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Vulvodynia information center

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.

Types of vulvodynia

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. You can learn more about each type below.

  • Provoked vestibulodynia (PVD), formerly vulvar vestibulitis syndrome (VVS)

    PVD is the most common cause of dyspareunia (i.e., painful intercourse) in women of child-bearing age. An 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 or vaginal penetration attempt. The other half has secondary or acquired PVD, which develops after a period of pain-free intercourse or vaginal penetration activities, 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.

    Treatment for PVD

    There is scientific evidence that the following treatments are effective for PVD:
    • Psychotherapy including a specific focus on pain management and sexuality. This can be done in group, couple, or individual format
    • Pelvic floor physiotherapy
    • Surgical removal of the painful area of the vulvar vestibule (vestibulectomy)
    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 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, mindfulness, and acupuncture, have been successful in some women with PVD. However, more research is needed to fully understand the effects of these treatments.
  • Generalized vulvodynia (GVD)

    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.

    Treatment for GVD

    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.

Vulvar health

Below are some suggestions for general vulvar health. While these suggestions are unlikely to provide significant relief from vulvodynia, they may help prevent further irritation. It is not critical that you follow all the suggestions, however we recommend that you start with as many as is practical for your lifestyle and try them for a period of time. After that, you can gradually re-introduce, if necessary, the previous habits one at a time and watch for signs of irritation.

  • Laundry care

    • Use dermatologically-approved detergent (e.g., Purex®, Clear®) on underwear or any other type of clothing/material that comes into contact with the vulva (e.g., pyjama bottoms, exercise clothing, towels); Use 1/3 to 1/2 the suggested amount per load. Other clothing may be washed with the laundry soap of your choice.
    • Avoid using fabric softener and/or bleach on underwear or any other kind of clothing or material that comes onto contact with the vulva.
    • Avoid using dryer sheets on clothing/material that comes into contact with the vulva; hang-dry these items.
    • Double-rinse underwear and any other kind of clothing that comes into contact with the vulva.
    • If you use stain-removing products on items that come into contact with the vulva, soak and rinse them in clear water and then wash them in your regular washing cycle (given the restrictions above) in order to remove as much of the product as possible.
  • Clothing choice

    • Wear white, 100% cotton underwear to allow air in and moisture out.
    • Go without underwear when possible (e.g., when sleeping).
    • Avoid thong (g-string) underwear.
    • Avoid wearing full-length pantyhose; try thigh-high or knee-high stockings instead.
    • Avoid tight fitting pants or jeans that may put pressure on the vulva.
    • Avoid spandex®, lycra® and other tight-fitting clothing during workouts, and remove wet bathing suits and exercise clothing promptly.
  • Hygiene hints

    • Use soft, white, non-recycled, unscented toilet paper and 100% cotton pads or tampons.
    • Avoid using scented products such as bubble bath, feminine hygiene products (pads or tampons), creams, or soaps that come into contact with the vulvar region.
    • Avoid using feminine deodorant sprays, Vaseline®, and colored soaps in the vulvar area, and avoid douching unless recommended by your physician.
    • When you shower/bathe, do not use soap until the very end, and avoid applying it directly to the vulva. Use mild soaps such as Dove® (or even mild cleansers such as Cetaphil® or CeraVe®) and avoid getting shampoo on the vulvar area.
    • Wash the vulva with cool to lukewarm water with your hand. Pat your vulvar area dry, do not rub. Do not use soap, wash cloths, or loofahs on the vulva; these can dry out and /or irritate the sensitive vulvar skin.
    • Many women wash the vulva too often, which can further irritate the area. Once a day is enough.
    • Avoid shaving the vulvar area.
    • Keeping the vulvar area dry is important; if you are chronically damp, keep an extra pair of underwear with you in a small bag and change if you become damp during the day at school/work.
    • If you suffer from repeated vaginal infections, avoid using over-the-counter creams which might irritate the sensitive vulvar skin. Instead, discuss with your doctor the option of a systemic, oral medication (e.g., Diflucan®). It is important to visit your doctor for an examination when you suspect you have an infection; self-diagnosis and treatment without confirmation may lead to misdiagnosis and unnecessary treatment that can cause more harm than benefit to your vulva.
  • Physical activities

