If you’ve ever felt like something was wrong with your vulva — which refers to your outer genitalia, including your labia and clitoris — you probably grabbed your phone, typed in a list of symptoms, and let your mind (and search engine) lead you down a rabbit hole of possibilities.
Once you’ve ruled out STIs, pregnancy, and death (according to your doom scrolling), you might be wondering what on earth could be causing your vulvar pain, discomfort, itching, burning, and/or rawness. Few people realize that when symptoms like these persist for three months or more, they can be a sign of chronic pain of the vulva or vulvodynia.
Unfortunately, vulvodynia is commonly misdiagnosed and ignored in doctors’ offices, NSFW conversations with friends, and even search engine results. Research shows that while there’s no singular, identifiable cause of vulvodynia, activities like sex, injury, stress, and a tight, painful pelvic floor are often linked to the onset of this chronic pain condition that affects 8-10% of individuals with vaginal anatomy.
Read below to learn more about vulvodynia, how it’s diagnosed, and treatments like pelvic floor therapy that can soothe your symptoms and put your mind at ease.
WHAT IS VULVODYNIA?
Vulvodynia (Vull - vo - DIN - ee - uh) is a chronic pain condition of the vulva, often lasting three or more months. The pain, itching, and burning may occur around the vaginal opening, clitoris, and/or labia. Vulvodynia can appear out of the blue, or be linked to an infection, skin condition, or even injury resulting from activities like sex, spin class, sitting for too long, and more.
There are two different categories of vulvodynia, and symptoms can vary based on the location of the pain on the vulva.
Types of Vulvodynia:
- Localized vulvodynia occurs when one specific area of the vulva is impacted by symptoms — this may be in one spot on the labia, clitoris, or the vaginal opening for example.
- Generalized vulvodynia is when the entire vulva is affected.
WHAT CAUSES VULVODYNIA
According to Dr. Ashley Rawlins, PT, DPT at Origin, some common causes of vulvodynia can include: an allergic reaction, hormone imbalances, STIs, dermatologic conditions, and pelvic floor muscle dysfunction. “Up to 90% of those with pelvic pain (including those with vulvodynia), have musculoskeletal pain and dysfunction,” reports Rawlins. “Whether it’s the primary cause of one’s pain or develops secondary to pain in the area, pelvic floor therapy can be highly effective in minimizing symptoms.” Stress can also trigger and/or worsen symptoms of vulvodynia.
SYMPTOMS OF VULVODYNIA
Symptoms of vulvodynia can include:
Any one or combination of these symptoms can be provoked by touch or pressure to the area (pressure from a bicycle, sexual touch or touch from underwear for example), occur spontaneously, or both.
Because many of these sensations can appear or feel similar to those of other conditions and infections, it is important to consult your healthcare provider in order to provide an accurate diagnosis of the cause of your vulvodynia.
HOW VULVODYNIA IS DIAGNOSED
You may wonder, “How can I get diagnosed with vulvodynia?” since there are so many different causes and overlapping symptoms with other conditions like STIs. While the sole source and onset of your battle with the chronic condition may be difficult to define, common methods and techniques to diagnose vulvodynia include:
- Medical questionnaire: Your healthcare provider may ask you a list of questions about your symptoms, changes in routine, sexual partners, surgical history, frequency of pain, and more in order to identify the underlying causes of the vulvar discomfort.
- Cotton-swab test: Your doctor may use a cotton swab to press on the vulva in order to identify the area(s) in pain. They may ask you to rate your pain on a scale from 1-10 or describe the pain's frequency. The cotton swab test is one of the most commonly used ways to diagnose someone with vulvodynia, and can differentiate between localized versus generalized types.
- Pelvic Exam: Your doctor may take samples of vaginal discharge, routine cultures, and more to rule out yeast infections, STIs, and other conditions. They may also examine the external genital area for sores, areas of pain, and others to conduct a full analysis of your gynecologic health.
- Biopsy: Your doctor may take a sample of your vulvar tissue to examine in the case of any existing, concerning sores or rawness.
Understanding the cause of your vulvar pain is important, so that effective treatment options can be used to target and improve your symptoms as soon as possible.
TREATMENTS TO RELIEVE VULVODYNIA
The most effective preventative treatment for vulvodynia? “Staying on top of your gynecologic health,” advised Rawlins. Such practices include regularly exercising your pelvic floor, using STI protection, scheduling routine visits to your gynecologist, and avoiding scented soaps and detergents that can mess with your vaginal pH.
While getting relief for persistent, painful symptoms may feel out of reach, relief is completely possible. Once all of the medical causes of your pain have been ruled out and/or treated, there are several effective adjunct treatments options to help alleviate your chronic vulvar pain and return to feeling your best:
Pelvic Floor PHYSICAL Therapy
Have you ever gone for a strenuous walk, run, or hike and noticed that your thighs or calves were itchy afterward? The same thing can happen to your vulva if your pelvic floor muscles are overworked. “Sometimes itching and burning is a result of muscle overactivity and limited blood flow, which can cause irritation in the nerves, and pelvic floor PT can help with that,” explained Rawlins. “Everyone’s needs are different, but most often pelvic floor therapy will include manual therapy and exercises to help improve the health and flexibility of the pelvic floor muscles, to minimize scar tissue or improve blood flow.”
