Vulvodynia

Vulvodynia is pain in the vulva lasting for several months or longer, often without an obvious infection, skin change or injury. The discomfort may be burning, stinging, rawness, throbbing or soreness. It can be present all the time or brought on by touch, sitting, clothing, inserting a tampon or sexual activity. Symptoms are real even when the skin looks normal.

Vulval pain is a very common presentation of vulvodynia. Pain during sex is also a common presentation, although vulvodynia can affect people who are not sexually active. Some people feel symptoms at the entrance to the vagina, while others feel them across a wider area. Itching, irritation and pelvic-floor tightness may occur alongside pain, but they can also point to another condition that needs assessment.

There is no single cause in every person. Nerves that carry sensation from the vulva may become unusually sensitive, and the pelvic-floor muscles may tighten in response to pain. Previous irritation, repeated thrush-like symptoms, hormonal changes, skin conditions or an injury may contribute in some cases. A clinician may also check for infection, dermatitis, nerve pain and other explanations before diagnosing vulvodynia.

Symptoms can fluctuate, with quieter periods and flares after friction, pressure, stress or hormonal shifts. The pain may stay localised or spread over time. Improvement often involves several measures and can take time; progress is usually judged by comfort, function and fewer flares rather than by one examination finding.

Vulvodynia can affect people of any age and does not require a particular sexual or reproductive history. Factors that may be relevant include recurrent vulval irritation, pelvic-floor muscle overactivity, painful periods, bladder or bowel pain, prior procedures, and other persistent pain conditions. These associations do not establish the cause for an individual.

Diagnosis is based on your history and an examination, while excluding other causes of vulval pain. The clinician may gently examine the vulval skin and use light touch in different areas to map tenderness. Tests for infection or skin conditions may be offered when the symptoms or examination suggest them. Tell the clinician if an examination is painful so it can be paused, explained or adapted.

Treatment is tailored to the pain pattern and may combine education, gentle skin care, pain medicines, topical treatment, pelvic-floor rehabilitation and psychological support for coping with persistent pain. Pelvic floor physiotherapy can address muscle guarding, movement and relaxation. Vaginal dilator therapy may be considered when gradual, controlled insertion is part of the treatment goal. These approaches should be guided by a clinician familiar with vulval pain.

Loose, breathable clothing and unscented products may reduce irritation. Notice patterns in sitting, exercise, touch and products without blaming yourself for flares. Use agreed pacing and relaxation exercises, and discuss ways to maintain intimacy that do not increase pain.

Persistent pain can interfere with sleep, sitting, movement, intimacy, mood and concentration. Avoiding activities because of anticipated pain can add muscle tension and reduce confidence. Support for pain, relationships and emotional wellbeing is part of appropriate care.

Because its cause is not always known, prevention is not guaranteed. Avoiding harsh or fragranced products, treating confirmed infections, reducing friction and seeking help for ongoing pain may limit irritation and prevent symptoms from becoming harder to manage.

A gynaecologist, vulval skin specialist, pelvic-floor physiotherapist or pain clinician may contribute to care. Choose someone who can examine gently, explain alternatives and coordinate treatment when symptoms involve skin, muscles, nerves or sexual wellbeing.