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Alternative Names: The term is also used to refer to vestibulitis or Vulvar Vestibulitis Syndrome (VVS), which is an inflammation of the vestibule, or opening into the vagina and the tissues immediately around the vaginal opening. This condition is sometimes also called 'vestibular adenitis'.
Vulvodynia is a medical term that means 'painful vulva'. The term can cover a wide variety of vulvar pain syndromes including various infections and skin disorders.
Causes & Development
Some cases of vulvodynia may be due to compression or disease of the pudendal nerve, one of the main nerves that relays sensation to and from the genitals.
Signs & Symptoms
In mild cases, a burning or stinging sensation is noted during intercourse or when tampons are inserted. Upon touching the area with a cotton swab, pain is felt when the hymen and inner vaginal lips are touched. There also may be redness and swelling. In severe cases, the pain can be agonizing and much of the vulvar can be reddened, swollen and very inflamed. Often the edges of the inner vaginal lips are very sensitive and the pain so severe that it makes walking difficult. There may be a constant itching or stinging sensation in the grooves between the large and small vaginal lips. Wearing underwear may be very uncomfortable as the slightest touch to the area may result in excruciating pain.
Other signs include pain or discomfort upon touching the pubic hair, over the vulvar skin or in certain spots. These sensations may extend to the rectal area or skin of the perineum. The clitoris can become involved, becoming painful or hypersensitive and there may be shooting pains from the clitoris up the abdomen. Sexual intercourse and urination may be very painful.
Treatment & Prevention
Some women need to avoid underwear that irritates the area or avoid using underwear altogether. If you must wear pantyhose or stockings for work, wear brands with a cotton crotch over the all-cotton underwear and slit the pantyhose crotch to relieve binding, or use old fashioned garter belts and stockings. Additionally, during your menstrual period, if you cannot tolerate a tampon string, you may cut off the string prior to insertion. If menstrual pads are too painful, you may use rolls of absorbent cotton.
Vulvar pain due to skin conditions such as dermatitis, lichen sclerosis may be relieved with topical corticosteroids. Compresses made from prophyllin powder may provide soothing relief.
Prognosis
In a few people vulvodynia clears up on its own after 6-12 months.
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Signs, symptoms & indicators of Vulvodynia / Vestibulitis: | | | | | Symptoms - Reproductive - General |  (Severe) vulvar pain | Symptoms of vulvodynia or vestibulitis can range in severity from mild to severe. Burning, itching and pain are experienced in the skin of the vaginal entryway and sometimes the labia or clitoris. |
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Conditions that suggest Vulvodynia / Vestibulitis: | | | | | Uro-Genital |  Urethritis / Urethral Syndrome| | Vestibulitis may sometimes be part of bladder and/or urethral inflammation as seen in the interstitial cystitis or urethral syndrome. The lining of both vagina and bladder arise from the same tissue during fetal development; thus when one becomes inflamed, the inflammation may spread to the adjoined areas. |
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Risk factors for Vulvodynia / Vestibulitis: | | | | | Immunity | Chronic Fatigue / Fibromyalgia Syndrome| | Dr. St. Amand, MD, specializing in fibromyalgia and author of What Your Doctor May Not Tell You About Fibromyalgia believes that all women with chronic vulvodynia have a form of fibromyalgia. He discovered that at least 11% of his female patients with fibromyalgia also have vulvodynia (painful genitals). The guaifenesin therapy for chronic fatigue enhances oxalate crystal excretion which has been shown to be beneficial in vulvodynia also. |
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Infections |
Yeast / Candida Infection| | Cyclic vulvovaginitis is probably the most common cause of vulvodynia and is believed to be caused by a hypersensitivity reaction to Candida. While vaginal smears and cultures are not consistently positive, microbiologic proof should be sought by obtaining candidal or fungal cultures during a symptom-free phase. The diagnosis of cyclic vulvitis is made based on the patient's report of cyclic symptomatic flare-ups (or, conversely, symptom-free days) and by the patient's report of symptomatic improvement after the administration of long-term topical or systemic anticandidal therapy. [Autoimmunity as a factor in recurrent vaginal candidiasis and the minor vestibular gland syndrome. J Reprod Med 1989;34: pp.264-6] |
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Sexually-Transmitted Diseases |
 HPV (Human Papilloma Virus)| | Whether there is an association between vestibulitis and HPV infection is still being debated. |
Herpes Simplex Type II| | Some women seem to develop vulvodynia in response to infection with the herpes virus. [Vulvodynia: A Perplexing Disorder; Questions and Answers With Stanley Marinoff, M.D. NVA News, Vol. I, Issue 1; Winter, 1995] |
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Vulvodynia / Vestibulitis can lead to:
Recommendations and treatments for Vulvodynia / Vestibulitis: | | | | | Diet |  Dairy Products Avoidance
Oxalate Avoidance| | Reducing the amount of oxalate in your diet may be helpful. Things to avoid include tea, spinach, beer, berry juices, baked beans in tomato sauce, peanuts, peanut butter creams, pecans, soybean curd, concord grapes. In addition, do not take more than 250mg of Vitamin C per day as it may contribute to oxalate formation. Restrict or limit milk or dairy products to reduce the amount of calcium oxalate in the body. Calcium citrate may prescribed to neutralize high blood or urine levels of oxalate. |
