At a glance......
- 1 Types of Vulvodynia
- 2 Causes of Vulvodynia
- 3 Symptoms of Vulvodynia
- 4 Diagnosis of Vulvodynia
- 5 Treatment of Vulvodynia
- 6 Vulvodynia Home Remedies
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Vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation.[rx] It has been established by the ISSVD that for the diagnosis to be made symptoms must last at least three months.[rx]
Vulvodynia (LPV) is a common, chronic, and disabling condition; patients experience profound pain and a diminished quality of life. The etiologic origins of vulvodynia are poorly understood, yet recent evidence suggests a link to site-specific inflammatory responses. Fibroblasts isolated from the vestibule of LPV patients are sensitive to pro-inflammatory stimuli and copiously produce pain-associated pro-inflammatory mediators (IL‐6 and PGE2).
Types of Vulvodynia
Vulvodynia affects the vulva, your external female genital organs. This includes the labia, clitoris, and vaginal opening. There are two main types:
- Generalized vulvodynia – is a pain in different areas of the vulva at different times. Vulvar pain may be constant or happen every once in a while. Touch or pressure may or may not cause it. But it may make the pain worse.
- Localized vulvodynia – is a pain in one area of the vulva. Often a burning sensation, this type of vulvar pain usually results from touch or pressure, like sex or prolonged sitting.
Causes of Vulvodynia
A wide variety of possible causes and treatments for vulvodynia are currently being explored. Moreover, there are probably several causes of vulvodynia, and some may be individual to the patient. Doctors don’t know the cause of most forms of vulvodynia. And there’s no proof that infections, such as sexually transmitted diseases (STDs), lead to vulvodynia.
|A. Vulvar pain caused by a specific disorder|
|Infectious (eg, recurrent candidiasis, herpes)|
|Inflammatory (eg, lichen sclerosis, lichen planus, immunobullous disorders)|
|Neoplastic (eg, Paget disease, squamous cell carcinoma)|
|Neurologic (eg, postherpetic neuralgia, nerve compression or injury, neuroma)|
|Trauma (eg, female genital cutting, obstetrical)|
|Iatrogenic (eg, postoperative, chemotherapy, radiation)|
|Hormonal deficiencies (eg, genitourinary syndrome of menopause [vulvovaginal atrophy], lactational amenorrhea)|
|B. Vulvodynia—vulvar pain of at least 3 months’ duration, without a clear identifiable cause, which may have potential associated factors. The following are the descriptors:|
|Localized (eg, vestibulodynia, clitorodynia) or generalized or mixed (localized and generalized)|
|Provoked (eg, insertional, contact) or spontaneous or mixed (provoked and spontaneous)|
|Onset (primary or secondary)|
|Temporal pattern (intermittent, persistent, constant, immediate, delayed)|
Researchers are trying to find the causes. They may include
- Infections – vulvovaginal candidiasis, trichomoniasis, and genital herpes
- Inflammation – lichen sclerosis, lichen planus, contact dermatitis, lichen simplex
- Neoplastic disorders – squamous cell carcinoma
- Neurologic disorders – pudendal, genitofemoral and/or ilioinguinal nerve injury, nerve entrapment, neuropathy, Tarlov cysts
- Vulva trauma, leading to pain – straddle injuries, female genital cutting, motor vehicle accidents
- Estrogen deficiencies
- Iatrogenic causes
- Painful bladder syndrome
- Irritable bowel syndrome
- Temporomandibular disorder
- Nerve injury or irritation
- An abnormal response in vulvar cells to an infection or trauma
- Genetic factors that make the vulva respond poorly to chronic inflammation
- Hypersensitivity to yeast infections
- Muscle spasms
- Allergies or irritation to chemicals or other substances
- Hormonal changes
- History of sexual abuse
- Frequent antibiotic use
- Painful bladder syndrome
- Irritable bowel syndrome
- Temporomandibular disorder
Possible causes include
- Sjögren syndrome, the symptoms of which include chronic vaginal dryness.
