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What is persistant vulval pain? Dr Shona Brown explains the symptoms, conditions and treatments available for people living with these conditions
Persistent vulval pain is described as soreness, and sometimes burning or itching in the vulval area. The vulva is the area of skin around the vaginal opening. For some the pain is constant. For others the pain happens with sex, smear tests or tampons. Women may have been told they have a condition such as vulvodynia, vestibulodynia or pudendal neuralgia. Often women have been told that their test results are normal. This can lead women to fear that others do not believe they are experiencing ongoing pain, or that they are making it up.
The ongoing pain symptoms are very real and can be distressing to try to live with. Scientists are learning more about vulval pain and what causes it. This leaflet aims to tell you more about this, and what other women living with persistent vulval pain have found helpful in managing it.
How is persistent vulval pain identified?
Doctors make the diagnosis based on asking questions about the symptoms and carrying out examinations.
Why do I have it?
The symptoms often begin seemingly ‘out of the blue’ with no obvious trigger. Sometimes women experience persistent vulval pain after childbirth, recurrent infections (e.g. thrush) or following another medical condition affecting the vulva. The pain can develop over time or start suddenly. Scientists are still trying to find out why some people develop this. We do know that it is linked with oversensitivity in the pain system.
We need pain signals to be sent when there is damage to our body requiring our attention. However, the pain system can ‘get stuck’ and continue to send signals when there is no damage. The problem can be that the pain nerve fibres become over sensitive. The nerve fibres in the vulval area send pain signals instead of recognising gentle touch or stretch.
A problem with the pain nerves does not show up on visual examination, blood tests, scans or other medical tests. This is why tests come back normal. It does not mean there is nothing wrong, but helps determine that it is a problem with pain signalling in the vulval area. The Pain Concern leaflet Neuropathic pain gives you further information regarding the science of the pain system.
Pudendal neuralgia is one form of vulval pain and results from pressure on the pudendal nerve which travels to the vulval area. Women with this condition often experience pain on sitting and can gain some relief from standing or lying.
What can help?
Learning more about the condition
People find it helpful to learn more about vulval pain. The Vulval Pain Society http://www.vulvalpainsociety.org/vps/ provides more information about different types of vulval pain, treatment options and links.
Pacing activities that aggravate pain (such as exercise, bending, squatting, and sitting) can help. Often people continue with an activity until the pain is very intense, then they are required to rest and recover. Pacing activity means completing a chunk of activity but then resting, or changing to a different activity, before the pain becomes more intense. Women with vulval pain often find it helpful to pace how long they sit for, perhaps alternating sitting with standing. A gel or donut cushion can help when sitting.
Some women find it more helpful to wear loose clothing and to consider things that may irritate the vulva. Creams, washing powder and feminine hygiene products (e.g. sanitary towels) are examples of potential irritants. It can be helpful to reduce possible causes of irritation.
Pelvic floor muscles
Pelvic floor muscle tension may be a cause of persistent vulval pain, or an unhelpful response to pain which makes things feel worse. We don’t always recognise tension in the pelvic floor muscles. Specialist physiotherapy assessment and treatment can be helpful. Physiotherapists use a range of techniques and aids to help relax unhelpful pelvic floor tension. There are physiotherapists who specialise in this area of work. Developing skills in relaxing the pelvic floor muscles can be helpful when there is pain on sexual intercourse.
Stress is not a cause of vulval pain but when we are stressed our pelvic floor muscles are often tense and this has been shown to be linked to pelvic pain. The chemicals that are released by our bodies when we are stressed (adrenaline and cortisol) have an impact on the nervous system. They act to ‘turn up the volume’ of pain signals. Living with vulval pain is life altering and this can be stressful, so it can help to manage stress levels. Practising a relaxation technique like progressive muscle relaxation, soothing rhythmic breathing, guided imagery or mindfulness meditation can be helpful. The Pain Concern leaflet Stress, Pain and Relaxation gives you more information about stress management.
There is no medication to cure vulval pain. Medication can help to lessen the symptoms. There is not one medicine that helps all. Some medicines act on the nervous system and aim to dampen down the oversensitive nerve fibres. Some women worry about the fact they have been prescribed an antidepressant medicine for pain. These medicines have lots of uses and this does not mean that your doctor thinks you are depressed, or that depression is the cause of pain.
Some women find creams and lotions can provide some relief. It is best to discuss which ones to use and how often to use them with your doctor to get the best advice for you. For women with a diagnosis of pudendal neuralgia, pudendal nerve block injections can be helpful.
The medical professionals involved in your care can give you advice on medical interventions for persistent vulval pain.
Adjusting to persistent pain
The duration of pain varies between women. For some they may experience pain for a couple of months and it then resolves. Others continue to experience some pain but it is much less intense. Persistent vulval pain may mean adapting to a new way of life taking the symptoms of the condition into consideration. Relationships, work and hobbies may all be affected. Coming to terms with these changes and making adjustments to ensure that life can still be enjoyed is a process. If you are struggling with this please seek support from your GP. It might be that there are local services to help, such as a pain management service.
Further information and help
Dr Shona Brown is clinical psychologist with EXPPECT, NHS Lothian’s multidisciplinary pelvic pain service.
Long-term pelvic pain
An award from The Women’s Fund for Scotland has allowed us to produce the
- Airing Pain programme 87: Vulvodynia radio programme 87 and accompanying leaflet, Vulval Pain
- Airing Pain programme 88: What to EXPPECT When You’re in Pelvic Pain and accompanying leaflet, Bladder Pain Syndrome.
Vulval Pain © Shona Brown. All rights Reserved. January 2018. To be reviewed January 2021.