Vulvodynia

Vulvodynia is chronic pain or discomfort in the vulva (the external female genital area) that lasts for at least 3 months, with no clear cause (e.g., infection, injury, or skin disorder). It is a real and treatable condition that affects daily life, intimacy, and emotional well-being.

Common symptoms

• Burning, stinging, or rawness in the vulva.
• Sharp, throbbing, or aching pain.
• Pain triggered by touch (e.g., tampons, tight clothing, or intercourse).
• Discomfort while sitting, exercising, or during daily activities.

Possible causes

• Nerve hypersensitivity: Overactive nerves in the vulval area.
• Pelvic floor dysfunction: Tight or spasming pelvic muscles.
• Hormonal changes: Low oestrogen (e.g., menopause).
• Genetic predisposition: Family history of chronic pain conditions.
• Past trauma: Surgery, childbirth, or recurrent infections.

Diagnosis

• Rule out other conditions: Tests for infections (yeast, BV), skin disorders (lichen sclerosus), or allergies.
• Physical exam: Gentle touch with a cotton swab to map pain areas (“Q-tip test”).
• Pelvic floor assessment: Check for muscle tightness or tenderness.

Treatment options

Medical treatments

• Topical therapies:
  • Lidocaine gel (numbing cream) for temporary relief.
  • Oestrogen cream (for hormonal-related pain).
• Oral medications:
  • Antidepressants (e.g., amitriptyline) or anticonvulsants (e.g., gabapentin) to calm nerve pain.
• Pelvic floor physical therapy: Stretching and massage to relax tight muscles.
• Nerve blocks or Botox injections: For severe, localised pain.