Vulval discomfort or pain occurs in the vulva, one of the most sensitive parts of the body. The sensation felt in this region differs from woman to woman, and can include itching, burning, inflammation. Vestibulodynia (previously known as Vulval Vestibulitis) specifically affects the vestibule, the area inside the inner lips of the vulva where the vagina is found. This region contains the Bartholin’s gland which produces vaginal lubrication, the urethra where you pass urine, and some small minor vestibule glands producing vaginal discharge. It is characterised by pain felt whenever pressure is applied to the vestibular region. It is thus a localised form of vulvodynia, chronic pain in the vulva area.
The symptoms of Vestibulodynia typically last from three to six months but women can suffer from the condition for years. This hyper-sensitivity can make tasks such as sexual intercourse, insertion of a tampon or even movement in tight clothing a painful and uncomfortable task. Even sitting down for long periods of time or walking can become daunting tasks to the sufferer, so it really does have a great impact on everyday life.
It usually affects women aged 20 to 40 who are sexually active but younger and older women may also be affected. The primary form of the condition is found in someone who, for example, experiences pain in their first attempt at sexual activity whereas the secondary form of the condition develops after a continued period of comfortable sexual relations.
Vestibulodynia occurs when there is an overgrowth of nerve fibres in the vestibule area of the vulva, or when the existing nerve fibres are extremely sensitive. Some women with tendencies of pain problems may be more likely to experience this condition. Chronic yeast infections such as thrush are thought to exacerbate the problem, including injury to the vulva area through childbirth or surgery for instance, or sensitivity to irritants such as detergents or panty liners.
Symptoms may develop slowly and gradually or may be initiated by a significant event such as having birth, moving house or sexual trauma causing undue stress to the individual, emotionally and physically. Although Vestibulodynia is a very real condition, patients may be reluctant to believe that their pain may be partly rooted in psychological issues when it feels real enough to them. However, looking at all the possible triggers may make it easier for patients to deal with and even diminish the amount of pain they experience.
When presented with vulval tenderness, a doctor will examine the area and try to rule out other infections or vulval conditions that may have arisen. You could be referred to a specialist such as a gynaecologist or a dermatologist who may apply pressure to the vestibule region to try and pinpoint the location of the pain. The tender areas may be red but often there are no visible symptoms, which is why Vestibulodynia is often misdiagnosed as thrush, for instance – this can ultimately be ruled out by a vaginal swab. Skin infections would cause the vulva to look abnormal as well as feel tender, and no change would be felt if treatment was used.
Different doctors treat the condition in various ways but listed below are a selection of suggested treatments:
- Use of vaginal dilators that can be inserted to relax the muscles around the vagina.
- Use of anaesthetic gel such as lidocaine, which can numb the nerves prior to sexual intercourse.
- Pelvic floor muscle physiotherapy, which can help to relax the vulval region. Fear of being hurt can lead to muscular spasms, thus increasing pain in the vagina, known as vaginismus.
- Prescription of antidepressant drugs, such as Amitriptyline; this particular oral medication is now used to treat a number of pain problems.
- Prescription of corticosteroids
- Surgery is rarely carried out for this condition, but is effective in select patients.
Vestibulodynia can often have negative affects on one’s sex life which is why your physician may suggest psychosexual counselling. Many women have found it useful to explore non-penetrative sexual activity to encourage confidence and intimacy around their partner.
As Vestibulodynia is such a difficult condition to diagnose, there is no single way of treating it. The effectiveness of treatments will vary from woman to woman. It is a case of testing to see which methods suit your needs the best.
Vulval Pain Society
Vulval Health Awareness Campaign
[accessed July 2007]:
Vulval Pain Society: Vestibulodynia
This factsheet has been produced by Women’s Health Concern and reviewed by members of our Medical Advisory Panel. It is for your information and advice and should be used in consultation with your own medical practitioner.
Updated: March 2010
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