- Others include genetic predisposition to inflammation,[rx] allergy or other sensitivity (for example oxalates in the urine), an autoimmune disorder similar to lupus erythematosus or to eczema or to lichen sclerosis, infection (e.g., yeast infections, bacterial vaginosis, HPV, HSV), injury, and neuropathy—including an increased number of nerve endings in the vaginal area.
- A significantly lower pain threshold, especially in the posterior vestibulum, has also been associated with the use of hormonal contraceptives in women without vulvar vestibulitis syndrome.[rx]
- Pelvic floor dysfunction may be the underlying cause of some women’s pain.[rx]
Vulvodynia is a vulvar pain of at least three months’ duration without a clear, identifiable cause. It may be generalized or localized with respect to location. It may always occur spontaneously or have to be provoked. It could occur throughout a patient’s life or just with a new partner (primary or secondary) and/or it can be intermittent, persistent, constant, immediate, or delayed in timing. [rx]
Symptoms of Vulvodynia
Pain is the most notable symptom of vulvodynia and can be characterized as a
- Burning, stinging, irritation, or sharp pain that occurs in the vulva and entrance to the vagina.
- It may be constant, intermittent, or happen only when the vulva is touched, but vulvodynia usually has a long duration.[rx]
- Symptoms may occur in one place or the entire vulvar area. It can occur during or after sexual activity, when tampons are inserted, or when prolonged pressure is applied to the vulva, such as during sitting, bike riding, or horseback riding.[rx]
- Some cases of vulvodynia are idiopathic where no particular cause can be determined.[rx]
Diagnosis of Vulvodynia
The patient should undergo a thorough gynecologic examination. Once all infectious, inflammatory, hormonal, neoplastic, and neurologic causes are investigated and treated, a visual inspection of the vulva and vulvar vestibule should be performed. [rx]
- Cotton swab evaluation – Ask the patient, “Where does it hurt?” and, “Does it hurt before I even touch you?” From the outside in towards the vestibule, mark the area to find the location of the pain. Starting from the inner thigh, move to labia majora, inner labial sulcus, clitoris, and clitoral hood, perineum, and sites within the vestibule. The patient should rate their pain on a scale of 1 to 10.
- Neurosensory – Cotton versus pinprick exam in the same places – note whether it is normal, hypersensitive, sharp, burning, or shooting pain.
- Pelvic muscle exam – Starting with puborectalis and working way into the pelvic muscles.
- Evaluation of pain comorbidity – Interstitial cystitis, endometriosis, temporomandibular joint syndrome, chronic headaches.
- Assessment of factors contributing to pain – Emotional functioning, sleep interference, relationship problems, physical functioning, sexual functioning
- There are no blood tests necessary – A thorough history and physical with medication and drug allergy review should be performed.
- Swabs to test for infection – Your doctor uses a moistened cotton swab to gently check for specific, localized areas of pain in your vulvar region.
- Biopsy – An examination of tissue removed from the area. This test is not done routinely and is only performed if there is a lesion or abnormal exam finding.
Treatment of Vulvodynia
There are a number of possible treatments with none being uniformly effective. Treatments include:
- Lifestyle – A number of lifestyle changes are often recommended such as using cotton underwear, not using substances that may irritate the area, and using lubricant during sex.[rx] The use of alternative medicine has not been sufficiently studied to make recommendations.[rx]
- Counseling – Education and accurate information about vestibulodynia: Gynaecologist-led educational seminars delivered in a group format have a significant positive impact on psychological symptoms and sexual functioning in women who suffer from Provoked (caused by a stimulus such as a touch or sexual activity) vestibulodynia.[rx] Provoked vestibulodynia, whilst similar in some respects, is different from vulvodynia which this article refers to.
