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The most common cause of chronic vulval pain is a condition called vulvodynia. Localized, provoked vulvodynia of the inner vulva (vestibulodynia), is the most common cause of painful sex in young women.

What is vulvodynia?

Vulvodynia is a pain syndrome characterised by ‘vulval discomfort, most often described as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurologic disorder’. In other words – the vulva looks normal.

In the past, vulvodynia has been known by a number of different names which caused confusion.

Studies have also noted an increase in anxiety, stress, and depression among women who have vulvodynia.

How is vulvodynia diagnosed?

The diagnosis is one of exclusion and the challenge is to eliminate a recognisable cause (of which there are many) for your pain, before deciding that the diagnosis of vulvodynia is appropriate. Infections and skin inflammations are frequent causes of vulval pain. In some cases the diagnosis of vulvodynia is not even considered, while in others it is misdiagnosed. It is vital to take a detailed history and do a careful examination. Investigations often include swabs for infection and a biopsy to examine the tissue microscopically.

Vulvodynia and co-morbidities

Women with vulvodynia often have other chronic pain syndromes and medical problems. These include; a history of headache, irritable bowel syndrome, bladder pain syndrome, fibromyalgia, chronic fatigue syndrome, back pain, and temporomandibular joint disorder. These co-morbidities are not particularly helpful in establishing the diagnosis of vulvodynia, but they are an important consideration when choosing therapy.

A majority of women will also have pelvic floor muscle malfunction and this may contribute a significant amount to the overall pain level. Abnormalities commonly identified include muscle spasm, poor contraction/relaxation and trigger points (hard tender spots in the muscles).

It is important to be assessed by a physiotherapist who is familiar with vulval pain syndromes.

Studies have also noted an increase in anxiety, stress, and depression among women who have vulvodynia.

How is vulvodynia managed?

Once the diagnosis of vulvodynia has been made, the challenge shifts to finding an effective treatment. However, this is not a quick fix, and often takes time. Simple measures include avoiding irritants and using emollients and moisturizers. Adequate lubrication at intercourse should be used. There are a number of drug treatments available and these include topical agents as well as oral ones. Both tricyclic and anticonvulsant medications are commonly used. Non-drug interventions include nerve blocks and pulsed radiofrequency of the pudendal nerves.

Physiotherapy can be very successful if there are pelvic floor muscle abnormalities. There are a number of good studies showing benefit from psychological input namely cognitive behavioural therapy and mindfulness based programmes. Surgery is an option in a small proportion of cases but needs very careful assessment.

Most patients will need to trial a number of treatment options to find the one that works best for them. Our dedicated, multidisciplinary team has expertise within in all relevant areas, and is committed to providing you with the highest quality of care.