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Vulvodynia (vulval pain)

Vulvodynia is long-lasting pain in the vulva, the area around the opening of the vagina.

The main symptom of vulvodynia is pain in and around the vulva. The pain may be there all the time or it may come and go.

Treatments for vulvodynia include painkilling gels you can get from a pharmacy, stronger prescription painkillers, physiotherapy and talking therapy.

A cause for vulvodynia cannot always be found. Sometimes it’s caused by nerve damage from surgery or giving birth.

Read more on the NHS website.

The main symptom of vulvodynia is pain in and around the vulva. The pain may be there all the time or it may come and go.

Symptoms of vulvodynia

The main symptom is persistent pain in and around the vulva and vagina. The vulva usually looks normal.

The pain may be:

Some women also have problems such as vaginismus (where the muscles around the vagina tighten involuntarily), interstitial cystitis (a painful bladder condition), painful periods and irritable bowel syndrome (IBS).

Having persistent vulval pain can affect relationships, reduce sex drive, and cause low mood and depression.

Pain in the genital area is often embarrassing to talk about and can make you feel isolated.

Read more on the NHS website.

Treatments for vulvodynia include painkilling gels you can get from a pharmacy, stronger prescription painkillers, physiotherapy and talking therapy.

Self-care

Lifestyle changes may help reduce symptoms:

  • wear cotton underwear and loose-fitting skirts or trousers
  • avoid scented hygiene products, such as feminine wipes, bubble bath and soap (an emollient is a good substitute for soap)
  • apply cool gel packs to your vulva to soothe the pain
  • use petroleum jelly before swimming to protect the vulva from chlorine
  • try not to avoid sex or touching your vulva completely, as this may make your vulva more sensitive. If sex is painful, try to find a position that's more comfortable, or do other sexually intimate activities together until you have sought advice if penetration is painful
  • try to reduce stress, as it can increase the pain of vulvodynia
  • for pain when sitting, using a doughnut-shaped cushion can help

Medical treatments

A combination of treatments can often help relieve the symptoms of vulvodynia and reduce its impact on your life.

Vulval gels and lubricants you can buy

Apply an anaesthetic gel, such as lidocaine, up to 20 minutes before sex. This may make sex more comfortable.

To stop the gel getting on your partner, either wipe it off just before having sex or ask your partner to wear a condom (if using condoms, use latex-free ones as latex condoms can be damaged by lidocaine).

If your pain is more constant, apply lidocaine regularly throughout the day. You can also use it overnight.

You can buy tubes of 5% lidocaine gel, cream or ointment over the counter from a pharmacy, although it's a good idea to get a doctor's advice before trying it.

Read the instructions carefully before you use it.

Vaginal lubricants and aqueous cream (also available over the counter from pharmacies and supermarkets) may soothe the area and help moisturise the vulva if it's dry.

Speak to a pharmacist about these treatments.

Prescription medicine from a doctor

Conventional painkillers like paracetamol will not usually relieve the pain of vulvodynia.

But several prescription medicines may help, including:

  • antidepressants called amitriptyline and nortriptyline – possible side effects include drowsiness, weight gain and dry mouth
  • anti-epilepsy medicines called gabapentin and pregabalin – possible side effects include dizziness, drowsiness and weight gain

Your doctor will probably start you on a low dose and gradually increase it until your pain subsides.

You may need to take the medicine for several months.

If you have pain in a specific area of your vulva, injections of local anaesthetic and steroids into a nearby nerve may provide temporary pain relief.

Physiotherapy

A physiotherapist can teach you some pelvic floor exercises (such as squeezing and releasing your pelvic floor muscles) to help relax the muscles around your vagina.

Another technique to relax the muscles in the vagina and desensitise it involves using vaginal trainers.

These are smooth cones of gradually increasing size and length that can be inserted into your vagina in the privacy of your own home.

Some physiotherapists may also suggest trying TENS (transcutaneous electrical nerve stimulation) to reduce your pain. 

This is where a machine is used to deliver a mild electrical current to the painful area.

Therapy and counselling

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.

It can often help women cope with the impact that vulvodynia has on their life.

CBT focuses on the problems and difficulties you have, and looks for practical ways you can improve your state of mind on a daily basis.

Psychosexual counselling is helpful when pain is affecting intimacy between you and your partner.

This is a type of therapy that aims to address problems such as fear and anxiety about sex, and restore a physical relationship with your partner.

Surgery

Surgery to remove part of the vulva is done in very rare cases.

But the pain can come back and it's usually not recommended.

Read more on the NHS website.

A cause for vulvodynia cannot always be found. Sometimes it’s caused by nerve damage from surgery or giving birth.

Read more on the NHS website.