- Biofeedback – physical therapy and relaxation: Biofeedback, often done by physical therapists, involves inserting a vaginal sensor to get a sense of the strength of the muscles and help a patient get greater control of her muscles to feel the difference between contraction and relaxation. Sessions are linked with at-home recommendations including often Kegel exercises (e.g., hold for 9 seconds, relax for 30 seconds, for 10–15 sets), and relaxation. [rx]
- Massage – Pelvic floor muscle weakness and spasm. Treatment includes exercises, massage, soft tissue work, and joint mobilization. Nerve block, psychotherapy, mindfulness, yoga, and neurostimulation are also helpful in treatment.
- Vulvar self-care – Avoid irritants, directly or through diet.
- Pelvic floor therapy – Many women with vulvodynia have tension in the muscles of the pelvic floor, which supports the uterus, bladder, and bowel. Exercises to relax those muscles can help relieve vulvodynia pain.
- Diet modifications – Talk with your provider about the pros and cons of eliminating certain types of foods from your diets, such as those high in oxalates or sugar. To test for food sensitivity and to determine which foods, if any, are affecting you, eliminate one food or food group at a time. Use a food diary to record your results—you might begin to notice an association between your symptoms and certain foods you wouldn’t have otherwise suspected. This may be especially helpful in women who also have interstitial cystitis.
- Relaxation and breathing techniques – Like biofeedback, learning to recognize when you are tensing your pelvic floor muscles due to stress and then learning specific relaxation techniques to reduce stress and anxiety can help alleviate pain.
- Neurostimulation and spinal infusion pump – If other treatment forms haven’t helped and your pain is severe, your health care professional may have you consult with a professional skilled in neurostimulation or in the use of a spinal infusion pump. With neurostimulation, an electronic device delivers low-voltage electrical stimulation to a targeted nerve or the spinal cord in an attempt to substitute a tingling sensation for pain. A spinal infusion pump is an implanted device that constantly administers a small dose of medication to the spinal cord and nerve roots to help dull pain. Experience treating vulvodynia with these interventions is limited.
- Oral “pain-blocking” medications – These may be effective in alleviating vulvodynia pain. The classes of drugs are tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and anticonvulsants. The TCAs are used most often, and the most commonly used among them are amitriptyline and nortriptyline. Because nortriptyline has fewer side effects, it is usually the first choice. The dose is lower than that which is used to treat depression. Due to side effects, it is suggested, to begin with very low doses and increase gradually. The more commonly used SNRIs are duloxetine and venlafaxine, and the anticonvulsants typically used are gabapentin, pregabalin, lamotrigine, oxcarbazepine, and topiramate.
- Topical medications – applied directly to the vulva can alleviate pain as long as there are no allergens in the ointments. These are usually compounded. Examples combined or used alone are lidocaine, estrogen, testosterone, and gabapentin.
- Tricyclic antidepressants (TCAs) – have been the focus of both oral and topical therapies due to their dual effects in treating depression and neuropathic pain. Amitriptyline has thus far been the most researched TCA and is widely used by healthcare professionals. However, the wide range of amitriptyline dosing (10 mg to 225 mg taken by mouth daily) and lack of a consistent method of assessing pain further complicate the ability to extrapolate useful efficacy data from studies.[rx–rx] Additionally, TCA use is associated with adverse effects such as weight gain, fatigue, tachycardia, and seizures.[rx,rx] The only other TCA researched in vulvodynia is desipramine.
- Selective serotonin reuptake inhibitors (SSRIs) – have not been studied individually but rather in a combination regimen or after the failure of a TCA. These include escitalopram, paroxetine, and citalopram. Oral escitalopram, amitriptyline, and perphenazine were researched in vulvodynia patients in one study. Low-dose serotonin-norepinephrine reuptake inhibitor (SNRI), venlafaxine 75 mg daily, showed that the patient was able to achieve complete remission of symptoms.[rx] In another SNRI study, milnacipran (titrated up to 200 mg daily) also showed some lowering of pain scores when studied in provoked vestibulodynia.
