain.
- Allergies : Soaps, gels and feminine deodorant products can cause allergic reaction leading to irritation; swelling and pain.
- Hormonal changes; especially in menopause there is drying of the vulvar tissues which can give pain. Or when a woman is given contraceptive pills to regularise the cycles at a very early age leading to vulvar vestibulitis syndrome and chronic vulvar pain.
- Weakness in the pelvic floor muscles with spasms. These are the muscles responsible for giving support to the uterus, rectum and bladder.
What to Expect When You are Visiting Your Gynecologist for Vulvar Pain
Treatment of Vulvar Pain
There are various treatments for vulvar pain like:
- 1.Lifestyle : Lifestyle changes like always using cotton underwear; using lubricants during sexual intercourse etc can alleviate vulvar pain.
- Counceling; education and information about avoiding the allergens and other factors that cause vulvar pain; biofeedback; physical therapy and relaxation. Biofeedback, in which sensors placed in the vagina send impulses to help you strengthen your pelvic floor muscles and teach you how to relax them
- Medications to control the pain. Other medications include local numbing agents; cyclical estrogen therapy; local steroids application and antidepressants .
- Botox injection have promising results. Botox relaxes the vaginal muscles thereby relieving the spasms and pain. Further studies are however awaited. The pain relief can last for 3 to 6 months and it needs to be repeated.
- Vulval vestibulectomy is last surgical option though they are not very high quality studies for surgery as the treatment of choice for vulvar pain.
Prevention of Vulvar Pain
Effective treatment for vulvar pain does exist. However prevention is possible if some disciplines are observed.
- Clean vulvar area with water only instead of using soaps; shampoos ; scented products which could contain irritants.
- Wear cotton underwear which prevent irritation of the vulvar skin.
- Wear loose fitting underwear clothes.
- Use a vaginal lubricant during sex.
- Dryness of vagina can be controlled by local moisturisers and estrogen creams.
- Apply cool ice gel pack begore the area starts paining.
- Gently rinse and pat dry your vulva after you finish passing urine and wipe from front to back to prevent bringing germs to your vagina.
Still if you regularly experience the pain; please talk to your gynaecologist as it may be a sign of an underlying condition.