Vaginal Pain Symptoms and Diagnosis

Vulvodynia is persistent, unexplained pain in the vulva, which is the skin surrounding the vagina. There is usually no obvious cause, but much can be done to help relieve the pain so that it no longer causes problems.
The pain of vulvodynia is often described as a burning, stinging or raw sensation. Some women describe the feeling of a needle being stuck in their genitals.

What are vaginal pain and vulvodynia?

Vulvodynia refers to pain in the area of the vulva and vaginal opening. Vulvodynia is considered to be pain for which there is no known cause. It is different from pain that is located deep in the pelvis or internally in the vagina.

This article focuses on pain in the vulvar region and at the opening (introitus) of the vagina.

Vulvodynia can be chronic and can last for years in some women. The degree of severity varies among women. It often occurs in the absence of physical signs or visible abnormalities.

It can be severe and can interfere with sexual activity and cause painful intercourse ( dyspareunia).

Vulvodynia can be:

unprovoked vulvodynia – pain that is in the background constantly or that comes on spontaneously, with no particular trigger
pressure-provoked vulvodynia (also known as vestibulodynia) – pain triggered when the vulva or vestibule (where the vulva meets the vagina) is lightly touched (for example, after inserting a tampon or during sex)
The pain can also be limited to the vulva or part of the vulva (localised).

However, it may also be more widespread (generalised), spreading to the urinary tract, the bottom or the inside of the tops of the thighs.

It can be made worse by activities such as cycling or horse riding, which may put prolonged pressure on the vulva.

What causes vaginal pain and/or vulvodynia?

It is unclear why some women develop vulvodynia. It is not thought to be related to sexually-transmitted diseases (STDs), although some women with vulvodynia have had multiple STDs.

Some theories suggest that vulvodynia may be related to damage or irritation of nerves, abnormal responses to irritation or inflammation, allergic reactions, muscle spasms, a history of sexual abuse, or frequent use of antibiotics.

Familial or genetic factors have also been suggested to play a role in vulvodynia. Unfortunately, the exact cause has not been determined and most women have no known contributing factors.

Possible causes

The cause of vulvodynia is not understood. It’s possible that it is caused by:

  • a nerve problem – irritation or damage of the nerves around the vulva, oversensitive nerve endings in the skin
  • of the vulva, or (less likely) a trapped nerve in the spine
  • previous surgery to the vulva, especially if it resulted in scarring

Vulvodynia is not contagious and has nothing to do with personal hygiene or hygiene products.
Other conditions that may cause vulval pain

Your GP will want to rule out other conditions that can cause vulval pain, such as:

  • persistent vaginal thrush
  • sensitivity to something touching the vulva, such as soap, bubble bath or steroid and antifungal creams (known as irritant contact dermatitis)
  • a drop in the hormone oestrogen, causing dryness of the vulva, especially during the menopause
  • a recurrent herpes simplex infection
  • lichen sclerosus or lichen planus (skin conditions that may cause intense irritation and soreness of the vulva)
  • In rare cases, Behcet’s disease (a disease of the blood vessels that can cause genital ulcers) or Sjogren’s syndrome (a disorder of the immune systemthat can cause vaginal dryness) may be a cause. However, these conditions have often been previously diagnosed.
  • Stress may also be a factor for some people.

Who is affected?

Vulvodynia affects women of all ages, from 20 to 60, but often starts in women younger than 25. It can be very distressing, significantly affecting quality of life.

Women with vulvodynia are usually otherwise healthy, with no history of sexually transmitted infections. However, some women with vulvodynia also have vaginismus, when the muscles around their vagina tighten involuntarily whenever penetration is attempted.

What you should do

If you have vulval pain as described above, see your GP or visit your local genitourinary medicine (GUM) clinic.

Your doctor may touch your vulva lightly with the tip of a cotton bud to see if this causes pain. A diagnosis of vulvodynia is made based on your symptoms.

What symptoms are characteristic of vaginal pain and vulvodynia?

Symptoms of vulvodynia include pain that can be perceived as burning or stinging. The pain may also have an aching or throbbing nature. Sometimes, itching is associated with the pain.

The pain may be constant or it may come and go. It can occur during certain activities including sex or exercise. It may also occur at rest. Some women report pain that is localized to one side or one area of the vulva, while others have more generalized and widespread pain.

There are usually no physical signs or changes that accompany vulvodynia, but sometimes there is evidence of inflamed skin.

