Medicines for Vulvodynia

What it is

Vulvodynia is persistent or recurrent pain, soreness, or discomfort of the vulva — the external female genital area around the opening of the vagina — that does not have an identifiable underlying cause (such as an infection or a skin condition). It is a real and recognised condition, and, importantly, the pain is genuine, even though examination and tests do not find a specific cause; it is thought to involve the nerves in the area becoming oversensitive or the pain signals being altered. Vulvodynia is more common than often realised, but it is often not talked about, and women may suffer for a long time before seeking help or getting a diagnosis. The pain of vulvodynia can be described in various ways — such as burning, stinging, soreness, rawness, throbbing, or aching — and can be constant, or come and go. It may be felt across the whole vulva (generalised) or in a specific area, such as at the entrance to the vagina (localised, for example provoked vestibulodynia, where pain is triggered by pressure or touch to that area). The pain may be present much of the time, or it may be provoked by touch or pressure — such as during or after sex, when inserting a tampon, when sitting for long periods, or with tight clothing. Vulvodynia can significantly affect a woman’s life — including sex and relationships, physical activity and sitting, and emotional wellbeing — and can be distressing, particularly as it can be persistent and, without a diagnosis, confusing. It is important to understand that vulvodynia is a genuine condition, that the woman is not imagining the pain, and that help is available. Because vulval pain can also be caused by other conditions (such as infections like thrush, skin conditions, or other causes), assessment is important to look for and treat any identifiable cause, and vulvodynia is generally diagnosed when persistent vulval pain is present without such a cause being found. There is no single cure, but a range of treatments and measures can help manage the pain and improve quality of life — including self-care and vulval care measures, nerve pain medicines, physiotherapy (particularly pelvic floor physiotherapy), psychological support, and other treatments — and specialist and multidisciplinary support helps. The key messages are that vulvodynia is persistent, unexplained pain of the vulva that is a real and treatable condition, and that a range of measures and specialist support help.

How it is treated

Vulvodynia is managed with a range of measures to reduce the pain and improve quality of life — including vulval care, nerve pain medicines, physiotherapy, and psychological support — often with specialist and multidisciplinary input, once other causes have been excluded; there is no single cure, but it can be managed, and taking the pain seriously is important. Because vulval pain can be caused by other conditions (such as thrush or other infections, skin conditions like lichen sclerosus, or other causes), assessment is important to look for and treat any identifiable cause — this involves a sensitive history and examination, and, where relevant, tests (such as swabs), so that treatable causes are addressed; vulvodynia is diagnosed when persistent vulval pain is present without such a cause being found. A crucial foundation is that the pain is genuine and the woman should be taken seriously and reassured that vulvodynia is a real, recognised condition — this understanding is itself helpful, given how confusing and distressing unexplained pain can be. Management is usually a combination of approaches, tailored to the individual, and may include: self-care and vulval care measures — such as avoiding irritants (like perfumed soaps, bubble baths, and washing products, and washing gently with plain water or an emollient), wearing loose cotton underwear, using emollients or barrier preparations to soothe and protect the skin, and, where relevant, measures around sex (such as lubricants, and pacing); nerve pain medicines — because vulvodynia involves altered pain signalling, medicines used for nerve pain (rather than ordinary painkillers) may be prescribed to help control the pain, and treatments applied to the area (such as certain numbing or other topical treatments) can help some women; physiotherapy — particularly specialist pelvic floor physiotherapy, which can help address muscle tension and other factors and is an important part of care for many women; and psychological support — as living with chronic pain, and its effects on sex, relationships, and wellbeing, can be distressing, psychological approaches (such as certain therapies) and support can help with coping and with the impact, and, for provoked pain affecting sex, specific approaches and, where relevant, psychosexual support can help. Other treatments may be considered for particular situations, guided by specialists. Because vulvodynia can be persistent and multifactorial, a multidisciplinary approach — often involving gynaecology or specialist vulval clinics, pain specialists, physiotherapists, and psychological support — helps, particularly for difficult cases, and support for the impact on the woman’s life and relationships is important. Support organisations (such as those for vulval pain) provide information, support, and community. The reassuring messages are that vulvodynia is a real, recognised condition (the pain is genuine), that it is treatable — with a range of measures including vulval care, nerve pain medicines, physiotherapy, and psychological support — and that specialist and multidisciplinary care and support help; so being taken seriously, assessment to exclude other causes, and a tailored combination of treatments and support are the keys to managing vulvodynia.