Vulvodynia (vulval pain)

Vulvodynia can affect women of all ages. Anyone with a vulva can have vulval pain.

There's usually no change to the way your vulva looks, but it may feel uncomfortable or painful.

The pain may feel like:

• burning
• throbbing
• stabbing
• soreness

The pain can also:

• affect all or part of your vulva
• be constant or come and go
• start on its own or when your vulva is touched – for example, when inserting a tampon or having sex
• affect other areas, such as the inside of your thighs, around your bottom (anus), or the area where pee leaves your body (urethra)
• sometimes start when you have a poo

Vulvodynia can have a big impact on your life, affecting things like your sleep, concentration and sexual relationships.

Other causes of genital pain

Other conditions that can cause genital pain include vaginitis, vaginismus and some sexually transmitted infections (STIs).

• you have pain or discomfort in your vulva that does not go away or keeps coming back
• you find it difficult inserting a tampon into your vagina because of the pain
• you find having sex difficult because you feel pain, such as burning or stinging

You can ask to see a female GP and for someone else to be with you in the room. This could be someone you know or another member of medical staff.

If you see a GP about vulval pain, they'll ask about your symptoms. They may also ask if you've had any skin conditions or infections in your vagina, or if having sex is painful.

They may ask if they can examine your vulva and vagina. A cotton bud is often used to gently touch your vulva to see which areas are painful.

A swab may be taken to help rule out other conditions that can cause vaginal soreness, such as an infection.

If the cause of your vulval pain cannot be found, you may be referred to a specialist for help managing the pain.

The main aim of treatment for vulvodynia is to help manage the pain.

Vulvodynia is often treated by more than one specialist, including:

• a gynaecologist
• a physiotherapist
• a psychologist
• a pain specialist

A number of different treatments may be recommended under the guidance of these specialists.

Treatments for vulvodynia can include:

• medicines – this may be a cream you rub on your vulva to numb the pain or tablets to treat nerve pain
• pelvic floor exercises to help you control your vaginal muscles
• gently widening your vagina using tampon-shaped objects (vaginal trainers)
• psychological therapies, such as cognitive behavioural therapy (CBT) or psychosexual therapy (therapy to help with sexual problems)
• surgery to remove the painful part of your vulva – this may occasionally be offered if other treatments have not worked

No single treatment works for everyone, and you may need to try several treatments to find out what works best for you.

There are some things you can do to help reduce vulval pain and ensure good vaginal hygiene.

• wear loose, cotton underwear

• try using pads instead of tampons during your period

• try different positions when having sex and use lubricant

• try to avoid stress – things like yoga and mindfulness can help you relax

• do not sit in the same position for long periods

• do not clean inside your vagina (douching)

• do not have hot baths (make sure the water is cool or lukewarm)

• do not use scented products, such as soaps and deodorants, in or around your vagina – you can use an emollient (ask a GP or pharmacist for advice)

The exact cause of vulvodynia is not known.

It may be related to a number of things including:

• damage, irritation or over-sensitivity of the nerves in the vulva
• previous vaginal infections
• changes in levels of hormones, such as oestrogen
• weak pelvic floor muscles

Vulvodynia does not change the look of your vulva, but it may feel uncomfortable or painful. The pain may feel like burning, throbbing or stabbing.

A GP may use a cotton bud to gently touch your vulva to see which areas are painful. They may also take a vaginal swab to check for an infection.

Treatments for vulvodynia include medicines, pelvic floor exercises, psychological therapies and using vaginal trainers to gently widen your vagina.

Things that can help ease vulvodynia include wearing loose, cotton underwear, using pads rather than tampons and using lubricant when having sex.

The cause of vulvodynia is unknown. It may be related to nerve irritation, previous infections, hormonal changes and weak pelvic floor muscles.