Vulvodynia (vul-vo-DIN-ee-uh) — or chronic vulvar pain — is characterized by pain in the area around the opening of your vagina (vulva). The pain, burning or irritation associated with vulvodynia may make you so uncomfortable that sitting still for long periods or even having sex becomes unthinkable. The condition can go on for months or years.

Experts believe vulvodynia is underreported. There are several reasons why. It may be partly due to the absence of visible signs in vulvodynia. Or it could be the reluctance of many women to talk about their symptoms.

If you or someone you know is living with vulvodynia, don't hesitate to get help. Treatment options are available to lessen the pain and discomfort of vulvodynia.

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Vulva

The word "vulvodynia" means "painful vulva." Your vulva consists of the pad of fatty tissue at the base of your abdomen (mons pubis), the labia, the clitoris and the opening of your vagina.

The main vulvodynia symptom is pain in your genital area, which can be characterized by:

• Burning
• Soreness
• Itching
• Stinging
• Rawness
• Painful intercourse (dyspareunia)
• Throbbing

The pain you experience may be constant or intermittent and can last for months or even years, but it can vanish as suddenly as it started. A similar condition, vulvar vestibulitis, may cause pain only when pressure is applied to the area surrounding the entrance to your vagina.

Vulvar tissue may look minimally inflamed or swollen. More often, your vulva appears normal.

When to see a doctor
Although women often don't tell their doctors about the problem, vulvodynia is a fairly common condition.

If you experience pain in your genital area, discuss it with your doctor, or ask for a referral to a gynecologist. It's important to have your doctor rule out more easily treatable causes of vulvar pain, such as yeast or bacterial infections, skin conditions, and medical problems such as diabetes. Once your doctor has evaluated your particular symptoms, he or she can recommend treatments or ways to help you manage your pain.

Doctors don't know what causes vulvodynia, but contributing factors may include:

• Injury to or irritation of the nerves surrounding your vulvar region
• Past vaginal infections
• Allergies or a localized hypersensitivity of your skin

Many women with vulvodynia have a history of treatment for recurrent vaginitis or vaginal yeast infections. Some women with the condition have a history of sexual abuse. But most women with vulvodynia have no known contributing factors. Vulvodynia isn't sexually transmitted or a sign of cancer.

You're likely to start by first seeing your family doctor or primary care provider. However, in some cases when you call to set up an appointment you may be referred immediately to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist).

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance to prepare for common diagnostic tests.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of your key medical information, including any other conditions for which you're being treated, and the names of any medications, vitamins or supplements you're taking.
• Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

For vulvodynia, some basic questions to ask your doctor include:

• What could be causing my symptoms?
• What tests do you recommend?
• What types of treatments are most likely to improve my symptoms?
• How long will I need to be treated?
• Is this condition permanent or temporary?
• When might I expect to experience relief from my pain and discomfort?
• Is there a generic alternative to the medicine you're prescribing?
• Do you have any brochures or other printed material that I can take with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing your symptoms?
• Have your symptoms changed over time?
• How often do you experience pelvic pain?
• How severe is your pain, and how long does it last?
• Where is your pain located? Does it always occur in one place?
• Would you describe your pain as sharp or dull?
• Does your pain come in waves or is it constant?
• Can you anticipate when the pain is coming?
• Is your pain usually triggered by a specific event, such as intercourse or exercise?
• Do you feel pain during urination or a bowel movement?
• Does your menstrual cycle affect your pain?
• Does anything make your pain better or worse?
• Does your pain limit your ability to function? For example, have you ever had to miss school or work because of your pain?
• Is your pain causing difficulty in your marriage or other important personal relationships?
• Have you recently felt down, depressed or hopeless?
• Have you recently lost interest in things you once enjoyed?
• Have you ever had pelvic surgery?
• Have you ever been pregnant?
• Have you ever been treated for a urinary tract or vaginal infection?
• Have you ever been touched against your will?
• What do you think is causing your pain?
• What treatments have you tried so far for this condition? How have they worked?
• Are you currently being treated or have you recently been treated for any other medical conditions?

Before diagnosing vulvodynia, your doctor will ask you several questions to get a better idea of your medical history and to understand the location, nature and extent of your symptoms.

As part of his or her evaluation, your doctor may also perform these tests:

• Pelvic exam. During this exam, your doctor visually examines your external genitals and vagina for signs of infection or some other cause of your vulvodynia symptoms. Even if there's no visual evidence of infection, your doctor may take a sample of cells from your vagina to test for a vaginal infection, such as a yeast infection or bacterial vaginosis.
• Cotton swab test. During this test, your doctor uses a moistened cotton swab to gently and methodically check for specific, localized areas of pain in your vulvar region.

Vulvodynia treatments focus on relieving symptoms. No one treatment works for every woman, and you may find that a combination of treatments works best for you. It may take weeks or even months for a new treatment regimen to noticeably improve your symptoms. Available options may include:

• Medications. Tricyclic antidepressants that may help lessen chronic pain include amitriptyline, desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). Anticonvulsants such as carbamazepine (Tegretol) and gabapentin (Neurontin) also may lessen the pain of vulvodynia. Antihistamines such as hydroxyzine can reduce itching.
• Biofeedback therapy. This therapy can help reduce pain by teaching you how to control specific body responses. The goal of biofeedback is to help you enter a relaxed state in order to decrease pain sensation. To cope with vulvodynia, biofeedback can teach you to relax your pelvic muscles, which can contract in anticipation of pain and actually cause chronic pain.
• Local anesthetics. Medications such as lidocaine ointment can provide temporary symptom relief. Your doctor may recommend applying lidocaine 30 minutes before sexual intercourse to reduce your discomfort. Your partner may also experience temporary numbness after sexual contact.
• Surgery. In cases where painful areas can be specifically pinpointed at the hymeneal ring (localized vulvodynia, vulvar vestibulitis), surgery to remove the affected skin and tissue (vestibulectomy) relieves pain in some women.

The following tips may help you manage the symptoms of vulvodynia:

• Try cold compresses. Cool compresses placed directly on your external genital area may help lessen pain and itching.
• Avoid tightfitting pantyhose and nylon underwear. Tight undergarments restrict airflow to your genital area, often leading to increased temperature and moisture that can cause irritation. Wear cotton underwear to increase ventilation and dryness, and sleep without underwear at night.
• Avoid hot tubs. Spending time in a hot tub may lead to discomfort and itching.
• Avoid excessive hygiene. Washing or scrubbing the affected area harshly or too often can increase irritation. Instead, use plain water to gently clean your vulva and pat the area dry. After bathing, apply a preservative-free emollient, such as plain petroleum jelly, to create a protective barrier.
• Use lubricants. If you're sexually active, apply lubricants before engaging in sexual intercourse.
• Try an antihistamine at bedtime. This may help reduce itching and help you rest better.
• Look for triggers and avoid them. The triggers that can make vulvar pain worse tend to be different for each woman. Your observations of what causes you pain are important. Avoid potentially irritating soaps, clothing dyes, contraceptive devices, creams and bath products. Use only white, unbleached toilet paper and 100 percent cotton sanitary products.
• Work with your doctor. Over time you can work with your doctor to identify the approaches that work best for you.
• Stay active. Regular exercise can help ease chronic pain, but stay away from exercises that put pressure directly on the vulva, such as bicycling.
• Accept small steps of progress. Don't expect instant cures. Have confidence that you'll feel better over time.