Pelvic Pain
Vulvodynia is a condition that causes ongoing pain or discomfort in the vulva (the external part of the female genital area). This pain can feel like burning, stinging, irritation, or rawness. For many people, the most common feeling is a burning sensation. The pain may be constant or come and go, and it can affect different areas or stay in one place.
If you’re experiencing these symptoms, it’s important to know that you’re not alone—and that your pain is real, even if no obvious cause can be found.
Sometimes, understanding a few basic terms can help. The vulva includes the outer and inner lips (called the labia), the area around the vaginal opening (the vestibule), and the area between the vagina and anus (the perineum). You don’t need to remember all these names, but they can help describe where your symptoms are.
Vulvodynia has been classified into the following subtypes:
Generalised vulvodynia can affect different areas of the vulva, and the location of the pain may change over time. Pain may be felt in the outer or inner lips of the vulva (labia), the entrance to the vagina (vestibule), the clitoris, the area between the vagina and anus (perineum), or even the inner thighs.
Symptoms may be triggered by touch or pressure, such as during sexual intercourse, inserting a tampon or cycling. Many women describe the pain as a burning sensation, although it can also feel sore, tender or irritating. The pain may be constant or come and go, and even gentle rubbing from clothing against the vulval skin can sometimes trigger symptoms.
Women with Vestibulodynia (VVS) experience pain only at the entrance to the vagina (the vestibule), only during or after touch or pressure is applied. The most common symptom is a burning sensation, although pain can vary from woman to woman. Symptoms may be triggered by:
- Sexual intercourse
- Inserting tampons
- Gynaecological examinations
- Cycling
- Wearing tight-fitting clothing
There are also a number of skin conditions that can cause vulval pain. Scratching the vulva or overusing topical creams may irritate the skin, causing inflammation, swelling and increased discomfort.
Vulvodynia can have a significant impact on a woman’s quality of life. It may affect intimate relationships, make sitting, exercising or daily activities uncomfortable, and, if left untreated, can negatively affect confidence and emotional wellbeing.
- Many women experience symptoms for years before receiving an accurate diagnosis, as vulvodynia is often mistaken for recurrent thrush.
- To diagnose vulvodynia, Dr McCaffrey will take a detailed medical history, including your symptoms, previous treatments, medications and any relevant medical or gynaecological history.
- A careful examination of the vulva and vagina will be performed to rule out other causes of pain, such as infection or skin conditions. Vaginal swabs may also be taken if required.
- A gentle cotton bud (Q-tip) test may be performed. During this test, different areas of the vulva and vestibule are touched with a Q-tip to help determine the location and severity of your pain. With vulvodynia, even the slightest touch can trigger pain and tenderness.
- If an area of skin requires further assessment, she may recommend a biopsy. She may also use a magnifying glass to look more closely at any lesions in the vulva, or may recommend a colposcopy, a test in which an instrument is used to look at the vulva more closely.
Our treatments are directed toward easing symptoms, and may provide partial or indeed complete relief. It’s important to remember that the cause of vulvodynia is unknown. Each woman’s symptoms are unique, and no single treatment works all the time or is appropriate for every patient.
Some women respond very well to a particular treatment, while others respond poorly or experience unacceptable side effects. It takes time to find the treatment, or combination of treatments that work for you.
Some of the current treatments include:
- Lifestyle changes, including avoiding possible irritants like bleaches or shower gels.
- Local anaesthetic gels (i.e. lidocaine)
- Amitriptyline
- Tegretol, Neurontin
- Nerve Blockades
- Topical estrogen cream
- Pelvic floor therapy (for patients who have pelvic floor muscle abnormalities as measured by surface electromyography)
- Physical therapy
- Diet modification
- Surgery is very rarely necessary, and the only for vulvar vestibulitis syndrome