What is Vulvodynia? Causes, Symptoms, Treatments NYC

Medically reviewed by Dr. Jennifer Purwin PT, DPT, CSCS.

What is vulvodynia?

Vulvodynia is identified as chronic and unexplained vulvar pain—that is, pain in and around the opening of the vagina (vulva). Besides pain, you may experience burning, irritation, stinging, itchiness, rawness, or even pain during intercourse.

Because vulvodynia sometimes has an unidentifiable cause and its symptoms can be invisible, it can be misdiagnosed or even undiagnosed. Additionally, some patients feel embarrassed and might not consult their doctors, which can only exacerbate the problem. 

In some cases, women with vulvodynia or vestibulodynia (aka vestibulitis vulvar, which is a more localized and specific subset of vulvodynia) might experience pain from prolonged sitting, discomfort when wearing certain clothing, and even lower quality sleep due to the vulvar pain. 

If you are experiencing what you believe to be vulvodynia, just know that relief is possible. The discomfort and pain that you feel is not permanent. 

What causes vulvodynia?

The cause of vulvodynia is not clear and the research on this topic is limited. That being said, there is plenty we do know. Vulvodynia has no hereditary or genetic ties, meaning it cannot be passed down to you from a relative.

Additionally, it is not related to hygiene or hygiene products. And there is no proof that infections such as STDs lead to or cause vulvodynia. So what might be the cause(s)?

Some research has led to the following as possible causes of vulvodynia:

• Irritation to or injury of the nerves in your vulvar area

• Changes to your hormones

• Allergies

• Antibiotic use

• Former vaginal infections or susceptibility to infections

• Muscles spasm or weakness to the pelvic floor muscles

In addition to the primary physical challenges caused by vulvodynia, it can also lead to secondary problems, such as depression, anxiety, PTSD, sleep deprivation, relationship trauma, and a general decreased quality of life.

And because vulvodynia can cause painful sex, it can lead to spasms in the muscles surrounding the vagina, also known as vaginismus. 

What are symptoms of vulvodynia?

If you are experiencing vulvar pain or discomfort, you may have vulvodynia. As always, consult with your healthcare provider to be certain. 

Common vulvodynia signs and symptoms:

• Throbbing, soreness, or pain in the vulvar area

• Vaginal or vulvar itchiness

• Raw, stinging, or burning sensation near or at the vulvar site

It is important to know that any or all of these symptoms may occur at any given time. Some women report experiencing them worse while sitting, and some while doing activities such as exercise or intercourse. Some women experience symptoms intermittently while others have them on a chronic basis.

And for some, the vulva may show no visual signs of problems while for others the vulva may be red or swollen. Whatever the case may be for you, just know that you can and should seek the help and support you need and deserve.

How is vulvodynia diagnosed?

To diagnose vulvodynia, your physician may first try to rule out other possible conditions.

Before your doctor diagnoses you, she or he may ask about your health history, information regarding past surgeries, any sexual history, and your current vulvodynia symptoms. Following that, the doctor may perform a pelvic exam to investigate and assess your vagina and vulva. 

Because vulvodynia may sometimes not present any visual symptoms, the doctor can still look for signs of infection by taking a cell sample and testing it. This can also help the doctor to rule out other conditions or infections. 

The pelvic exam is also used to assess your pelvic floor muscles and identify any other areas of pain. Additionally, she or he may ask for a blood sample to examine your hormone levels. 

After a health history and pelvic exam, it is common for doctors to perform a cotton swab test. This is where the doctor uses a cotton swab to apply gentle pressure to various localized vulvar areas to check for where your pain may be coming from.

You might be asked to rate the severity of the pain in the different areas. And in some cases, a doctor might take a small biopsy of any suspicious skin areas, for further examination. 

What foods cause vulvodynia? 

Because the cause of vulvodynia varies from person to person, some have concluded that certain foods may cause vulvodynia to worsen. However, everyone’s microbiome is different.

Some have found that eliminating dairy, gluten, and soy from their diet has alleviated their vulvodynia symptoms. Others have eliminated certain fruits and vegetables and have found symptom relief as well. 

If you decide to address your symptoms with an elimination diet, we recommend that you do so under the direction and care of your healthcare provider.

What is the best treatment for vulvodynia?

When it comes to the treatment of vulvodynia, it may not necessarily be a quick process. With an often unclear cause, treatment can take time. But relief is possible. Once your doctor can zero in on the cause or causes, she or he can address your vulvodynia accordingly. 

The following is a list of some of the common vulvodynia treatments:

• Medications: these may include but are not limited to anesthetics, topical creams, nerve blocks, or steroids

• Therapy: TENS therapy, biofeedback therapy, or pelvic floor physical therapy

• Surgery: removing affected skin or tissue may be the best treatment for some women suffering with vulvodynia

Your treatment may include visits to different specialists such as a specialized gynecologist, neurologist, dermatologist, or physical therapist.