- Anticonvulsants – When neuropathic pain is suspected, the practitioner may consider starting an anticonvulsant as either monotherapy or in combination with an antidepressant. Thus far, studies have been limited to gabapentin, pregabalin, lamotrigine, and carbamazepine. Although initially marketed as an anticonvulsant, gabapentin has shown efficacy in treating neuropathic pain. For this reason, investigators have studied its use in vulvodynia both topically and orally. In 3 out of 4 trials using oral gabapentin, the dosage was titrated up gradually based on tolerability and efficacy. Therefore, there are wide-ranging dosages (100 mg to 3000 mg orally each day in divided doses), making it difficult to extrapolate specific dose-response relationships.
- Topical lidocaine – has become a popular vulvodynia treatment due to vulvodynia’s similarity to post-herpetic neuralgia. One randomized placebo-controlled studyrx] was performed using topical lidocaine and demonstrated no efficacy over placebo.
- Baclofen’s muscle relaxation – actions and decreased adverse effect profile make it a feasible treatment option.[rx,rx]One study found baclofen an effective treatment when combined in cream with amitriptyline.[rx] Additionally, a case report used a compounded baclofen cream with oral palmitoylethanolamide, which is a fatty acid produced naturally and taken orally as a food supplement to decrease inflammation.
- Gonadal hormones – (ie, estrogen and testosterone) appear to play a role in pain transmission at various sites. Recently, topical creams containing gonadal hormones have been tested to target premenopausal vulvodynia along with the comorbidity of interstitial cystitis/bladder pain syndrome (IC/BPS). IC/BPS and vulvodynia both belong to a larger category of chronic pelvic pain syndromes, which may often overlap. A study of premenopausal patients using estriol cream saw significant improvement in both bladder and vaginal pain symptoms.[rx]
- Botulinum toxin A – has been shown to decrease and even cure vulvodynia pain in case studies.5 However, the only randomized-controlled trial performed using botulinum toxin A in vulvodynia found no difference from placebo.[rx] Although rare, botulinum toxin A carries a risk of systemic effects if it spreads beyond the site of injection.
- Triamcinolone, betamethasone, and methylprednisolone – have been studied due to their anti-inflammatory effects and in some cases have improved pain in less than 1 to 2 weeks.[rx] Due to the use of other medications in combination with corticosteroids, it is difficult to assess their efficacy in these studies. Other alternative therapies requiring more controlled studies include acupuncture, localized transcutaneous electrical nerve stimulation (TENS) therapy applied to the labia majora, and avoiding diets high in oxalates.
- Injectable Therapies – Several injectable therapies exist for vulvodynia pain that is more localized in nature. Those showing efficacy include enoxaparin, botulinum toxin A, and corticosteroids. Although effective, injectable therapies are not often recommended due to their inconvenience and cost.
- Psychological approaches – Cognitive behavioral therapy is associated with a 30% decrease in reported vulvar pain with intercourse [rx]. Although there is no proven connection between vulvodynia and psychological predisposition, pain may be related to interpersonal or individual psychological problems. Marriage, sexual, or individual psychological consultation is also recommended in patients with similar symptoms.
- Physical therapy – Physical therapy has also proven itself as a method of choice in connection with the combined treatment of vulvodynia [rx]. It includes an assessment of the patient’s pelvic muscles, joints, fasciae, and ligaments. The assessment of the adjacent pelvic organs – urinary bladder, large intestine – is also necessary. Most of the therapies include weekly sessions of one or two hours, which are focused most frequently on the training of the muscles of the pelvic fundus, soft tissue mobilization, joint manipulation, muscle relaxation, and general tone balance. Unfortunately, there is no standardized approach regarding effective physical therapy in connection with vulvodynia, and that is why the results cannot be accurately validated nor reproduced.