What causes vaginal pain and/or vulvodynia?

It is unclear why some women develop vulvodynia. It is not thought to be related to sexually-transmitted diseases (STDs), although some women with vulvodynia have had multiple STDs.

Some theories suggest that vulvodynia may be related to damage or irritation of nerves, abnormal responses to irritation or inflammation, allergic reactions, muscle spasms, a history of sexual abuse, or frequent use of antibiotics. Familial or genetic factors have also been suggested to play a role in vulvodynia.

Unfortunately, the exact cause has not been determined and most women have no known contributing factors.

What symptoms are characteristic of vaginal pain and vulvodynia?

Symptoms of vulvodynia include pain that can be perceived as burning or stinging. The pain may also have an aching or throbbing nature. Sometimes, itching is associated with the pain.

The pain may be constant or it may come and go. It can occur during certain activities including sex or exercise. It may also occur at rest.

Some women report pain that is localized to one side or one area of the vulva, while others have more generalized and widespread pain.

There are usually no physical signs or changes that accompany vulvodynia, but sometimes there is evidence of inflamed skin.

What are risk factors for vaginal pain and vulvodynia?

Since the cause is poorly understood, it is difficult to predict who is at risk for vulvodynia. It can affect women of all ages and races. It can begin as early as adolescence and can occur both before and after menopause.

Managing vulvodynia

A combination of some of the following treatments can help relieve symptoms of vulvodynia and reduce its impact on your life. Discuss these options with your doctor.

Lifestyle tips

The following lifestyle tips may help to prevent symptoms of vulvodynia:

  • Wear 100% cotton underwear and loose-fitting skirts or trousers.
  • Avoid scented hygiene products such as feminine wipes, bubble bath and soap – an emollient is a good substitute for soap, but long-term use of aqueous cream should be avoided.
  • Use petroleum jelly before swimming to provide protection from chlorine.
  • Avoid cycling and any other activities that put prolonged pressure on the vulva.
  • If sexual intercourse is painful, try to find a position that is comfortable (many women find that being on top is the most comfortable position).
  • Try to reduce stress as high levels of stress can increase the pain of vulvodynia – read some relaxation tips to relieve stress.

What diagnostic tests are used to evaluate vaginal pain and vulvodynia?

There are no specific tests that confirm vulvodynia, and the diagnosis is made based upon the characteristic symptoms.

However, since vulvar and vaginal infections (yeast infection, bacterial vaginosis, vaginitis) are sometimes associated with burning and itching, cultures or other diagnostic tests to rule out infections may be ordered.

What diagnostic tests are used to evaluate vaginal pain and vulvodynia?

There are no specific tests that confirm vulvodynia, and the diagnosis is made based upon the characteristic symptoms.

However, since vulvar and vaginal infections (yeast infection, bacterial vaginosis, vaginitis) are sometimes associated with burning and itching, cultures or other diagnostic tests to rule out infections may be ordered.

How are vaginal pain and vulvodynia treated?

Vulvodynia can be managed both by medical treatments and self-care (home remedies). Not all treatments will be effective for every woman, and a woman may have to try different treatments to find the most effective option for her.

Medications and other medical therapies for vaginal pain and vulvodynia

Some of the medications that have been useful include:

  • Topical estrogen creams
  • Topical or local anesthetics
  • Tricyclic antidepressants
  • Anticonvulsants (anti-seizure medications are sometimes useful in managing chronic pain)
  • Other medical therapies for women with severe vulvodynia include injections of interferon or nerve blocks, in which medications are injected to reduce signaling from nerves in the affected area. Biofeedback training and pelvic floor exercises have been helpful for some women.

Finally, surgical removal of affected tissue can be of benefit in women with vulvodynia due to vulvar vestibulitis syndrome, a particular type of vulvodynia that is located at the area of the hymenal ring.

What are the complications of vaginal pain and vulvodynia?

The pain of vulvodynia can be debilitating and interfere with daily activities and sexual intercourse. It can make women feel a loss of control their bodies, causing profound emotional and physical discomfort.

What is the outlook (prognosis) for vaginal pain and vulvodynia?

Vulvodynia is a chronic condition, meaning that it may persist for months to years. In other women it may come and go. While it is not associated with cancer or with any serious medical diseases, it may be a source of chronic pain and emotional discomfort.

Source & More Info: Medicine Net and NHS.uk

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