Vulvodynia and vulval pain

Vulvodynia is a pain syndrome. The diagnosis is made when a woman has experienced burning pain on the vulva for at least three months and there is no vulval abnormality on examination.

The condition is due to the nerve fibres in the skin of the vulva being over-sensitive. This results in the nerve fibres over-firing and sending abnormal signals to the brain that the woman then feels as pain. Vulvodynia is a common condition but women are often embarrassed to talk about it and delay seeing their doctor.

We do not understand why the condition affects some women and not others. There is a thought that an infection with thrush may create the initial nerve irritation. Vulvodynia is not infectious or contagious; you cannot pass it on to anyone else. The prognosis of vulvodynia is very variable. Some women’s symptoms improve over time spontaneously whilst other women have symptoms for many years. Most women will get some symptom control with treatment.

Vulvodynia is classified according to when symptoms occur. If a woman only has pain with touching of the vulva such as during intercourse, riding a bike or inserting tampons it is termed Provoked Vulvodynia. If the symptoms are persistent or come and go randomly, it is termed Unprovoked Vulvodynia.

• Burning and soreness anywhere over the vulva
• Pain with intercourse, often making sex impossible
• Pain with smear tests

Diagnosis
A diagnosis is made by taking a detailed history and performing an examination in clinic. There is no diagnostic test for the condition.

Treatment
Vulvodynia is a complex condition that should be managed by a specialist in vulval disease. Treatment often involves a combination of therapies and is dependent on whether you have a diagnosis of Provoked or Unprovoked Vulvodynia. Aims of treatment are to control pain and achieve pain-free intercourse.

• Topical anaesthetic treatments
• Specialist physiotherapy
• Medication to try to reduce the abnormal nerve impulses (as tablets or as an ointment)
• Steroid injection
• Psychosexual therapy
• Water-based vaginal lubricants
• Vaginal dilator therapy
• Cognitive Behavioural Therapy
• Acupuncture
• Surgery (a procedure called a vestibulectomy). This is only offered to a select group of women that fulfil pre-operative criteria. It is used as a treatment for Provoked Vulvodynia but only in those women where it is deemed likely to be a successful treatment. Surgery has the potential of making symptoms worse and your specialist will advise on an individual case basis.

Follow up
Management of this condition will vary for each patient and should be tailored to the individual.