Vulvodynia (vul-vo-DIN-ee-uh) — or chronic vulvar pain — is characterized by pain in the area around the opening of your vagina (vulva). The pain, burning or irritation associated with vulvodynia may make you so uncomfortable that sitting still for long periods or even having sex becomes unthinkable. The condition can go on for months or years. Experts believe vulvodynia is underreported. There are several reasons why. It may be partly due to the absence of visible signs in vulvodynia. Or it could be the reluctance of many women to talk about their symptoms. If you or someone you know is living with vulvodynia, don't hesitate to get help. Treatment options are available to lessen the pain and discomfort of vulvodynia.

Causes of Vulvodynia

Doctors don't know what causes vulvodynia, but contributing factors may include:

• Injury to or irritation of the nerves surrounding your vulvar region
• Past vaginal infections
• Allergies or a localized hypersensitivity of your skin

Many women with vulvodynia have a history of treatment for recurrent vaginitis or vaginal yeast infections. Some women with the condition have a history of sexual abuse. But most women with vulvodynia have no known contributing factors. Vulvodynia isn't sexually transmitted or a sign of cancer.

Signs & Symptoms of Vulvodynia

The word "vulvodynia" means "painful vulva." Your vulva consists of the pad of fatty tissue at the base of your abdomen (mons pubis), the labia, the clitoris and the opening of your vagina.

The main vulvodynia symptom is pain in your genital area, which can be characterized by:

• Burning
• Soreness
• Itching
• Stinging
• Rawness
• Painful intercourse (dyspareunia)
• Throbbing

The pain you experience may be constant or intermittent and can last for months or even years, but it can vanish as suddenly as it started. A similar condition, vulvar vestibulitis, may cause pain only when pressure is applied to the area surrounding the entrance to your vagina. Vulvar tissue may look minimally inflamed or swollen. More often, your vulva appears normal.

Diagnosis of Vulvodynia

Before diagnosing vulvodynia, your doctor will ask you several questions to get a better idea of your medical history and to understand the location, nature and extent of your symptoms.

As part of his or her evaluation, your doctor may also perform these tests:

• Pelvic exam. During this exam, your doctor visually examines your external genitals and vagina for signs of infection or some other cause of your vulvodynia symptoms. Even if there's no visual evidence of infection, your doctor may take a sample of cells from your vagina to test for a vaginal infection, such as a yeast infection or bacterial vaginosis.
• Cotton swab test. During this test, your doctor uses a moistened cotton swab to gently and methodically check for specific, localized areas of pain in your vulvar region.

Treatments of Vulvodynia

Vulvodynia treatments focus on relieving symptoms. No one treatment works for every woman, and you may find that a combination of treatments works best for you. It may take weeks or even months for a new treatment regimen to noticeably improve your symptoms. Available options may include:

• Medications. Tricyclic antidepressants that may help lessen chronic pain include amitriptyline, desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). Anticonvulsants such as carbamazepine (Tegretol) and gabapentin (Neurontin) also may lessen the pain of vulvodynia. Antihistamines such as hydroxyzine can reduce itching.
• Biofeedback therapy. This therapy can help reduce pain by teaching you how to control specific body responses. The goal of biofeedback is to help you enter a relaxed state in order to decrease pain sensation. To cope with vulvodynia, biofeedback can teach you to relax your pelvic muscles, which can contract in anticipation of pain and actually cause chronic pain.
• Local anesthetics. Medications such as lidocaine ointment can provide temporary symptom relief. Your doctor may recommend applying lidocaine 30 minutes before sexual intercourse to reduce your discomfort. Your partner may also experience temporary numbness after sexual contact.
• Surgery. In cases where painful areas can be specifically pinpointed at the hymeneal ring (localized vulvodynia, vulvar vestibulitis), surgery to remove the affected skin and tissue (vestibulectomy) relieves pain in some women.

When to seek Medical Advice

• Although women often don't tell their doctors about the problem, vulvodynia is a fairly common condition.
• If you experience pain in your genital area, discuss it with your doctor, or ask for a referral to a gynecologist. It's important to have your doctor rule out more easily treatable causes of vulvar pain, such as yeast or bacterial infections, skin conditions, and medical problems such as diabetes. Once your doctor has evaluated your particular symptoms, he or she can recommend treatments or ways to help you manage your pain.