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.
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 to remove part of the vulva is done in very rare cases.
But the pain can come back and it's usually not recommended.