Vulvar pain

Vulvodynia is pain in the vulva that can't be explained by another health problem, such as an infection or a skin problem. The vulva is the genital area outside the body that surrounds the opening of the vagina and the urethra. It also includes the clitoris and the labia.

Pain is the main symptom of vulvodynia. Depending on the person, the pain may:

• Be felt only in one spot, such as near the opening of the vagina. This is called localized vulvodynia. Or you may feel the pain on or around most of the vulva. This is called generalized vulvodynia.
• Occur only when something touches the area. Or it may happen when nothing touches the area.
• Be constant or come and go for months or even years.
• Be mild or very bad.
• Be felt during and after sex.
• Flare up when you sit on a bicycle, put in a tampon, or wipe your vulva.

Other symptoms may include:

• Burning or stinging.
• Itching.
• Swelling.
• Throbbing.

Your doctor will first ask you about your past health, your sexual history, and your symptoms. Then you will get a pelvic exam to rule out other possible causes for your pain, such as an infection or a skin problem.

During the exam, your doctor may use a cotton swab to touch different areas on and around your vulva to see where the pain is and how bad it is. If your doctor sees a problem or any skin changes, you may need more tests. Your urine, blood, or other fluids may be checked for infection. Or you may need a biopsy. This means that your doctor will remove a small piece of tissue from your vulva and send it to a lab to be studied for the cause of your pain. Your doctor may also recommend an exam called a colposcopy to take a closer look at the cells on your vulva.

If a cause for your pain is not found, you may have vulvodynia.

There are many treatments for vulvodynia, but what works for someone else may not help you. Work with your doctor to find what is best for you. Even though there is no cure, treatment can help you feel better.

Treatment may include:

Medicines.

Medicines that are applied to the skin, such as estrogen cream or lidocaine ointment, may help relieve pain. Other medicines that may be used include antidepressants, seizure medicines, and nerve blocks.

Physical therapy and biofeedback

Specific exercises can help you learn how to control and relax your pelvic muscles. Tightness or spasms in these muscles can make vulvar pain worse.

Cognitive behavioral therapy.

This is a type of counseling that can help you learn to change the way you think about and manage your pain.

Surgery.

In rare cases, surgery is done to remove tissue that is very sensitive.

There are other things you can try to relieve your symptoms:

• Always clean your vulva gently.
• Avoid soaps and other products, such as vaginal sprays or douches, that irritate your skin.
• Wear loose-fitting cotton clothes. Avoid nylon and other fabrics that hold moisture close to the skin. This may cause irritation and allow an infection to start.
• Avoid hot baths, and don't use soaps or bath products to wash your vulva. Rinse with water only, and gently pat the area dry.
• Relieve itching and pain with a cold water compress or a cool bath. Don't scratch the area.
• Try using a vaginal lubricant, such as Astroglide or K-Y Jelly, to reduce irritation from having sex.
• Stay active. But limit exercises that can irritate the vulva, such as bike riding or horseback riding.