Painful vulva

Painful vulva

Any of the causes of vulval itching may cause actual pain if they are severe; trichomoniasis, for example, can make the vulva very sore. But if what you are feeling is rawness and burning, not itching, there are three main possibilities: genital herpes, ‘vulvodynia’ or ‘vulval vestibulitis syndrome’. If your main problem is pain on intercourse, look at the section on painful sex.

Genital herpes
Genital herpes results from infection with the herpes simplex virus. Small blisters form on the genital area and these burst to form small ulcers that take about 10 days to heal. If you have not had herpes before and this is your first episode, it can be quite severe. Your vulva may be very sore, especially when you pass urine, like very bad cystitis. The lymph glands in your groin will probably be swollen, and you may have flu-like symptoms (tiredness, aching muscles, fever), and feel very miserable and tearful. You may feel angry with your partner for giving you this infection, but it is unlikely that he knew he had it. And you should not feel bad about having it yourself – research has shown that about half the population has been exposed to the virus, but usually it is passed on without causing any symptoms. You were just unlucky to have the pain and discomfort.

If you think that you have herpes, take a look at the section on herpes to find out what you should do.

Vulvodynia
Vulvodynia is a very unpleasant burning or aching feeling. The sensation is unremitting and is often worse at night. It is more common in older women. It is diagnosed only when other causes of pain, such as a skin disease, have been ruled out. The vulva looks perfectly normal, but the pain is real.

What can be done about vulvodynia? First, look at the Common-sense dos and don’ts for vulval problems.

Try applying some ice – some women find this is the best way of relieving the pain.
Aloe vera gel, Calendula and Dr Bach Rescue Cream are remedies for sore and painful skin. You can buy them from health food stores. Try each separately. You may also be able to soothe the area by applying vitamin E oil (which you can squeeze out from capsules of vitamin E).
Aqueous cream is a plain, soothing, perfume-free cream that you can buy from pharmacies. Many women with vulvodynia find that aqueous cream helps by soothing and rehydrating the skin. Use it cold, by storing it in the fridge. Unlike steroid creams, you can use it as often and for as long as you like.
Aveeno (oatmeal) baths are a useful treatment for severe attacks of pain. You can buy the sachets from health shops. Put a sachet in the bath and bathe for 20 minutes. Repeat up to four times.
Talk to your family doctor, because tricyclic antidepressant medication often helps. This is not because you are depressed (or imagining the condition), but because these drugs suppress transmission in nerves of the skin. Another medication, gabapentin, is sometimes used ( Lancet 2004;363:1058 –60).
Your local hospital may have a ‘vulval clinic’ that your family doctor could refer you to. Vulval clinics are usually part of the hospital dermatology department, and doctors at these clinics are experts in painful vulvas.
Other organizations that can offer further information and support are listed in the Useful contacts.

The good news is that many women with vulvodynia eventually become pain-free, and are able to stop their medication.

Vulval vestibulitis syndrome
With vulval vestibulitis syndrome, you experience severe pain when the opening of the vagina (the ‘vestibule’) is touched. The syndrome usually comes on quite suddenly, and is most common in women in their 20s or 30s. It is very distressing because, as well having to cope with the pain, your sex life is probably zero and it can even prevent you using tampons, wearing jeans or riding a bike. It may affect 1 in 20 women at some time ( British Medical Journal 2004;328:1214 –5).The cause of vulvar vestibulitis is not known. Some experts think the nerves of the genital skin become oversensitive. Research from Sweden ( British Journal of Obstetrics and Gynaecology 2001;108:456 –61) suggests that women with vulvar vestibulitis tend to be oversensitive and worry about things that may never happen. So perhaps your brain is over-alert to signals from the nerves of the vulval skin.

What can be done about vulval vestibulitis syndrome? First, look at the Common-sense dos and don’ts 'for vulval problems.

Do not feel too discouraged, because the problem often improves with time.
Teabags (Indian tea) or Earl Grey contain tannic acid, which is a local anaesthetic and can calm the burning sensation of vulval vestibulitis. Put teabags in the bath, or put a cold, damp teabag on the sore area at night.
You may be able to soothe the area by applying vitamin E oil (which you can squeeze out from capsules of vitamin E).
Aqueous cream is a plain, soothing, perfume-free cream that you can buy from pharmacies. Many women with vulval vestibulitis find that aqueous cream helps by soothing and rehydrating the skin. Use it cold, by storing it in the fridge. Unlike steroid creams, you can use it as often and for as long as you like.
5% lignocaine ointment contains a weak amount of the local anaesthetic lignocaine. It numbs the nerves in the skin and can be used safely on a regular basis. Although it does not cure the problem, it will allow you to have sexual intercourse comfortably if you apply it 15 minutes beforehand.
You could try a diet that is low in oxalate, a plant chemical. The evidence that this works is scanty, but some women find it helpful. This means avoiding beetroot, chocolate, cola drinks, cranberries, nuts, rhubarb, soya foods, spinach, strawberries, tea and wheat bran.
As with vulvodynia, tricyclic antidepressant medication often helps. This is not because you are depressed (or imagining the condition), but because these drugs suppress transmission in nerves of the skin. So talk to your family doctor.
As with vulvodynia, ask your family doctor if your local hospital has a ‘vulval clinic’ that you could be referred to. Some clinics use a technique called ‘electromyographic feedback from pelvic floor muscles’, which is a method of training your nervous system to stop sending the pain signals.-