Let’s Talk About Sex | What is Vulvodynia? Everything You Need to Know About Vaginal Pain

While sex is ubiquitous in our popular culture, conversations about it are still associated with stigma and shame in Indian households. As a result, most people struggling with sexual health issues or seeking information about sex often resort to unverified online sources or follow the unscientific advice of their friends. To combat the widespread misinformation about sex, News18.com publishes this weekly sex column titled ‘Let’s Talk About Sex’. Through this column, we hope to spark conversations about sex and address sexual health issues with scientific evidence and nuance.

In this article, we explain what vulvodynia really is, the different types there are, and what treatment options are available to provide you with relief.

Vulvodynia is a common condition that affects many women but is often misunderstood. Vulvodynia is a chronic pain condition that affects the vulva – the external female genital area. It involves persistent, burning, stinging, or sore sensations around the vaginal opening that can make intercourse, inserting a tampon, or even sitting extremely painful or uncomfortable. This condition is surprisingly common, affecting an estimated 16 percent of all women at some point in their lives. Although vulvodynia can occur at any age, it most commonly develops in women between the ages of 18 and 25 or after menopause. The constant discomfort can greatly impact a woman’s quality of life, relationships, and mental health.

There are two main types of vulvodynia:

• Localized vulvodynia: This type of vulvar pain is limited to one area or location. The most common type is vestibulodynia or vestibulitis – where the pain is felt around the vaginal opening (vestibulum). Other localized types include clitoridodynia (pain in the clitoris) and pain in the Bartholin’s glands.
• Generalized vulvodynia: In this form, the pain spreads throughout the vulva area rather than being localized to one spot. It can affect the labia, vestibule, clitoris, and even the perineum (the area between the vagina and the anus). The burning, soreness, or throbbing may be made worse by pressure from sitting, tight clothing, or sex. It is often further classified as provoked (pain triggered by touch/pressure) or unprovoked/spontaneous (constant pain with no obvious trigger).

Symptoms of vulvodynia: What to look out for

• Burning or stabbing pain: The most common symptom of vulvodynia is a persistent, burning or stabbing pain in the vulvar area. This pain can range from mild discomfort to severe, unbearable agony. It can worsen with certain activities such as sitting for long periods, exercising, wearing tight clothing, or having sex.
• Soreness or irritation: Many women with vulvodynia describe a feeling of soreness, soreness or irritation in the vulva, almost as if the skin has been scratched or scraped. This irritated feeling is often made worse by rubbing or pressure on the area.
• Pain on penetration: For some people, the pain of vulvodynia occurs specifically at the entrance to the vagina during attempts at penetration, such as when inserting a tampon or during intercourse. This localized discomfort, known as “pain on penetration,” can make intimacy extremely difficult and distressing.
• Other possible symptoms: In addition to the pain itself, vulvodynia can cause muscle spasms or general tightness and tension in the pelvic floor. You may also feel a burning sensation when urinating or notice unusual discharge.

Possible causes for the development of vulvodynia

Vulvodynia can have a variety of causes. The exact cause is often difficult to determine and may involve several overlapping factors. Some possible causes and risk factors include:

• Injuries or trauma to the vulvar area due to events such as childbirth, surgery, chemotherapy, or recurrent vaginal infections.
• Genetic factors make some women more susceptible to the disease.
• Hormonal changes or imbalances during periods, pregnancy or menopause.
• Increased nerve irritation or pelvic muscle tension in the vulva area.
• Inflammatory diseases of the vulvar skin such as lichen sclerosus or lichen ruber planus.

Who is at risk of vaginal pain?

Certain groups of women are at higher risk of developing vulvodynia. These include:

• Women aged 18–25 years and in menopause.
• Women with a history of chronic yeast infections or vulvovaginal candidiasis.
• Those who have undergone certain cancer treatments in the pelvic area.
• Women who have suffered a vulvar injury or other trauma during childbirth.

Diagnosis and treatment options for vulvodynia

An accurate diagnosis is crucial for effective treatment of vulvodynia. Your gynecologist will likely first rule out other possible causes of your vaginal pain, such as infections or skin conditions. They may perform a cotton swab test to map the painful areas and look for abnormalities. There is no one-size-fits-all treatment for vulvodynia, as the condition can have a variety of underlying causes. However, some common treatment approaches include:

• Medications: Low-dose antidepressants, antiepileptics or local anesthetics can help reduce pain signals.
• Physical therapy: Pelvic floor exercises and massage can relax tight muscles that contribute to pain in the vulvar area.
• Lifestyle changes: Avoiding irritants, using lubricants during sex, and managing stress may provide relief.

It may take some trying to find the right combination of treatments. Be patient and work closely with your doctor to monitor your symptoms.

Living with vulvodynia: self-care tips and coping strategies

• Managing stress and anxiety: Living with chronic vaginal pain can be incredibly stressful and anxiety-provoking. Finding healthy ways to manage stress and anxiety is crucial to your overall well-being. Practices like meditation, deep breathing exercises, yoga, or talking to a therapist can help you cope better.
• Try pelvic floor physical therapy: Pelvic floor physical therapy can be hugely helpful for some women with vulvodynia. A specialist pelvic floor physical therapist can guide you through exercises and techniques to relax and strengthen the pelvic floor muscles. This can reduce tension and spasms that contribute to vulvar pain.
• Try alternative remedies: Although there is limited evidence, some women find relief through alternative remedies such as acupuncture, herbal supplements or topical applications. Be sure to discuss complementary therapies with your doctor first to make sure they are safe for you.
• Build a support system: Don’t go through this alone. Surround yourself with supportive loved ones who can offer compassion and encouragement.
• Practice self-care: It’s important to nurture your mental and physical health through self-care. Prioritize stress reduction, light exercise, a nutritious diet, and getting enough sleep. Be patient, kind, and compassionate with yourself along the way.

Ultimately, vulvodynia is no fun. But you don’t have to suffer in silence! Be your own health advocate and find a doctor who will really listen to you. Try different treatments until you find relief. And remember, you are not alone – millions of women suffer from vaginal pain. With patience and perseverance, you can definitely get your momentum back. Stay positive, take care of yourself, and don’t give up!