- Laser therapy – Laser ablation of the vulvar epithelium with the KTP-Nd: YAG laser and the CO2 laser presents as an alternative to the more aggressive treatment by means of vestibulectomy. Based on the angiogenesis and increased nerve sensitivity, which characterize vulvodynia, the laser is used with the purpose of disturbance of these histological abnormalities, and to cause collagen remodeling, without altering the macroscopic anatomy. Results of laser therapy for vulvodynia are comparable to vestibulectomy. The complete response has been reported in 62% and improvement in 92% of patients [rx].
- Applications of platelet-rich plasma – This is a new, alternative method for the treatment of some gynecological disorders such as vulvar dystrophy, urogenital disorders, female sexual dysfunction, and others [rx]. There is no scientific confirmation of positive results of this treatment for vulvodynia, but it is a potential opportunity and the future will show if it can become a part of the treatment options.
What else can I do to relieve the pain of vulvodynia?
- Avoid tight clothing and pantyhose.
- Wear all-cotton underwear.
- Use cold compresses or gel packs.
- Avoid exercises that put pressure on the vulva, like cycling or horseback riding.
- Wash the area gently with plain water. Don’t use soap in the genital area, don’t douche, and don’t use other possible irritants like deodorants or bubble bath.
- Use a lubricant during sex, but stay away from the lubricants that are flavored or designed to create a cooling or warming sensation.
- If you have to sit down for prolonged periods, it might help to sit on a foam “donut” or some other type of cushion that reduces pressure on the area of the vulva.
- Reduce your stress levels and get adequate sleep.
Vulvodynia Home Remedies
It may help to stay away from things that could irritate your vulva. These might include certain soaps, medications, or douches. You can:
- Use a dermatologist-approved detergent
- Don’t use fabric softener on your panties.
- Use unscented toilet paper that’s soft and white.
- Wear 100% white cotton underwear
- Use 100% white cotton menstrual pads, and tampons.
- Don’t get shampoo on the vulvar area.
- Avoid perfumed creams or soaps, pads or tampons, and contraceptive creams or spermicides.
- Stay out of hot tubs or pools with lots of chlorine.
- Rinse your vulva with cool water after you pee or have sex.
- Avoid foods that make your urine more irritating. This may include greens, beans, berries, chocolate, and nuts.
- Wear loose-fitting pants and skirts
- Don’t wear pantyhose.
- Keep your vulva clean and dry.
- Remove wet swimsuits or damp gym clothes as soon as you can.
- After bathing, gently pat your vulva dry and apply a vegetable or plant-based oil or preservative-free emollient to protect it
Some activities put pressure on your vulva. To ease it you can:
- Use a water-soluble lubricant during sex.
- Avoid activities that put direct pressure on your vulva. This includes bicycling and horseback riding.
- Sit on a foam rubber doughnut.
These steps may help relieve vulvar pain:
- Soak in lukewarm or cool sitz baths.
- After sex, apply ice or a frozen gel pack wrapped inside a hand towel to the area.
- Try a heating pad.
- Try relaxation techniques.
Facts To Know
- Vulvodynia is chronic pain or discomfort of the vulva (the area surrounding the vaginal opening) that lasts for three months or longer in the absence of other skin or gynecological disorders.
- Women who suffer from vulvodynia report burning, stinging, irritation, and rawness in the area. For some, this pain affects the whole vulva, for others, it is localized to one area. Pain may be constant or episodic, often when triggered by tampon insertion, sexual activity, or exercise, especially bicycling.
- Vulvodynia can be difficult to diagnose. It’s not uncommon for women to see multiple doctors before getting an accurate diagnosis.
- It is estimated that approximately 15 percent of women will suffer from chronic vulvar pain at some point in their lives.
- There is no known cause of vulvodynia. However, we do know it is not caused by an active infection, including sexually transmitted diseases; skin disorders; cancer; or generalized neurologic or psychological disorders.
