The Inexplicable Pain of Vulvodynia

The cause of vulvodynia, chronic pain or discomfort around the entrance of the vagina or vulva, remains largely a mystery. Not only is the source of pain unknown, but the discomfort can also begin seemingly out of nowhere and linger for months or years, and approximately 200,000 women in the U.S. are impacted by the condition, according to the National Institutes of Health.

While answers are elusive, among suspects are inflammation, injury to nerves in the area and hormonal-related issues. Women with the non-life-threatening condition often experience common pain syndromes such as painful bladder syndrome, fibromyalgia and irritable bowel syndrome (IBS).

Meanwhile, risk factors for vulvodynia run the gamut from anxiety, depression and post-traumatic stress disorder to history of abuse.

The condition has no entrenched pattern—the location, persistence and degree of pain varies, according to NVA.org. For example, some women experience discomfort on a single area of the vulva, others in several parts. Some women experience a burning sensation, while others describe an itching, raw feeling.

The majority of women afflicted with localized vulvodynia also deal with provoked vestibulodynia, where there's pain during or after pressure is applied to the vestibule. The malady stems from various factors including sitting for a long period, incorrect insertion of a tampon, a gynecologist exam, wearing fitted pants and intercourse. The pain associated with sex could spark sexual dysfunction, possibly damaging a woman's quality of life.

How is vulvodynia treated?

This can't be emphasized enough: If you have the condition, seek help—don't be dissuaded by the lack of viable signs, much less embarrassment over talking about your symptoms. An exam might allow your physician to determine the source of your vulvar pain. Your discomfort can be minimized through treatment options.

Common treatment options include topical medications such as creams and ointments containing anesthetics or medication that stabilize the nerves in the vulva area. For nerve pain, options are oral medications, like antidepressants and anticonvulsants. Other medications can be injected into the affected area.

Now, given the exact cause of vulvodynia is the $50,000 question, there's no way to assure there won't be flare-ups. However, there's seemingly a link between recurrences of the condition and activities or situations that can ignite it, such as sexual intercourse and exercise—cycling in particular. Even walking could be a trigger, along with the insertion of tampons and irritating contraceptive creams or spermicides.

To manage potential flare-ups, it's important to regularly clean your vagina with water to keep irritation at bay. Strong-smelling soaps and detergents pile on more trouble, so opt instead for chemical-free options. Another thing: Because it contains a host of chemicals, washing your underwear with fabric softener is a no-go.

Physical therapy is another alternative. It can relax tissues in the pelvic floor and ease tension in muscles and joints. One form of PT, biofeedback, trains you to strengthen the pelvic floor and muscles, which can help blunt pain.

In some cases, where traditional treatment isn't working, your doctor may recommend a surgical procedure called a vestibulectomy, where painful tissues are extracted from the areas of the vulva known as the vestibule. This procedure is only viable in situations where the condition is contained to that area; the procedure is not recommended when the vulvodynia has strayed to areas beyond the vestibule.

If you suffer from vulvodynia symptoms, you're not alone. Talk to your doctor about the pain you are experiencing and discuss the treatment options best for you.