Vulvodynia means pain in your genital area (the vulva) when no other cause is found. Vestibulodynia means pain around the opening of your vagina (the vestibular area) when it is touched, or pressure is put on it.

What are the symptoms of vulvodynia and vestibulodynia?

Symptoms of vulvodynia include pain in your vulva and sometimes your buttocks and inner thighs. It is usually felt as burning, stinging or discomfort. The pain may be constant or come and go. Symptoms may happen in a small area or can involve your entire vulva. Symptoms of vestibulodynia include pain that happens when the vestibule is touched. You may feel pain when urinating. It can stop you from having penetrative sex.

What causes these conditions?

Exact causes are not known. Pain might be caused by over-sensitive nerve endings in the area, sending signals which are felt as pain. The condition may be triggered or made worse by:

• chronic skin conditions
• skin infections like candidiasis (thrush)
• laser treatment or surgery
• injury in the area
• childbirth
• soaps, detergents, douches, panty liners/pads, condoms, or synthetic underwear
• emotions (e.g. stress or anxiety)
• tight clothing or prolonged use of swimwear or other wet clothing

How can these conditions be treated?

There are different treatments that may be useful. It may be worth trying several treatments to see which works best for you. Treatment can take time. Sometimes symptoms can settle by themselves, although it may take months or sometimes years to do so. The most successful treatments include:

• avoiding soaps, bubble baths, shower gels, shampoos and deodorants on the vulva
• washing with a soap substitute like aqueous or sorbolene cream, or a soap-free wash (brands include QV or Cetaphil) to keep your skin hydrated and reduce irritation
• cool compresses
• salt-water baths
• avoiding tight, synthetic clothing and activities that irritate the area
• seeing a pelvic health physiotherapist for advice about pelvic muscle relaxation training
• topical (creams or ointments) or oral medicines to reduce nerve pain

Education and support about these conditions can help. You might like to try:

• talking about the problem openly with your partner and bringing them to appointments
• making sure you are comfortable before trying any penetrative sexual activity
• using water-based lubricant before sex or putting in a tampon
• having a warm, relaxing bath when you feel the pain
• seeing a sex therapist or counsellor to:
  • address the emotional impacts of this diagnosis
  • explore ways to enjoy intimacy without vaginal penetration.

If you need more information or have any questions, please contact the Canberra Sexual Health Centre on (02) 5124 2184 or talk to your GP.

Other resources:

• https://dermnetnz.org/topics/vulvodynia
• https://t203.membes-ams.com/public/203/files/Patient%20Information/Vulvovaginal-pain.pdf

References:

• Vulvodynia treatment guidelines - Melbourne Sexual Health Centre (MSHC)