We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual and women's health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions remain anonymous. This week’s topic: how to know whether your vaginal pain might be vulvodynia.
Q: My vagina hurts so much all the time. It’s been going on for a while now and I don’t have an infection or anything — I went to my doctor and she gave me a full STD panel and checked my vagina for yeast infection and bacterial vaginosis. So if it’s not an infection, what could it be? I have to do something, this is awful. I can’t handle it. Sex hurts, everything hurts, I’m going absolutely insane.
A: I’m so, so sorry this is happening to you. Body pain is terrible no matter where it is, but when your vagina hurts it can cause all sorts of other problems, both physical and emotional. From what it sounds like, it’s possible you have vulvodynia, a chronic vaginal pain condition.
But first, an important note: Please remember that I’m not a doctor and even if I was, there’s no way I could write an article that would enable you to diagnose yourself with as complex a condition as vulvodynia. So if anything below sounds like you, please go talk to your doctor about it and get professionally assessed.
1. What Is Vulvodynia?
Vulvodynia is a mysterious condition that is the medical name for chronic pain in your vulva (around the opening of your vagina) that doesn’t have any other cause. So basically, in addition to being painful, it’s also frustrating and mysterious.
This condition can start at any time in your post-pubescent life (teenage years onward), can last for months or even years, and can be constant or sporadic. It’s estimated that anywhere from 200,000 to six million people have it — so the good news is you’re not alone, but the bad news is lots of people are suffering.
2. What’s It Like To Have It?
There are two subtypes of vulvodynia, each of which has slightly different symptoms. Generalized vulvodynia is when you have pain in different parts of your vulva, which can happen all the time or just every so often. It can be triggered by touch or pressure, but sometimes it’s there regardless. Vulvar vestibulitis syndrome is pain that is localized to the entrance of your vagina. This type of pain is triggered by touch or pressure, like when you’re having sex.
Both of these subtypes are characterized most often by burning pain sometimes described as knife-like, or like you’re being burned by acid. (Not like most of us know what either being stabbed or acid-burned feels like, but perhaps we can imagine.) Other descriptors include stinging, throbbing, or raw pain, pain during sex, soreness, and itchiness. Other than the pain, your vagina will probably look normal — some people get a bit of inflammation, but that’s pretty rare.
This chronic vaginal pain has a serious impact on quality of life. Constant or even sporadic vaginal pain can make daily living difficult, and if the pain shows up during sex it can mess up that aspect of your life too. Emotional challenges arising from this syndrome include fear of having sex, anxiety and depression, trouble sleeping, and relationship challenges.
3. How Can I Be Sure I Have It?
Unfortunately, the only way to figure out if you have vulvodynia is to rule out every other potential cause for your vaginal pain. This means you need to work closely with your doctor to exclude all other causes. Your doctor will ask you medical history questions as well as a bunch of questions about your pain — where you feel it, how often, and how intense it is.
You might also get a pelvic exam to make sure you don’t have a sexually transmitted infection (STI) or other form of vaginal infection, since some of these can cause vaginal pain. Your doctor will also do what’s called a cotton swab test, which is when they will gently touch different parts of your vulva area to see where you are experiencing pain.
4. What Causes It?
Doctors don’t know why some people get vulvodynia, but they have identified some potential causes. If the nerves surrounding your vulva have been injured or irritated, you’ve experienced vaginal infection (specifically recurrent yeast infections or vaginitis), you have allergies or sensitive skin, your genetics make your vulva area not great at responding to inflammation, you use antibiotics a lot, you’ve experienced sexual abuse, or you’re experiencing hormonal changes, you might be at greater risk.
5. How Can I Fix It?
There’s no silver bullet to cure vulvodynia, but there are some options to relieve your pain symptoms.
Things you can do on your own include minimizing irritation and potential infection through wearing cotton panties to let your vagina breathe, avoiding irritants like perfumed soaps or douches and instead cleaning your vagina with just water, and making sure your vulva is dry after you wash it or pee. It’s also a good idea to always use lube when you have sex (if you decide to continue to have penetrative sex, that is, which should always be your choice). If you’re in pain, you can apply cold compresses to your vulva area, sit in a lukewarm or cool bath, and avoid hot baths and anything that puts pressure on your vaginal area — such as horseback or bike riding, or wearing very tight clothing.
There are also a bunch of medical options to treat vulvodynia, which you will work out with your doctor to select and complete. Certain medications such as steroids, some antidepressants, and anticonvulsants can help lessen chronic pain, local anesthetics can numb the area to provide relief, and antihistamines can help with the itching. You can check out biofeedback therapy or pelvic floor therapy exercises, which are different ways to help you learn to relax your pelvic muscles so that you don’t clench, which can increase your pain. More intense options include nerve block injections and surgery to remove skin or tissue in the painful areas.
To deal with the emotional reactions to dealing with chronic extreme pain in your most tender of bits, it can be a good idea to seek mental health support. Therapy can help you work through feelings of frustration, and sex therapy and counseling can help with difficult emotions related to sex. While vulvodynia is by no means simply psychosomatic, women who have experienced sexual abuse are particularly at risk for the condition, and might especially benefit from this treatment.
For all of these options, it’s important to know that relief won’t come right away. For many people, it takes weeks or even months to feel a change, and for some, the solution will unfortunately never be complete.
The Bottom Line
Vulvodynia is a totally unfortunate, cruel, unfair condition to have to deal with. Most people suffer in silence, though, and that helps no one and only means you aren’t getting the relief you could. So if this sounds like something you might have, find a gynecologist you trust and tell them about it so you can begin to figure out a plan.
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