Vulvodynia is defined as “vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurologic disorder.” Vulvodynia affects an estimated 16% of women in the general population. There are two major types of vulvodynia that are based on pain location. The first is localized vulvodynia, in which pain is restricted to a portion of the vulva, such as the vestibule, as in provoked vestibulodynia (PVD). The second is generalized vulvodynia (GVD), in which the pain is more diffuse, involving the whole vulva.
PVD is the most common cause of dyspareunia (i.e., painful intercourse) in women of child-bearing age. A recent epidemiological study estimated that PVD affects 12% of pre-menopausal women in the general population. Women with PVD experience a highly localized, burning and/or cutting pain at the entrance of the vagina (called the vulvar vestibule) during sexual intercourse, as well as during other activities that involve applying pressure to the vestibule (e.g., tampon insertion, gynecological exams). Although the pain of PVD typically disappears after pressure to the vestibule is removed, many women report lasting pain or discomfort after sexual intercourse or similar activities.
Approximately 50% of women who suffer from PVD have what is called primary PVD, indicating that the pain has been present since their first intercourse attempt. The other half has secondary or acquired PVD, which develops after a period of pain-free intercourse, and in many cases, after an aggravating factor (e.g., repeated vaginal infections, sexually transmitted infections). Not all women with secondary PVD, however, can identify a trigger for the onset of their pain. Little is known about the causes of PVD; most health professionals agree that it is caused by a combination of factors.
How is PVD Treated?
There is scientific evidence that the following treatments are effective for PVD:
It is generally recommended to begin treatment with either psychotherapy or pelvic floor physiotherapy (PFP), or both. One study found that psychotherapy and PFP are equally successful in treating the pain, physical and emotional components of PVD. Not surprisingly, psychotherapy is a little better at treating the sexual component of PVD, and PFP is a little better at treating pelvic floor muscle tone and post-contraction relaxation of the muscles; both treatments complement each other well. As well, another study indicated that 77% of women who underwent 8 sessions of PFP reported significant improvements in their pain and sexual functioning, and cognitive and emotional function. Although less commonly offered, a combined treatment of PFP and psychotherapy was reported to be beneficial in 19/24 (79%) of women with PVD.
If there is no significant improvement with psychotherapy or physiotherapy, a vestibulectomy may be indicated. This is a relatively minor day procedure carried out under general or spinal anesthesia. Following the operation, women will typically experience some discomfort in the genital region. Neither intercourse nor any other penetrative activity should be attempted for 6-8 weeks post-surgery. Seventy percent of women with PVD who underwent this surgery in one study published in the journal Pain reported a great decrease in their pain or complete pain relief. For a small percentage of women, however, there can be no benefit or worsening of symptoms.
You may have come across information about other forms of treatment for PVD, such as vaginal creams, diets, and laser surgery. There is no evidence for their effectiveness, and in fact, some of these treatments may have unintended negative side effects. Reports have suggested that alternative treatments, such as hypnosis for pain control and acupuncture, have been successful in some women with PVD. However, more research is needed to fully understand the effects of these treatments.
GVD is a common form of vulvar pain, affecting 6-7% of women in the general population, with a higher prevalence in women over the age of 30. In GVD, the pain is present on a constant or almost constant basis and affects the entire vulvar region. Like PVD, the pain of GVD is described predominantly as burning; in fact, the original term for GVD was “the burning vulva syndrome.” GVD not only affects sexual functioning in most women, it also affects daily activities (e.g., sitting for long periods of time at work, bicycle riding) due to the constant nature of the pain.
How is GVD treated?
There is little research on the treatment of GVD. A few small studies showed that women who were treated with a low dose antidepressant medication (i.e., amitriptyline; commonly used for the treatment of neuropathic pain conditions which share the “burning” and “constant” qualities of pain with GVD) or gabapentin (also used for the treatment of neuropathic pain) reported pain reduction. While psychotherapy that combines a pain management and sexuality component might be helpful for women with GVD, there is no direct evidence to support this. Surgery, however, should be avoided.
*If you do not reside in the Kingston area and would like help finding resources in your local area, please contact the Sexual Health Research Lab at 613.533.3276 or SHRL@queensu.ca
Contact your family doctor for a referral to a local gynecologist.
Contact your family doctor for a referral to a local neurologist.
Pelvic floor physiotherapy
Elizabeth Tata, Melanie Law, & Cindy Auchincloss at K-TOWN Physiotherapy (two locations)
368 King Street East
Kingston, ON K7K 2Y2
598 Cataraqui Woods Dr,
Kingston, ON K7P 1T8
Please note that if you would like to make an insurance claim after your appointment with one of the pelvic floor physiotherapists, you will need a referral from your family doctor.
Psychology (focusing on sex and couples therapy)
Sex Therapy Service, Psychology Clinic, Queen’s University
Dr. Caroline Pukall and student therapists
184 Barrie Street
Phone: (613) 533-6021
Fax: (613) 533-3282
Psychology (focusing on couples therapy)
Dr. Debra Kowalik
797 Princess Street, Kingston
Phone: (613) 544-1065
Dr. Gisele Pharand
55 Sunny Acres Road, Kingston
Phone: (613) 384-1014
Francoise Mathieu, M.Ed, CCC
847 Princess Street, Kingston
Phone: (613) 547-3247
Dr. Vince Caccamo
221 King Street East, Kingston
Phone: (613) 547-9814
Sexual Health Research Laboratory
Phone: (613) 533-3276