    • Avoid exercises that put direct pressure on the vulva such as bicycle riding and horseback riding. Use padded shorts/bicycle seats if you do engage in such activities.
    • Limit intense exercises that create a lot of friction in the vulvar area.
    • Use a frozen gel pack wrapped in a towel to relieve symptoms after exercise.
    • Enroll in a yoga class to learn relaxation and breathing techniques, and to improve core stability and strength.
    • Avoid swimming in highly chlorinated pools, and avoid using hot tubs.
  • Pre- and post-sexual intercourse suggestions

    • Use a lubricant that is water-soluble before penetration (e.g., Liquid K-Y®, Astroglide®). If you find that these lubricants irritate you or dry out during penetration, a pure vegetable oil (such as Crisco®, solid or oil) has no chemicals and is also water-soluble. Please note that Crisco® is not latex-friendly and therefore should not be used in combination with condoms.
    • A topical anesthetic (for example, Xylocaine®) may help before penetration; discuss this with your doctor and ensure that you know how, where, and when to apply it.
    • Trying out different sexual positions with a sexual partner may help in determining positions that trigger less pain during penetration. Attempting slower entry and an increased sense of control during entry can also be helpful for some women.
    • To relieve burning and irritation after intercourse, have a cool or lukewarm sitz or baking soda bath (4-5 tablespoons, 1-3 times a day for 10 minutes each).
    • Apply ice or a frozen blue gel pack wrapped in one layer of a hand towel to relieve burning after intercourse. Other ideas include a bag of frozen peas, or fill a dish-soap bottle with water and freeze it; these fit well against the vulva.
    • Urinate (to prevent infection) and rinse the vulva with cool water after sexual intercourse.

Advice for couples living with vulvodynia

Vulvar pain can affect your romantic life in various ways. For example, it can lead to avoidance of sexual activities, especially in the case of provoked vestibulodynia where pain is direct triggered by sex. Vulvar pain can also affect sexual self-esteem, sexual desire and arousal. It is important for couples who are coping with vulvodynia to recognize that the pain does not just affect the vulva, but also the entire self-perception of sexuality.

  • Advice for women with vulvodynia in a relationship

    • Seek information on your own. The more you know about vulvodynia, the more control you have over your situation.
    • Some women find that joining a support group or a chatroom for women with vulvar pain is helpful. It is important to know that you are not alone – and you are not.
    • Not all vulvodynia sufferers are the same; although joining an online support group helps break the isolation, it is important to consult a health professional before applying some of the advice received through the group. Keep in mind that not everything said in vulvodynia chatrooms applies to all situations or to all women with vulvodynia.
    • Participate in non-painful sexual activities (e.g., masturbation, oral sex). Sexual activity is more than vaginal penetration. Be creative with your partner; find out what activities are pain-free and enjoy them.
    • Do not blame yourself. Having chronic pain is not your fault.
    • It is helpful to talk about your fears with your partner – both of you might be afraid of emotional or physical abandonment. Clear communication can build your relationship. You might want to consult a sex or couple therapist to help you with this aspect of your relationship.
    • Your partner may feel rejected because of the limitations on sexual activity. It may be helpful to include him/her in your treatment visits (e.g., at the doctor’s office, psychotherapy, pelvic floor physiotherapy). Often, some of the techniques you learn through these therapies can be incorporated into foreplay and sexual activity by your partner. This may help him/her feel like part of your treatment and understand better that you are not rejecting him/her, but rather that it is your pain condition that is at the source of your diminished interest in sexuality. It may also be a way for your partner to get much needed support of his/her own.
    • Sex or couple therapists can help women and their partners confront difficult issues that arise when sexual dysfunction is present in a relationship due to pain, and help the couple explore alternative avenues of expressing love and affection.
  • Advice for partners of women with vulvodynia

    • Research vulvodynia (e.g., articles, websites).
    • Listen actively to your partner – acknowledge her fears and frustrations.
    • Communicate your fears and frustrations to your partner, and ask her to acknowledge them.
    • Vulvodynia may lead the two of you to question your attractiveness as a person and toward one another. Remind your partner that she is still attractive, sexual, and feminine. Ask her to do the same for you.
    • Take your partner seriously. Even if doctors do not find a physical reason for her pain, reassure her that you know it is real.
    • Remember that the pain is not your fault. She does not have the pain because you are a bad lover or because you are sexually unattractive.
    • If you feel isolated, some partners might find it helpful to join a support group or chatroom.
    • Not all vulvodynia couples are the same; although joining an online support group helps break the isolation, it is important to consult a health professional before applying some of the advice received through the group. Keep in mind that not everything said in vulvodynia chatrooms applies to all situations or to all women with vulvodynia.

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