ON HEALTH: What causes vulvar pain?

What is the vulva?

The vulva is the area comprising the external genitals in women. It contains several different structures, including:

• Labia majora or outer lips: These are the larger set of skin folds that surround the vagina and other vulvar structures. They contain hair on the outer surfaces.
• Labia minora or inner lips: These are the smaller and more internal of the two skin folds and do not have any hair on them. The labia minora meet at a small structure known as the prepuce, or the hood, which protects the clitoris.
• Clitoris: The clitoris is a small piece of tissue that contains many nerve endings and swells with blood during sexual stimulation.
• Vestibule or the opening of the vagina: The opening of the vagina also contains small Bartholin glands, which secrete a fluid that acts as a lubricant during sexual activity.

Vulvar pain can occur in any of these structures.

Symptoms

Vulvar pain varies among women and can be described as:

• burning
• stinging
• irritated
• raw
• stabbing
• pressure
• throbbing
• itching

The pain can occur in one spot, when it is known as localized, or throughout the entire vulva and is then known as generalized.

It can also be provoked, meaning it is caused by pressure or touch, or unprovoked, meaning it occurs on its own without touch. For some women, the pain comes and goes, but it can also be constant.

Vulvar pain can be triggered by:

• sexual activity
• insertion of a tampon
• wearing tight or form-fitting jeans
• sitting

Pain and discomfort that occurs when pressure is applied to the opening of the vagina is called vestibulodynia.

Causes

There are many different causes of vulvar pain. Some of the potential causes of pain in the vulva include:

Infections

Chronic yeast infections or bacterial infections can cause pain that ranges from mild discomfort and itching to severe burning or throbbing.

Viral and bacterial infections, such as bacterial vaginosis or the herpes simplex virus, can also cause vulvar pain or discomfort.

Trauma

The vulva contains very sensitive tissues and contains nerve endings. It is easy for those nerve endings to be damaged by childbirth, sexual activity, or by riding a bicycle or horse.

Chronic pain conditions

Research has found that women who have vulvodynia are more likely to also have a chronic pain condition, such as fibromyalgia, interstitial cystitis, or irritable bowel syndrome.

Allergies

Some women have allergies to soaps or feminine hygiene products that can cause pain, discomfort, and irritation in the genital area.

Most women with allergies also report having irritation or inflammation.

Hormonal changes

Hormonal changes associated with menopause or the menstrual period can cause sensitive tissues to become swollen, inflamed, or dry and uncomfortable.

Cancer

Vulvar cancer is the growth of abnormal cells in the tissues of the vulva. This type of cancer can cause itching, burning, inflammation, and pain.

Most cases of vulvar cancer also cause lumps, sores, or skin changes.

Treatment

Treatment depends on the cause of the vulvar pain. This may mean medication to treat an infection, hormone replacement to manage hormonal changes, or surgery to repair an injury.

Also, a therapist or physical therapist can help to relieve tight muscles or address chronic pain or anxiety.

Other treatments may include:

• Biofeedback: When used for vulvar pain, this type of therapy teaches women how to relax their pelvic floor muscles and control how their body responds to the pain triggers.
• Topical anesthetics: These are usually ointments and can be applied 20–30 minutes before sexual activity. These creams can make the area numb so that the woman does not feel any pain or discomfort.
• Pelvic floor therapy: In some cases, pelvic floor therapy can help to relax the muscles in the pelvis and can relieve muscle pain and tension. Strengthening these muscles supports the organs in the pelvis, including the bladder, uterus, and rectum, and also helps to relax them.
• Nerve blocks: A nerve block may be effective for someone who has pain that interferes with their daily life and does not get relief from other treatments or therapies. During this treatment, a doctor injects a numbing medicine into the nerves supplying the external genitals. This blocks pain receptors and can relieve discomfort.

Home remedies

Several home strategies can be used to reduce pain or discomfort. These include:

• Being mindful of hygiene products: Someone with vulvar pain should minimize the use of products that can irritate the vulva. They can start by avoiding scented products or strong soaps. Also, they should avoid using 'dry weave' feminine hygiene products in favor of 100 percent cotton menstrual pads and tampons.
• Not douching: The vagina is self-cleaning, and there is no need to use douches or other cleansers. These products can be irritating, especially in women with vulvar pain or irritation.
• Getting support: Vulvodynia can affect a person's relationship, self-esteem, or intimacy with another person. Getting support is vital. There are support groups or therapists that can help women and their partners learn to deal with the condition.
• Avoiding tight clothing: Tight clothing and synthetic fabrics such as spandex or Lycra can trigger vulvar pain.
• Using sitz baths: Sitting in a few inches of warm water with a teaspoon of Epsom salt can help relieve irritation.

• When to see a doctor

  Some women find it embarrassing to talk about vulvar pain or discomfort with their doctor.
  It is important to remember that the doctor is a professional and trained to help with all medical issues. A woman may also request a female doctor if that makes her more comfortable.
  Vulvar pain can cause uncomfortable quality of life issues and can signal that something is wrong. In most cases, vulvar pain can be treated, but it is important to diagnose the problem correctly.
  A doctor will look for signs of a serious cause, such as infection or cancer, and can recommend treatments to help relieve pain or discomfort.