- Diagnosis includes a cotton swab test in which the doctor places pressure on different parts of the vulva area to locate the pain and its relative intensity.
- As with other chronic pain conditions, the unrelenting nature of vulvodynia has a negative impact on a woman’s quality of life, and ability to perform daily activities. The challenges encountered in its diagnosis and treatment may lead to depression, anxiety, fatigue, and low self-image, especially related to a woman’s sexuality.
- There is no “cure” for vulvodynia. The goal of treatment is to manage pain, restore normal activities, and improve quality of life.
- Treatment may include a combination of advice on vulvar tissue care, oral and/or topical medications, nerve blocks, physical therapy, biofeedback, dietary modifications, counseling, and, in some cases, surgery. Many therapies recommended to promote general health may also be recommended with traditional medical approaches for people in chronic pain. These therapies include acupuncture, massage therapy, relaxation techniques, biofeedback, and cognitive-behavioral therapy.
- The aim of ongoing research is to determine the causes of vulvodynia and to find more effective ways to identify and treat chronic vulvar pain.
Questions To Ask
Review the following Questions to Ask about vulvodynia so you’re prepared to discuss this important health issue with your health care professional.
- Why am I having pain? Do I have a condition that is causing the pain?
- Do I need any tests to diagnose why I have pain?
- What topical or oral medications can you prescribe that will relieve my pain? What are the side effects?
- Are there nondrug, nonsurgical therapies that can reduce my pain and improve my condition?
- When can I expect the pain to subside?
- What can I do to cope with the pain and continue to lead an active lifestyle?
- What steps should I take to reduce vulvar irritation?
- What should I tell my partner about my condition?
- Is there a pain management specialist to whom you could refer me?
- Are there support groups for vulvodynia? Where can I get more information?
- What is vulvodynia?
Vulvodynia is chronic pain or discomfort of the vulva, the area surrounding the vaginal opening. It is diagnosed when pain lasts for three months or longer without any evidence of other skin or gynecological disorders that might cause the pain. Approximately 15 percent of women will suffer with chronic vulvar pain at some point in their lives.
- Do we know what causes it? Is it due to an infection?
We don’t know what causes vulvodynia, although it is likely due to multiple factors. Some factors that may contribute are pelvic nerve damage, spasms or weakness of pelvic muscles and genetic components such as susceptibility to inflammation. We do know that vulvodynia is not caused by active infection, the human papillomavirus (HPV) or other sexually transmitted diseases or cancer.
- What are the symptoms of vulvodynia?
Women with vulvodynia often report having one or more of the following symptoms around the vulva:
Burning sensations are most common; however, the type and severity of symptoms are highly individual. More than half of women who suffer from chronic vulvar pain have other health problems, including interstitial cystitis, fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, and recurring yeast infections.
- What triggers the pain?
Some women experience constant, generalized pain of the whole vulva area. Others have localized pain specific to one part of the vulva that may come and go. Vulvar pain may be triggered by sexual activity, tampon insertion or gynecological exams, or simply by wearing tight-fitting pants or sitting. Take note of what things make your pain better or worse and share this information with your health care professional, so he or she has a better sense of the location and intensity of your pain and how it impacts your overall and sexual health.
- How is it diagnosed?
Vulvodynia is a “diagnosis of exclusion.” That is, it is established after other potential causes of vulvar pain have been ruled out, including such things as yeast or bacterial infections. Most women see multiple health care providers before a correct diagnosis is made. To diagnose vulvodynia, your doctor will first take a complete medical history, including the duration and intensity of the pain, sexual health, treatments already tried, and previous medical problems and pelvic/abdominal surgeries. A pelvic exam will follow. A cotton swab test that applies pressure to various parts of the vulva is often used, especially for women whose pain is provoked by pressure on the vulva. You will be asked to rate the extent of the pain at each site so your provider can map your pain. It’s important to talk openly with your health care professional about any difficulties you have exercising, using tampons, or having sexual intercourse, so he or she knows how the pain impacts your daily life.