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Drug |
Conventional Drug Use| | If intercourse is painful, you can apply xylocaine jelly to numb the sore areas. |
 Antibiotics| | Vulvar pain that is due to infection e.g. ureaplasma, candida or strep will respond to the appropriate treatment. |
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Environmental |
Chemical Avoidance| | Carefully avoid all potential irritants in your underwear, such as laundry soaps and bleaches. You may use a mild non-perfumed soap such as Castile soap and run twice through the rinse cycle. Perfumed or even plain soaps may aggravate the irritation. Natural glycerin soap may be helpful as it has no residual drying effects. A hand-held shower massager is preferable to an overhead nozzle as it makes it much easier to wash away any soap residue that remains after washing. Washing the vulvar area with distilled water instead of tap water may help avoid irritation from chlorine. Another way to help painful urination is to pour a cup of water on the area while urinating: this dilutes the urine and helps to wash away any irritating residue. |
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Hormone |
Estrogen Replacement| | Topical estrogen creams may provide relief. Estrogen thickens or toughens the skin and increases blood supply. It may help you even if you have not reached menopause or do not have estrogen deficiency. If you find vaginal creams painful (possibly from the additives such as alcohol or parabens), your physician may mix 5-10% solution in a petroleum gel base or mineral oil instead of using the standard base. |
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Physical Medicine |
Hot Applications| | Soothing relief may be obtained by applying warm soaked tea bags to the area. This can be done by placing the tea bags on menstrual pads to hold them in place or you can take a sitz bath in which tea bags have been soaked. |
Physical Supports and Devices| | To relieve pressure on the vulvar area when sitting you may use a pressure relief cushion. |
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Psychological |
Visualization/Relaxation Techniques| | Biofeedback and pelvic muscle exercises involving relaxation and muscle strengthening may be helpful. |
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Surgery/Invasive |
Prolotherapy| | The iliolumbar ligament may be weakened and referring pain to the vulvar area. Prolotherapy can strengthen that ligament. |
Surgery| | Surgical treatment may include removal of painful areas such as the vulvar (bartholin's) glands, decompression surgery of the pudendal nerve to free the nerve and its branches up (from compressions due to blood vessels and veins, damaged tissue, and ligamental grip), and/or laser therapy to destroy underlying vulvar blood vessels. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | May do some good | | | Likely to help |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Candidiasis (Candida)
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge. Candidiasis is also known as: Candida; Candida albicans; Candida Related Complex; Chronic Candida Syndrome; (Chronic) Systemic Candidiasis; Monilia; Candidiasis Hypersensitivity Syndrome; Candidosis; (Chronic) Mucocutaneous Candidosis; Thrush (oral or vaginal); Moniliasis; Polysystematic Candidiasis.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chronic Fatigue Syndrome (CFS, Chronic Fatigue)
A disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Cup (Cups)
A unit of volume measurement equal to 8 fluid oz, or roughly 250ml. It also equals 1/2 pint, 1/4 quart and 1/16 gallon.
Dermatitis
A general term used to refer to eruptions or rashes on the skin.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Fibromyalgia (FMS)
Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Herpes
A small group of capsid-forming DNA viruses, sometimes divided into Type I (forming vesicles and blisters on the mouth, lips-generally above the waist) and Type II (usually sexually-transmitted, with symptoms mostly below the waist). Both types form acute initial outbreaks, go dormant, reactivate, and so forth. For most folks, frequent outbreaks are clear signs of stress or immunosuppression. Both types are equally dangerous for infants.
Interstitial Cystitis
A chronic bladder problem involving a bladder wall that is inflamed and irritated. Symptoms include an urgent need to urinate, both daytime and nighttime; pressure, pain and tenderness around the bladder, pelvis and perineum (the area between the anus and vagina or the anus and scrotum) which may increase as the bladder fills and decrease as it empties during urination; a bladder that won't hold as much urine as it did before; pain during sexual intercourse; in men, discomfort or pain in the penis or scrotum. In many women, the symptoms get worse before their menstrual period. Stress may also make the symptoms worse, but it does not cause them.
Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Mineral (Minerals)
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Prolotherapy
A single or series of injections that stimulates the body to regrow, tighten, and strengthen ligaments or tendons. It is unequaled for pain relief and restoration of normal function for any body joint where connective tissue is weak or has been damaged.
Sitz Bath
Immersion bath.
Streptococcus (Strep)
A genus of gram-staining chain-forming cocci bacteria. Some are responsible for common and potentially serious human infections, ranging from scarlet fever and strep throat to bacterial endocarditis and pus pockets. Most of the disease-potential streps are also a normal part of the skin, mouth and upper respiratory flora.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Topical
Most commonly 'topical application': Administration to the skin.
Virus (Viri, Viruses)
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
Last updated: May 04, 2008
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