Vulvodynia is persistent, unexplained pain in the vulva. The vulva is the female genital area including the skin surrounding the opening of the vagina.
It can happen to women of all ages.
Vulvodynia can become a long-term problem that's very distressing to live with, but much can be done to help relieve the pain.
The main symptom is persistent pain in and around the vulva and vagina. The vulva usually looks normal.
The pain may be:
Some women also have problems such as vaginismus (where the muscles around the vagina tighten involuntarily), interstitial cystitis (a painful bladder condition), painful periods and irritable bowel syndrome (IBS).
Having persistent vulval pain can affect relationships, reduce sex drive, and cause low mood and depression.
Pain in the genital area is often embarrassing to talk about and can make you feel isolated.
See a GP or visit your local sexual health clinic if you have persistent vulval pain.
Vulvodynia is unlikely to get better on its own and some of the treatments are only available on prescription.
There are also some other causes of vulval pain that need to be ruled out.
Your doctor will ask about your symptoms and may touch your vulva lightly with the tip of a cotton bud to see if this causes pain.
A swab may also be taken to check for health problems such as infections.
Women with vulval pain can often have it for many years before they get a diagnosis and treatment.
Ask a GP for a referral to a specialist vulval clinic if the pain persists.
Lifestyle changes may help reduce symptoms:
A combination of treatments can often help relieve the symptoms of vulvodynia and reduce its impact on your life.
Apply an anaesthetic gel, such as lidocaine, up to 20 minutes before sex. This may make sex more comfortable.
To stop the gel getting on your partner, either wipe it off just before having sex or ask your partner to wear a condom (if using condoms, use latex-free ones as latex condoms can be damaged by lidocaine).
If your pain is more constant, apply lidocaine regularly throughout the day. You can also use it overnight.
You can buy tubes of 5% lidocaine gel, cream or ointment over the counter from a pharmacy, although it's a good idea to get a doctor's advice before trying it.
Read the instructions carefully before you use it.
Vaginal lubricants and aqueous cream (also available over the counter from pharmacies and supermarkets) may soothe the area and help moisturise the vulva if it's dry.
Speak to a pharmacist about these treatments.
Conventional painkillers like paracetamol will not usually relieve the pain of vulvodynia.
But several prescription medicines may help, including:
Your doctor will probably start you on a low dose and gradually increase it until your pain subsides.
You may need to take the medicine for several months.
If you have pain in a specific area of your vulva, injections of local anaesthetic and steroids into a nearby nerve may provide temporary pain relief.
A physiotherapist can teach you some pelvic floor exercises (such as squeezing and releasing your pelvic floor muscles) to help relax the muscles around your vagina.
Another technique to relax the muscles in the vagina and desensitise it involves using vaginal trainers.
These are smooth cones of gradually increasing size and length that can be inserted into your vagina in the privacy of your own home.
Some physiotherapists may also suggest trying TENS (transcutaneous electrical nerve stimulation) to reduce your pain.
This is where a machine is used to deliver a mild electrical current to the painful area.
Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.
It can often help women cope with the impact that vulvodynia has on their life.
CBT focuses on the problems and difficulties you have, and looks for practical ways you can improve your state of mind on a daily basis.
Psychosexual counselling is helpful when pain is affecting intimacy between you and your partner.
This is a type of therapy that aims to address problems such as fear and anxiety about sex, and restore a physical relationship with your partner.
Surgery to remove part of the vulva is done in very rare cases.
But the pain can come back and it's usually not recommended.
Vulvodynia may be caused by a problem with the nerves supplying the vulva.
This nerve damage could be caused by:
Vulvodynia is not contagious. It has nothing to do with personal hygiene and is not a sign of cancer.
Sometimes the exact cause of vulvodynia is never found.
Pain in the vulva is not always vulvodynia.
It can have a number of other causes, such as:
Your doctor may want to rule out these conditions before treating you for vulvodynia.
Some women can have a combination of problems, such as recurrent thrush and vulvodynia.
Both of these need proper treatment to reduce pain.
Living with a long-term painful condition like vulvodynia can be frustrating and stressful.
You may find it useful to contact a support group for more information and advice, or to get in touch with other women who have vulvodynia.
The 2 main support groups are: