Vulvodynia

Overview

Vulvodynia (vul-vo-DIN-ee-uh) is long-lasting pain in the vulva — the outer part of the female genitals — with no clear cause. The pain may come and go or be constant, and it can make sitting, exercising, or having sex painful.

Vulvodynia is more common than many people realize. It affects about 1 in 6 women at some point in their lives, though many do not talk about it with their doctor.

Vulvodynia can affect anyone with a vulva, at any age. It is most often diagnosed in women between 18 and 50, but it can also occur in teenagers, older adults, and people who have never had sex.

Symptoms

Common symptoms

• Burning, stinging, or aching pain in the vulvar area
• Pain that feels raw or like a sunburn
• Throbbing, stabbing, or sharp pain
• Itching or a feeling of swelling
• Pain that occurs only when touched (provoked) or all the time (unprovoked)
• Pain during sex, inserting tampons, or wearing tight pants
• Pain that worsens when sitting or exercising

Symptoms in children

• In children, symptoms may include pain when urinating, difficulty sitting still, or avoiding activities like bike riding. Girls may also complain of itching or burning in the vulvar area.

Symptoms in older adults

• In older adults, vulvodynia may be mistaken for other common issues like vaginal dryness or urinary tract infections. Symptoms can include persistent burning or discomfort, especially after menopause.

Causes

Main causes

• The exact cause is unknown, but it is thought to be related to nerve damage or irritation, an imbalance in pain signals, or changes in hormone levels.
• Sometimes it starts after an infection, surgery, or injury to the vulva, but often there is no clear trigger.

Risk factors

• Having had repeated yeast infections or urinary tract infections
• Using certain medications or creams on the vulva for a long time
• Having a history of irritable bowel syndrome or fibromyalgia
• Past trauma or abuse (emotional or physical)
• Hormonal changes, such as during menopause or after childbirth

When to see a doctor

See a doctor urgently if:

• If you have severe pain that comes on suddenly
• If you also have a fever, chills, or pus-like discharge
• If you cannot urinate or have blood in your urine

Book a routine appointment if:

• If you have vulvar pain that lasts more than 3 months
• If the pain affects your daily life, sex, or ability to sit
• If you have not had a check-up in a while and want to rule out other causes

Diagnosis

A doctor or gynecologist will ask about your symptoms, medical history, and do a gentle physical exam. They may also do a 'cotton-swab test' — lightly touching different parts of the vulva with a cotton swab to find where it hurts. There is no single test for vulvodynia. Diagnosis is made after ruling out other conditions.

Tests that may be done

• A pelvic exam to check for infections or skin problems
• Swabs of the vulva or vagina to test for yeast or bacteria
• A urine test to rule out a urinary tract infection
• Sometimes a biopsy (taking a tiny piece of skin) if a skin condition is suspected

What to expect at your appointment

The doctor will listen to you and try to understand your pain. You may be asked to keep a diary of when the pain happens and what makes it better or worse. The process may take a few visits, but be patient — getting the right diagnosis is important.

Treatment

Treatment for vulvodynia focuses on relieving pain and making daily life more comfortable. Since the cause is unclear, treatment is often tried step by step. What works for one person may not work for another, so it can take time to find the best approach.

Self-care at home

• Use a cold pack (wrapped in a towel) on the vulva for 10-15 minutes to soothe burning.
• Wear loose-fitting cotton underwear and avoid tight pants.
• Use unscented, mild soap and avoid bubble baths, feminine sprays, or other irritants.
• Apply a plain, unmedicated moisturizer (like petroleum jelly) to protect the skin.
• Try sitting on a cushion or a 'doughnut' pillow to reduce pressure.
• Use a lubricant (water-based, without added flavors or colors) during sex.
• Practice relaxation techniques, such as deep breathing, to help manage pain.

Medical treatments

Doctors may recommend topical creams or ointments that numb the area (such as lidocaine) — but only under the guidance of a healthcare provider. Oral medications that affect nerve pain, such as certain antidepressants or anti-seizure medicines, may be prescribed. Pelvic floor physical therapy, biofeedback, or nerve blocks can also help. Always discuss risks and benefits with your doctor. Medications mentioned are examples of classes, not specific brands.

When is surgery considered?

Surgery is rarely used for vulvodynia. In a very small number of cases, a procedure called vestibulectomy (removing the painful tissue at the entrance of the vagina) may be considered if other treatments have not helped. This is only done after careful evaluation by a specialist.

Living with this condition

Living with vulvodynia can be challenging, but many people find ways to manage the pain and continue their normal activities. It may help to plan your day around pain flares — for example, take breaks from sitting, and choose softer fabrics for clothing.

Lifestyle tips

• Avoid tight pants, thongs, or synthetic underwear.
• Use unscented laundry detergent and avoid fabric softeners.
• Stay cool — heat can worsen pain for some.
• Rinse the vulva with plain water after urinating and pat dry.
• Talk openly with your partner about your pain and find other ways to be intimate if sex is painful.

Diet and exercise

Some people find that certain foods (like caffeine, spicy foods, or acidic fruits) can trigger pain. You might try an elimination diet — cutting out these foods for a few weeks and adding them back one by one to see if it helps. Low-impact exercise like walking, swimming, or yoga can improve blood flow and reduce stress. Avoid activities that put direct pressure on the vulva, like bike riding.

Mental health and emotional wellbeing

Chronic pain can be mentally and emotionally draining. You may feel frustrated, sad, anxious, or embarrassed. It is normal to feel this way. Talking to a therapist who understands pain can be very helpful. Remember — the pain is real, and it is not your fault.

Prevention

There is no known way to prevent vulvodynia. However, avoiding known irritants (like scented products and douches) and treating infections early may reduce the risk of developing chronic pain.

Vaccines

No vaccine prevents vulvodynia.

Screening programmes

There is no routine screening test for vulvodynia. If you have vulvar pain, see a doctor for a proper evaluation.

Complications

If left untreated

• Chronic pain that can interfere with daily activities, work, and relationships
• Difficulties with sexual intimacy and low sexual satisfaction
• Increased anxiety, depression, or stress related to ongoing pain
• Social withdrawal or avoiding activities like exercise or social events

Long-term outlook

With the right support and treatment, most people with vulvodynia can find relief and lead a full life. It may take time, and you might need to try several approaches. But many people do get better. Stay hopeful and keep working with your healthcare team.

Find support

International organisations

• National Vulvodynia Association (NVA)
• The International Society for the Study of Vulvovaginal Disease (ISSVD)

Local organisations

• The Vulval Pain Society (UK) · United Kingdom

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