Vulvodynia – pain in the vaginal opening during sex and touch

Rebecka Kaplan Sturk, senior physician gynecology/obstetrics, writes about vulvodynia, what was previously called vestibulitis and which precisely means pain in the vulva

Vulvodynia means a condition when there is pain in the vaginal opening in connection with vaginal sex, insertion of a tampon or other touch. It used to be called vestibulitis, but in the last twenty years the term vulvodynia has been used instead, which means pain in the vulva.

In vulvodynia, superficial nerves in the mucous membrane have become hypersensitive, and it can then be enough for just a light touch to cause pain. For many sufferers, the pelvic floor muscles are always more or less tense, and it is difficult to relax. Attempting vaginally intimate sex is painful, and many also describe that it hurts to try to insert a tampon, sit on a bicycle saddle or wear tight clothing. The pain may feel burning, stinging or cutting.

Many different causes behind vulvodynia and painful intercourse

The causes of vulvodynia are not fully understood, and studies have shown that there can be many different combinations of underlying causes that trigger the pain. Some common causes are repeated fungal infections and repeated use of local anti-fungal drugs, respectively having vaginal intercourse despite dryness and reduced desire. For others, birth injuries, excessive pelvic floor exercise, or previous vaginal surgeries may be behind the development of pelvic floor pain and tension.

It is most common to suffer from vulvar pain between the ages of 18 and 25, and in that age group approximately one in ten women suffer from vulvodynia.

It is important to seek care for vulvodynia and other pain in the abdomen

Many people with vulvodynia struggle with their problems for a long time before seeking help, and many also find that it can be difficult to know where to turn. It is important not to deal with the problem for too long, the earlier you seek help, the easier it is to treat.

Gynecologists and midwives are very familiar with this type of problem and can help you and refer you to a specialist if you need more advanced help.

You can do this yourself if you have pain in the vaginal opening

There are quite a few things you can try yourself to relieve and reduce the pain:

• Be sure to only have intimate intercourse when you are really excited

• Avoid intimate intercourse completely if you are in pain.

• Avoid over-the-counter anti-fungal drugs, rather seek care to get an examination to see if it really is a fungus, and if you can get other treatment than local treatment.

• Do not wash the vagina too often and avoid using soap in the vulva. Rather, wash with a perfume-free oil or the moisturizing intimate wash VagiVital Moisturizing V Cleanser

• If you feel dry in the vagina; lubricate with a little oil, alternatively a greasy ointment or try VagiVital Aktivgel after the shower.

• Yoga, especially Yin Yoga, and relaxation exercises can also help release tension in the pelvic floor.

• If you are using a contraceptive with hormones, discuss with your midwife or gynecologist about changing to something with more estrogen in it, or using topical estrogen to reduce dryness.

Treatment of vulvodynia

It is important to know that most people with vulvodynia get better with the right treatment. However, it can take time, and requires some patience and your own work.

Treatment for vulvodynia rests on five pillars:

The explanatory pillar is about getting a name for one's problems, getting an explanation as to why it might have turned out this way, and getting information about what treatment is available. To feel that you are taken seriously, that there is help to get and to get a plan for your treatment is a very important part of the healing process.

The vulva care pillar consists to a very large extent of what you can do yourself (see the heading above) to heal your mucous membrane, stop activities and treatments that make things worse and work on relaxation and vulva care yourself.

The pharmacological pillar is the one you get help with from doctors. For a short period, you may be prescribed to lubricate the vulva with an anesthetic gel to make the overactive nerve fibers calm down a bit, and not signal pain at the slightest touch. In more severe and lengthy cases, you can also give drugs that affect the interpretation of pain in the brain, drugs that are often used for various forms of nerve pain.

The physiotherapeutic foundation is very important, and you can get help with it from a specialized physiotherapist, urotherapist or specially trained midwife. Here you work with your own lubrication and massage exercises, relaxation, pelvic floor training (to learn to feel the difference between tension and relaxation) and much, much more.

The psychological pillar is conversations with a counsellor, psychologist or sometimes a sexologist. The pain condition can affect sexuality and desire, relationships, and psychological well-being, and therefore this is a very important part of the treatment. The treatment includes reading about pain mechanisms, strategies for working with troublesome thoughts, exposure exercises and sexual communication exercises.

For those who are not helped by the above treatment via the youth clinic, gynecology clinic or health center, there is the possibility of getting a referral to a specialized clinic, a so-called vulva clinic, for more advanced treatment. There, gynecologists, midwives, physiotherapists, psychologists/curators work in teams around the patient, and there is also the opportunity to involve other experts such as pain doctors, urotherapists, sexologists, psychiatrists and more.

Can we prevent vulvodynia?

When it comes to pain conditions that are difficult to treat, it is of course important to prevent the condition from even developing. Here we can all contribute by informing our children and young people, and our friends of the same age, about how to be kind to your vagina. Wash gently with lukewarm water and without soap. Don't have sex if it hurts. Seek advice and help from a midwife or doctor if you have pain, itching, burning or prolonged dryness in the vagina - or if it hurts during intimate sex.