Patient education: Vulvar pain (The Basics)

What is vulvar pain? — Vulvar pain is pain in the area around the opening of the vagina (figure 1). Vulvar pain can feel different to different people. Symptoms of vulvar pain can include:

●Burning or stabbing pain

●Irritation in the vulva – The skin can feel raw or itch.

●Feeling like something rough is rubbing the area

●Swelling – Some people feel swollen or puffy, or like they are sitting on a hard ball or knot.

Vulvar pain can be in a specific area or all over. Some people have pain all the time. Others have pain only when something touches the vulva. For example, some people feel pain when they wash the area or a sex partner touches it.

What causes vulvar pain? — Vulvar pain has many different causes. Some common causes include:

●An infection of the vagina or vulva

●A reaction to a soap, lotion, or other product that was on the vulva or in the vagina

●Hormone changes – For example, this can happen after having a baby, while breastfeeding, or during menopause (when monthly periods stop).

●Problems with the pelvic floor muscles – These are the muscles that support the organs in the pelvis, including the bladder, rectum, and uterus. If the muscles are too tight, it can cause pain in the vulva and nearby areas.

Sometimes, doctors are not able to tell what is causing a person's vulvar pain.

Should I see a doctor or nurse? — Yes. If you have vulvar pain, see a doctor or nurse so that they can figure out the cause. Your doctor or nurse will talk with you and do an exam.

Will I need tests? — Yes. Your doctor or nurse will do tests to look for the cause of your vulvar pain.

The most common tests include:

●Tests on a sample of fluid from the vagina to check for infection

●Urine tests to look for infections

You might also have a test called a "biopsy." In this test, a doctor takes a small sample of skin from the vulva. Another doctor looks at the sample under a microscope. You might have this test if other tests do not show the cause of your vulvar pain, but most people with vulvar pain do not need it.

How is vulvar pain treated? — That depends on the cause. If the pain is from another medical condition such as an infection, treating the condition usually gets rid of the pain.

Other treatments might include:

●Pelvic floor physical therapy – This involves working with a physical therapist who has special training in pelvic floor issues. They can check your muscle strength and teach you specific exercises.

●Counseling – Sex or relationship problems can cause vulvar pain. Or having vulvar pain can cause sex problems later on. Counseling can help with these problems. This can involve talking with a counselor on your own, with your partner, or both.

●Ointment to numb the area – This might help if you use it before activities that cause you pain.

●Estrogen cream – Your doctor might prescribe this if you have vaginal dryness caused by low levels of estrogen. This can happen during breastfeeding and after menopause.

●Medicines – Some medicines used to treat other conditions can also help with pain. For example, medicines for depression work on areas of the brain that process pain. Medicines for seizures can also be used to treat pain, because they help with overactive nerves.

●Botulinum toxin (brand name: Botox) – This is a medicine that is given by injection. It can block muscle contractions that cause pain.

●Surgery – Doctors might recommend surgery for vulvar pain that does not get better with other treatments. But this is uncommon.

If your vulvar pain is caused by an infection that can be spread through sex, your partner(s) will also need to see a doctor for treatment.

Is there anything I can do on my own? — Yes. In addition to getting treatment for whatever is causing your vulvar pain, there are things you can do at home. These might help you feel better. They might also help prevent pain from returning.

You can:

●Put a cold pack on the area – This might help relieve pain temporarily. You can use a frozen gel pack or bag of frozen vegetables wrapped in a soft cloth. Apply cold for 10 to 15 minutes at a time, every 4 to 6 hours.

●Soak in a lukewarm bath – Use plain water, or you can try adding Epsom salt or oatmeal to help soothe your skin. Do not use scented bath products.

●Avoid irritating products – Clean your vulva with cool or lukewarm water and unscented non-soap cleanser. Do not douche (put liquid inside your vagina to rinse it out) or use powders or sprays. After using the toilet, wipe with soft, unscented toilet paper.

●Wear cotton underwear – Avoid underwear or pants that are too tight.

●Try to lower stress – Vulvar pain can increase stress, and stress might also make pain worse. It can help to try to manage your stress and anxiety. There are different ways to do this, including physical exercise (such as yoga) and relaxation techniques.

●Avoid activities that make your pain worse – Activities like bike riding or horseback riding put pressure on the vulva and can make pain worse.

If your pain is related to vaginal dryness, some types of lubricant can help you feel more comfortable during sex. But if sex hurts, avoid it until you get treatment. Having painful sex can lead to problems with sex and relationships in the future. You can still explore other ways to be intimate with your partner that feel good. If you are having trouble with this, counseling can help.

More on this topic

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Patient education: Dyspareunia (painful sex) (The Basics)
Patient education: Vulvovaginal yeast infection (The Basics)

Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics)
Patient education: Sexual problems in females (Beyond the Basics)
Patient education: Vaginal dryness (Beyond the Basics)
Patient education: Vaginal yeast infection (Beyond the Basics)