- What are the treatments for vulvodynia?
There is no cure for vulvodynia, but there are a variety of medications and non-drug therapies. Medications may include topical anesthetics, hormone therapy, oral antidepressants, anti-seizure medications, and nerve blocks. Other options include pelvic floor physical therapy, biofeedback, dietary changes, counseling, and, in select cases, surgery. Acupuncture, massage therapy, relaxation techniques, and cognitive behavioral therapy, which often are recommended as treatments for other conditions causing chronic pain, may play a role in your overall care. No single approach works for all women. It often takes time to find a treatment or combination of therapies that will adequately alleviate the pain.
- What should I tell my partner?
Many women find it difficult, if not impossible, to engage in vaginal penetration due to the severity of what is sometimes described as “knife-like pain.” Since this condition significantly affects your sexual relationship, it’s important to educate your partner about this condition and how it affects you, both physically and psychologically. Be honest and open about how you feel, the steps you are taking to alleviate the pain, and ways your partner can support you. You may feel embarrassed to broach the subject, but it’s important for your peace of mind and for your significant other to feel involved in the process. Counseling with a sex therapist is often helpful for couples dealing with vulvodynia.
- A Combination of Therapies Works Best
Pain relief may not happen quickly. It may take several weeks for you to notice an improvement in the pain. Complementing drug therapy with physical therapy, biofeedback, sex therapy, and psychological counseling may further improve pain control. There is no single effective treatment for women with vulvodynia. Ask questions if you don’t understand the recommended treatment plan.
- Basic Vulvar Skin Care
There are simple steps you can take to reduce vulvar irritation. Here are a few tips:
- Wear 100 percent cotton underwear.
- Avoid tight-fitting pants; don’t wear pantyhose.
- Use plenty of water-soluble lubricant with all sexual activity.
- Steer clear of perfumed creams or soaps, pads or tampons, and contraceptive creams or spermicides.
- Don’t use douches or vaginal wipes.
- Refrain from exercises that are likely to place added pressure on the vulva, such as bicycling and horseback riding.
- Exercise and Eat Right
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, especially if your vulvar pain is provoked by certain types of physical activity.
- Get the Emotional Support You Need
Chronic vulvar pain can be debilitating and often interferes with daily activities and sexual relations. Many women with episodic vulvodynia become anxious and worried about their next pain flare-up. While chronic vulvar pain can be an embarrassing topic, it’s important to try to talk openly about it with your partner. Don’t let the pain overshadow you. Continue to engage in activities you enjoy even if you need to cancel or cut back some days. If you feel sad for several weeks at a time, you may be depressed. Common signs of depression include:
- sustained sadness, anxiety, irritability, or boredom
- loss of interest or pleasure in activities that were once enjoyed
- noticeable changes in eating and sleeping habits
- withdrawal from family, friends, and social activities
- difficulty thinking, concentrating, or remembering and an inability to complete schoolwork
- feeling guilt, hopelessness, emptiness
- physical symptoms such as headaches, stomach upsets, or pain that doesn’t respond to treatment
If you think you might be depressed, seek treatment. Many women with vulvodynia benefit from psychological counseling and sex therapy.
- Relax to Reduce Stress
Managing stress and learning to relax are important parts of any pain relief program. Stress appears to contribute to many chronic conditions, including chronic vulvar pain. Stress can increase blood pressure, reduce the immune system’s ability to fight infection, and affect hormone production, including turning on cortisone production in the adrenal glands and upsetting the balance between estrogen and progesterone. 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 biofeedback is sometimes recommended for women with vulvodynia to learn how to relax pelvic muscles, which can contract in anticipation of pain, thus causing chronic pain. You can download apps to your smartphone that can guide you through deep breathing or meditation with instruction, reminders and exercises.