Cognitive Behavioral Therapy
Many chronic pain conditions, including vulvodynia, can cause both mental and physical distress. Cognitive behavioral therapy can help patients navigate their discomfort by providing a mental and physical solution to their ongoing pain. “Pain science education is also a huge part of pelvic floor therapy for those with vulvodynia, and retraining the brain that the only response to vulvar touch does NOT have to be pain,” said Rawlins.
If your vulvodynia is triggered by stress, lifestyle changes such as regular exercise, meditation, breathwork, and therapy may help remedy this root cause. At Origin, “We may also include exercises that support the other treatment techniques we are using, such as yoga stretches to support blood flow and muscle range of motion in the area,” said Rawlins. These holistic practices can help to relieve your mind and body of the “fight or flight” response that often restricts blood flow, which can result in burning, itching, and irritation. Not only is stress a potential root cause of vulvodynia, but it can also worsen the condition even if it’s not the main source of one’s pain.
Medication & SURGERY
Topical creams, oral antidepressants, nerve blocks, surgery, and even botox can all be used to treat vulvodynia. “I would recommend consulting a physician prior to trying medicinal remedies,” advised Rawlins. “They would only be effective if it is targeting a medically diagnosed cause of the pain. Some over-the-counter topical salves can be soothing/moisturizing irritated vulvar tissues, and can be really helpful in conjunction with other treatments.” Always consult your healthcare provider before starting any medical treatment.
- Cotton underwear is key
- If you’re experiencing chronic vulvar pain, it’s best to ditch the nylon panties and opt for loose-fitting, cotton underwear. Not only is cotton better for your vaginal health, but its increased breathability can provide relief for any vulvar irritation caused by overheating and trapped moisture. Experiencing discomfort at night? Go commando.
- Stay away from tight-fitting clothing
- Gone are the days of making your vulva suffer for the sake of fashion — skinny jeans are out, and mom jeans are in. If you’re struggling with vulvodynia or looking to prevent the pesky, chronic pain from returning, make sure to wear loose-fitting, breathable clothing in order to allow for improved blood flow and circulation to the area.
- Avoid hot tubs
- You might want to reschedule your next jacuzzi date if you’re experiencing a vulvodynia flare-up. The hot water and chlorine chemicals can worsen any existing irritation or rawness. If you’re still in need of a good soak or self-care moment, you can draw yourself a room temperature Epsom salt or colloidal oatmeal tub, sans scented bubble bath products.
- Don’t buy scented pads or tampons
- While inserting a tampon can already be painful for some individuals with vulvodynia, scented tampons and pads can intensify the irritation. On your next trip to the drugstore, add unscented, 100% cotton products to your cart instead. After all, you shouldn’t feel pressured to change your natural scent, anyways. Unscented body wash and gentle detergent are healthy swaps for your vulva, as well. At Origin, “We will work with you on optimizing your perineal hygiene to minimize and eliminate any products that could be irritating your skin,” said Rawlins.
With all of these solutions available, how long will it take before you can finally alleviate your symptoms? “Often, people will feel an emotional relief quite immediately, once their symptoms and feelings are validated, and are reassured that there are evidence-based and effective physical therapy-based treatment options,” assured Rawlins.
THE LATEST RESEARCH ON VULVODYNIA
Research shows that vulvodynia reportedly affects 8-10% of individuals with vaginal anatomy. While this percentage may seem small, it represents roughly 1 out of every 10 people with vulvas - think of your group of friends, family, coworkers, teammates, and more. And that’s just the number of individuals who’ve been diagnosed in doctors’ offices.
Besides the physical toll of the chronic pain condition, one of the main reported side effects of living with vulvodynia is its negative impact on the quality of life of individuals suffering from it. Many researchers suggest that vulvodynia can put a strain on romantic relationships due to lack of sex, loss of energy, and increased irritability due to pain. Chronic pain’s mental and physical toll can also affect one’s job, especially if lots of sitting is involved.
Not only can this common condition make everyday life and your favorite workout class more painful, but it’s also a leading cause of pain during sex for women who have not undergone menopause. In addition to the impact of sex, bike riding, injury, etc., other causes of vulvodynia can include pelvic floor dysfunction, anxiety, depression, early childhood trauma, and other chronic pain conditions. “Chronic pain, even when there is no true tissue injury or damage remaining, can be debilitating. It’s real, consuming pain, and these medications can really help when learning how to help the other aspects of chronic pain,” explained Rawlins. Because of this, a combination of pelvic floor therapy, cognitive behavioral therapy, and medical treatment are popularly considered the most effective trio for ongoing relief.
A surgery called vestibulectomy can also be used to treat vulvodynia in extreme cases. “Vestibulectomies may help those who have certain skin conditions that are affecting the vestibular tissue of the vulva (the small hormone-sensitive skin from the inner labia to the vaginal opening),” said Rawlins. However, “If the large majority of those with pelvic pain have some amount of pelvic floor dysfunction, then the vestibulectomy won’t correct that.”
Pelvic floor therapy remains one of the most highly recommended, initially incorporated treatments for those struggling with vulvodynia. The benefits of pelvic floor therapy exceed just vulvodynia relief, helping improve bladder control, pelvic organ prolapse, postpartum pelvic floor function, sexual function, and other chronic pain conditions.
Through the regular practice of pelvic floor therapy exercises, proper genital hygiene, and holistic habit changes to improve your quality of life, you can make vulvar pain a think of the past.
For any questions about how pelvic floor therapy can improve your quality of life and relieve pain, schedule a consultation with an Origin PT who can reply to all the questions that your frantic Google search can’t (and sometimes shouldn’t) answer.