Dear Dr. Myrtle,
Why is my vulva so sensitive? I’ve been told I may have vulvodynia. What is vulvodynia? What can be done to treat it?
There are many potential causes for pain in the vulvar region, and the term "vulvodynia" is a word that describes a variety of conditions. Vulvodyina, or chronic vulvar discomfort, is characterized by burning, stinging, irritation or rawness of the vulva. Three different sub-types have been described, and have different treatment approaches:
- skin disease,
- inflammation of the vulvar opening, and
- irritation of the nerves that serve the vulva.
Vulvodynia is a diagnosis made after other diagnoses, such as vaginal infections, neuropathies, sexually transmitted infections, and other dermatological conditions are tested for and found not to be the cause. If you have an actual sore or scab patch on your vulva, you very likely need a series of biopsies to diagnose the problem. (One biopsy isn't enough: it usually takes three biopsies minimum to determine a diagnosis.) Even when health care providers have extensive genital dermatological experience, the good providers will get a biopsy to confirm the diagnosis.
For skin-related vulvodynia, steroid ointments are used, often successfully, for treatment. (NOTE: Steroid creams, by definition, have alcohol in them, and should be avoided.) Although it is true that we need to be careful of using steroid ointments on the skin of the body (because it causes thinning), the vulva is relatively steroid insensitive, and use of steroids on the vulva does not cause the same problems that it can elsewhere.
Having said that, one should only use the very smallest amount prescribed, and ONLY on the areas where directed. Using more doesn't make something better, and can cause it's own problem if you become irritated by the base that the medication is in. Also, make sure to completely avoid the anal area unless your health care provider has instructed you to use the steroid there. The anus is very SENSITIVE to steroid ointments, and thinning can cause fissures and other skin problems you don't need to add.
For women who experience inflammation of the vulvar opening, good attention to vaginal health may help. The skin at the opening of the vagina is just more sensitive than that of the lips, and often needs some healthy conditioning to help vaginal penetration be more comfortable. Look at the AWT Vaginal Renewal posts, and consider whether that may work for you.
We also find that strict attention to a low inflammation diet (see the AWT Good Sex Diet) helps dramatically with many types of skin inflammation disorders. Some women find relief with alpha-interferon injections, and others choose to pursue a surgical operation (vaginal advancement) when vestibular glands are infected or impacted for a long period of time.
The most severe cases of vulvodynia are those with neurologic irritation. Pain occurs wherever the nerves in the region receive too much sensation: the clitoris, vestibule (vaginal opening), urethra, perineum (skin between the vaginal and anal openings), and down the inner thighs. As in other cases of sensory neuropathies (diseases of the nerves), antidepressants and anticonvulsants may ease the pain in some cases by "resting the nerve" and allowing it to heal.
Other people may need an evaulation by a pelvic floor Physical Therapist, to determine whether a muscle spasm is causing compression on a nerve that you then feel as pain.
Vulvodynia can be a difficult condition. For many of the conditions, the cause is unknown, and the cure elusive. For some women, it’s a big breakthrough to know the name of this condition, and that this is not something "in their head", or something to be ignored.
For more information, try the book The Vulvodynia Survival Guide, visit the website www.vulvodyniasupport.com, or contact the National Vulvodynia Association (online at www.nva.org and ask for a referral for a gynecologist or genital dermatologist in your area who is familiar with vulvodynia.