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My vulva hurts

Most women will experience vulval discomfort, soreness or pain at some time in their life and it is a very common reason for women to seek medical help. Sometimes, vulval pain may be cause by painful intercourse, however the vulva seems ‘pain prone’ and almost anything can cause the discomfort.

Too often women endure this pain and sexual dysfunction with no definite diagnosis. Management can often be challenging and sometimes require input from a number of clinicians. Because of this, It is important to have some basic knowledge and understanding of vulval pain to appreciate how we approach the management of it.

Vulval pain

As with all pain, vulval pain is divided into acute and chronic pain. Vulval pain that has lasted three months or longer is classified as chronic. Research has shown that 14% of women will experience a chronic vulval pain disorder in their lifetime. Because of this, vulval pain is considered to be quite common. The whole vulva may be affected, or only a part. In addition, many will experience pain during sex.

For most women with acute vulval pain, and some of those with chronic pain, the cause is readily identified and a firm diagnosis is made so thst a treatment may be facilitated. However, some women suffering from chronic vulval pain find it very difficult to get a diagnosis or can be misdiagnosed and thus do not get the correct treatment and support. This pain and discomfort can seriously impact one’s quality of life.

What causes vulval pain?

Vulval pain is caused by a spectrum of diagnoses. Various genitourinary, neuromuscular, gynaecological and gastrointestinal disorders may cause or contribute to vulval pain. Infections and inflammations are frequently the cause of acute pain. Chronic pain is much trickier and it can be difficult to pin point the underlying cause. Sometimes multiple contributing factors may be present in a single patient.

Some of the more common causes are listed below:

  • Genitourinary Infections and Inflammations
  • Musculoskeletal and Neurological Disorders
    • Pelvic floor muscle dysfunction
    • Trauma and injury to bones and muscles e.g. coccyodynia
    • Osteoarthritis/degenerative joint disease
    • Pudendal Neuralgia
  • Gynaecological disease
    • Endometriosis
    • Chronic pelvic pain
  • Urological disease
    • Recurrent cystitis
    • Bladder Pain Syndrome e.g. interstitial cystitis
  • Gastrointestinal disease
    • Irritable Bowel Syndrome
    • Constipation
    • Inflammatory bowel disease, e.g. Crohn’s
  • Vulvodynia – see more below

  • Types of Vulval Pain

    The International Society for the Study of Vulvovaginal Diseases currently recommends the following classification for vulval pain:

    • Vulval pain related to a specific disorder
      • Infections
      • Inflammations
      • Neoplastic
      • Neurological
    • Vulvodynia
      1. Generalised (the whole vulva is affected)
        • a) provoked
        • b) unprovoked
        • c) mixed
      2. Localized (a part of the vulva is affected)
        • a) provoked
        • b) unprovoked
        • c) mixed

FAQs

  • How will the cause of my vulval pain be identified?

    For many patients, especially those with acute pain, a brief assessment will ascertain the cause of their pain. But diagnosis can be difficult and some women with chronic pain and complex issues will require a comprehensive work-up. Research has shown that 60% of women may see three or more doctors before getting an accurate diagnosis. However the most common cause of chronic vulval pain is a condition called vulvodynia.

  • How will my vulval pain be managed?

    The first challenge is to make the correct diagnosis as this will inform the treatment that is right for you. One management strategy will not be appropriate for all women. The level and amount of care will depend on the diagnosis and the needs of each patient.

    Here at The McIndoe Centre, we have put together a group of expert clinicians all with a special interest in pain management which enables us to give you a very high level of care within a multidisciplinary team.

    Chronic vulval pain requires:

    1. More time and effort, need to discuss the mechanisms of chronic pain
    2. Access to an integrated, specialist vulval clinic with a special interest in pain
    3. Pain mapping – site, intensity as defined by the history and examination
    4. A multidisciplinary team management programme

The most common cause of chronic vulval pain is a condition called vulvodynia. Find out more about vulvodynia.