Vulvar pain: symptoms, diagnosis, treatment and prevention

By Cristiano Antonino On Apr 17, 2023

Vulvar pain is a specific pain of the female genital apparatus that may be related to a chronic inflammatory condition of the vulva

This disorder can also be referred to as ‘vestibulodynia’ when it affects only the vestibule, or ‘clitoridodynia’ when the pain affects the clitoris.

The symptoms of vulvar pain are numerous and are often not limited to pain in the female genital apparatus: there may be associated burning sensations, apparent redness of the genital areas, and the possible presence of clearly visible clinical lesions.

The causes of vulvar pain are many and can be diverse and change depending on the age of the patient, but also on lifestyle, frequency of sexual activity and a history of physical trauma.

This condition and its underlying causes can make even simple everyday activities, such as sitting in the same position and crossing one’s legs, difficult.

Sometimes this pain is chronic and can affect the patient throughout the day.

Learning more about the symptoms, causes and possible remedies for vulvar pain is important in order to best address this disorder and avoid complications and chronicity of the pain process.

The causes of vulvar pain can be different

Among the most widespread and common causes are:

non-consensual sexual intercourse, with lack of lubrication and therefore causing a lot of pain. This experience, in addition to causing deep physical trauma, can also lead to considerable psychological trauma. In this case, the patient may link the unpleasant pain to the sexual experience by experiencing her sexuality and her relationship with her partner in a complex way in the future;
mast cell hyperactivity is another cause of vulvar pain. This term refers to an exaggerated immune defence response by cells reacting to allergies or inflammation. This response leads to abnormal activation of pain-causing nerve growth factor (NGF). The result is a condition of hyperalgesia, i.e. excessive pain sensation even in response to stimuli that are not necessarily painful.

Other diseases and infections can lead to vulvar pain that can become chronic. Among the most common diseases that lead to this type of pain and inflammation are sexually transmitted diseases and others such as Candida, Gardnerella or Escherichia coli infections.

Risk factors

In addition to the most common causes just listed, there are also several risk factors for vulvar pain that can lead to a greater susceptibility of the patient to developing this disorder.

Personal hygiene is an important element that must be considered and managed carefully in order to avoid inflammation and chronic pain.

In fact, many diseases of the vagina are caused by poor intimate hygiene and/or the use of products with ungentle and aggressive ingredients, which compromise the bacterial flora.

The use of the most suitable clothing, particularly when it comes to underwear, is also decisive.

Particularly during sporting activities, wearing underwear that is too tight can cause chafing and subsequent inflammation: women who practise sports such as horse riding, spinning and cycling are more at risk.

The material of composition of the garments is also fundamental, for example synthetic fabrics are the most risky in this respect and can promote vulvar pain and the proliferation of bacteria and infections: it is better to prefer cotton undergarments.

Medication for other concomitant conditions can also be a risk factor for vulvar pain.

For example, drugs with cortisone lower the immune defences, leading to increased exposure of the patient to pathogens and subsequent inflammation.

Finally, the application of vaginal creams and lubricants can cause allergic reactions or severe pain and burning.

These products that are for topical use and have to be smeared on the spot can lead to infection, although they may themselves be prescribed to combat burning or intimate itching.

Symptoms of vulvar pain can be different, depending on what the trigger or cause was

Certainly among the most common symptoms are:

severe constant or intermittent pain in the vulva or other areas of the female genital apparatus, which may be spontaneous or caused by contact;
spontaneous or contact-induced vulvar burning, which affects the vestibular area, but in more complex cases may also involve the anus and urethral area;
if the pain also involves the urethra, the burning may increase during urination and a suprapubic weight sensation may be felt;
pain when touching or during attempts at penetration;
swelling;
numbness in the genital area;
pain during sexual intercourse;
painful twinges in the pubis and perineal area;
typical symptoms of urinary tract infections, such as cystitis, but with specific microbiological tests (urine culture) always negative;
difficulty even in walking or sitting.

Moreover, the consequences of this disorder can not infrequently also lead to particularly serious psychological discomfort.

The frustration of not being able to engage in sexual activity with one’s partner can lead, for example, to feelings of severe anxiety and states of depression caused by widespread discomfort in experiencing the relationship with one’s body or partner.

Diagnosis of vuvlvar pain

The first step in diagnosing vulvar pain is certainly to take a thorough anamnesis by contacting one’s general practitioner or gynaecologist, who will listen to and analyse the symptoms, the triggering factors, and the general medical history of the patient affected by the disorder.

The history in the diagnosis of vulvar pain is even more important than the objective test, during which it is possible that no abnormalities are found.

In fact, typical changes in the vulvar area, such as lesions and inflammation, are rarely visible and can help in the diagnosis of this disorder.

However, in selected cases, the patient may undergo tests such as the Q-tip test or the swab test.

These tests are performed by applying light pressure with a Q-tip to the genital area reported to be painful.

The test is positive if the gentle pressure is able to trigger the characteristic pain that the patient reports.

Therapies

Vulvar pain is a complex condition that can be difficult not only to diagnose, but also to treat.

In order to solve the problem as quickly as possible, a relationship of transparency and trust with one’s doctor is essential, so as to overcome the embarrassment that this condition can easily and understandably generate.

Among the most frequently used treatment approaches for vulvar pain are pharmacological therapies, usually based on the use of antidepressants and anticonvulsants.

These drugs are prescribed in different doses depending on the severity of the disorder and the general condition of the patient.

These therapies aim to interrupt the transmission pathways of pain that has become chronic, but also to reduce the excessive sensitivity of peripheral nerve pathways.

In some cases, topically applied anaesthetic drugs are prescribed, e.g. lidocaine.

These remedies for vulvar pain are usually in cream form and are used to reduce pain, even before sexual intercourse.

There are also certain types of physiotherapy exercises specifically for the pelvic muscles, which are recommended if the latter are very tight. Finally, TENS (TransCutaneous Electrical Nerve Stimulation), a type of transcutaneous stimulation using electrodes that are capable of emitting low-frequency pulses, may be recommended.

In addition to these physical remedies, therapeutic courses of treatment with psychologists and psychotherapists may also be recommended, especially in cases where the pain has been caused by a well-known negative past experience for the patient (unfortunately, there are also cases secondary to some kind of violence).

Prevention of vulvar pain

As discussed so far, vulvar pain is characterised by several risk factors that may increase the likelihood of the patient presenting the first symptoms.

In order to prevent vulvar pain, it is therefore possible to adopt some simple measures and behaviours in everyday life.

These include:

avoid very tight-fitting clothing, especially trousers and underwear;
prefer natural materials such as cotton, avoiding synthetics;
do not over-wash the area and eliminate the use of depilatory creams, deodorants and vaginal perfumes that can facilitate inflammation;
use intimate hygiene products that are neutral and free of aggressive substances;
prefer external pads instead of internal ones, opting for washable and cotton solutions;
use lubricants, even natural ones under medical advice, e.g. essential or vegetable oils;
avoid excessive rubbing, hence sports such as spinning.

These attentions do not eliminate the symptoms of vulvar pain, nor are they to be considered a successful treatment for this pathology, but they are undoubtedly simple expedients that are easy to adopt and that can diminish the intensity of the symptoms.

Regular check-ups with your doctor are also recommended.

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