What Is Vulvodynia?Chronic Vulvar Pain With No Clear Cause

It burns. Not always, and not in a way that matches anything. You’ve been treated for yeast, twice. The swab was negative. You’ve changed your soap, your underwear, your detergent. Sitting through a movie hurts. Tampons are out. Sex is out. And every clinician has said the same sentence: “everything looks normal.”

What it feels like

The NICHD¹ describes burning, stinging, irritation or rawness in the external genitals. The National Vulvodynia Association (NVA)² says burning is the most frequently reported symptom, and that descriptions vary widely, from acid poured on the skin to constant knife-like pain. Pain location, intensity and duration differ from person to person.

The types

The NICHD¹ says it can be generalized, affecting the whole vulvar area, or localized to one spot, and that it can be provoked by activities such as intercourse, tampons or tight clothing, or spontaneous. Provoked vestibulodynia is pain in the vaginal entry area.

The NVA² says localized vulvodynia often affects the vestibule, the tissue around the vaginal opening, while generalized vulvodynia is relatively constant. It calls provoked vestibulodynia the most common form, with pain triggered by pressure during sex, tampon insertion or prolonged sitting.

What causes it

The NICHD¹ says the cause remains unknown, which is what separates it from conditions with an identifiable origin. That’s why clinicians first rule out other causes. See vulvar itching, yeast infections, vaginal dryness and genitourinary syndrome of menopause.

How it’s checked

American Family Physician³ lists vulvodynia among the causes of entry pain with sex, along with dryness, pelvic floor dysfunction, vaginismus and vaginitis. See painful sex. It says the exam includes inspecting the external genitalia and touching with a cotton swab to find focal tenderness, and that clinicians should create a safe and welcoming environment where you can talk about sex.

What helps

American Family Physician³ describes a multidisciplinary plan for vulvodynia that can include topical lidocaine, oral medicines such as amitriptyline and gabapentin, cognitive behavioral therapy, pelvic floor physical therapy and, for cases that don’t respond, surgical removal of the painful area. It describes the plan as multi-part rather than a single fix.

Pelvic floor muscles are often part of the picture. See pelvic floor dysfunction and tight pelvic floor.

The play

Try this: a pain map and trigger log

For two weeks, write down where the pain is, using words: burning, stinging, raw, sharp. Note what sets it off, what eases it, and how long it lasts.

Note what you wear, what products touch the area, and when it’s worst: sitting, after sex, with tampons, at night.

List what you’ve already tried and what you were told. Bring it to a clinician who treats vulvar pain, and ask whether they offer pelvic floor physical therapy or can refer you.

When to get checked

Book an appointment if any of these fit:

• Vulvar burning, stinging or rawness has lasted more than a few weeks
• You’ve been treated for yeast infections that didn’t help
• Tampons, sex, sitting or tight clothing cause pain
• Tests and exams were normal and you still hurt
• Pain is affecting your sleep, work or relationships
• You’ve stopped looking for an answer

If you’ve been told nothing is wrong, chronic pain without a visible cause is still a recognized diagnosis, and it can be treated.