Vulvodynia - Diagnosis and Treatment

Diagnosis

Diagnosing vulvodynia involves several steps. A health professional usually begins by asking about your health, past surgeries, medical conditions, and sexual history.

These questions help rule out other possible causes and guide the next steps. A pelvic exam usually comes next. The doctor checks the outside genitals and the vagina for signs of infection or other problems.

The doctor may take a sample of vaginal cells to test for yeast or bacterial infections. The doctor might also gently press on pelvic floor muscles with a gloved finger to check for tenderness.

A cotton swab test often follows. The doctor touches different areas of the vulva with a wet cotton swab to find painful spots.

You describe how the pain feels and rate its intensity. This test helps the doctor see if the pain is widespread or in one area.

In some cases, the doctor does a biopsy to examine skin changes more closely. A blood test may also check hormone levels like estrogen, progesterone, and testosterone.

Typical Steps in Diagnosis

Step	What It Checks For
Medical History	Other health problems, past surgeries
Pelvic Exam	Infections, abnormal tissue, muscle tenderness
Cotton Swab Test	Location and intensity of pain
Biopsy	Unusual skin changes
Blood Test	Hormone levels

Doctors do not always know what causes vulvodynia, and it can affect people of any age. It is estimated that vulvodynia affects many women, though the exact prevalence is unknown.

Doctors use a careful process of elimination to plan the best treatment.

Treatment

Medicine-Based Options

Many people with vulvodynia use different types of medicine to control pain. The right treatment depends on your symptoms and how you respond to certain drugs.

Medicine Type	Purpose	Notes
Antidepressants or Anticonvulsants	Lower ongoing pain	Can be used as pills or skin creams
Local anesthetics	Numb the area briefly	Lidocaine ointment can ease discomfort during activities such as sex; may cause numbness for partners
Nerve blocks	Interrupt pain signals	Shots near nerves for those with stubborn pain
Hormone creams	Address hormone-related vulvodynia	Creams like estrogen, sometimes paired with testosterone
Antihistamines	Control itching	May be used for those with bothersome itching

Doctors often include medications as part of a larger treatment plan. They may change the medicine or dose if side effects appear or if it does not work well.

Non-Medicine Therapies

Physical therapy and psychological support can help manage pain and improve daily life and relationships.

Physical Therapy Approaches

Pelvic Floor Exercises: Physical therapists teach stretching and relaxation routines if pelvic muscles are tight or painful. They may suggest at-home tools, such as vaginal dilators, to gently stretch the vaginal area and reduce pain during touch or sex.
Biofeedback: This technique shows how your body responds to pain and teaches you how to relax tense muscles. By learning to control these reactions, you may feel more comfortable and active.

Talk and Relationship Therapy

Cognitive behavioral therapy (CBT): CBT helps you change negative thoughts about pain. Keeping a pain diary can help track triggers and relief. Mental health professionals can teach better ways to respond to pain and lower stress linked to symptoms.
Couples and Sex Therapy: These therapies help partners talk openly and find ways to share closeness without pain. Counseling also offers safe support if relationship problems or past trauma make symptoms worse.

A team approach, with different health experts working together, often gives people more ways to manage symptoms.

Surgical and Other Techniques

Doctors rarely suggest surgery, but it may help people with severe pain near the vaginal opening when other treatments have not worked.

Vestibulectomy: In this operation, the surgeon removes painful tissue around the entrance to the vagina. The main goal is to lessen or stop pain for people with symptoms in this area.

Pros	Cons
May relieve pain when other methods fail	Risks include scarring, infection, or more pain; not suitable for pain outside the targeted area.

If you are thinking about surgery, talk with your health team about all possible benefits and risks. Not everyone with vulvodynia needs or benefits from surgery, and doctors usually try other methods first.

Nontraditional Care Options

Some people look for options outside regular medical treatments to help with vulvodynia symptoms. Acupuncture uses thin needles placed at specific points on the body by a trained professional.

Hypnosis uses guided relaxation to help reduce pain and tension.

Mindfulness and meditation techniques, which you can learn through practice or with apps, may also help lower discomfort.

Method	Description
Acupuncture	Thin needles used at key body points
Hypnosis	Guided state of relaxation
Mindfulness/Meditation	Focused breathing and awareness techniques
Transcutaneous Electrical Nerve Stimulation	Mild electrical currents applied to skin

Managing stress through yoga or meditation can also help, since stress might make symptoms worse.

Daily Tips and Self-Care at Home

Home care for vulvodynia focuses on comfort and protecting sensitive skin. Simple changes to routines can help reduce irritation and pain.

Work and Rest:

Use a foam donut cushion if you sit for long periods.
Stand up often to reduce pressure on the vulva.

Exercise:

Limit activities with a lot of friction or impact, like running.
After exercise, apply a cold gel pack wrapped in a towel to the area for up to 15 minutes.
Try to avoid biking or horseback riding, as these put extra pressure on the area.

Washing and Bathing:

Wash the vulva gently with plain, lukewarm, or cool water using your hand.
Pat the area dry and apply a preservative-free moisturizer, such as plain petroleum jelly.
Avoid scented and colored products like bubble baths, perfumed soaps, and feminine sprays.
Soak in a sitz bath with lukewarm or cool water, Epsom salts, or colloidal oatmeal for 5–10 minutes, two or three times a day.
Stay out of hot tubs and avoid hot baths, since heat can make irritation worse.
Swimming in pools with low chlorine levels is less likely to cause irritation.

Hygiene Habits:

Use pads or tampons without perfumes or deodorants. Choose 100% cotton options.
Use only soft, white, unscented toilet paper.
Do not wait until your bladder feels very full to urinate.
After urinating, rinse the vulva with water and gently pat dry.

Clothing and Laundry:

Wear loose-fitting clothes and 100% cotton underwear to let air flow.
Try skipping underwear when sleeping for extra comfort.
Use thigh-high or knee-high hose instead of pantyhose.
Change out of sweaty exercise clothes or wet swimsuits right away.
Use laundry detergents for sensitive skin and skip fabric softeners on underwear.
Use the extra rinse option on your washing machine for clothes that touch the vulva.

Sexual Activity:

Use only water-based personal lubricants before sex. Avoid lubricants with alcohol, perfumes, flavors, dye, or heating/cooling effects.
Some birth control methods, like spermicide or creams, may cause irritation. Talk to your healthcare provider about alternatives.
Always urinate after sex. Rinse the vulva with cool water and pat dry.
If burning occurs, use a wrapped cold pack or gel pack on the area for 15 minutes.

Helpful Table: Common Triggers and Safer Choices

To Avoid	Safer Choice
Tight synthetic clothing	Loose, cotton clothes
Scented feminine products	Unscented, plain products
Hot tubs, hot baths	Cool sitz baths
Deodorant pads/tampons	100% cotton options
High-impact exercises	Low-impact, gentle activity

Adjust daily habits to avoid triggers.
Gentle care helps prevent extra irritation.
Small changes to clothing, hygiene, and routines can improve comfort.

For more information or personal advice, visit Healthnile or speak with a health professional.

Ways to Manage and Find Support

Connecting with others who have vulvodynia can help reduce feelings of isolation. Support groups, either in-person or online, offer a place to share tips and stories.

Method	Description
Support Groups	Share experiences and advice with others.
Professional Help	Talk to a counselor familiar with vulvodynia.

If you do not feel comfortable joining a group, ask a healthcare professional for a counselor who knows how to help people manage vulvodynia.

Getting Ready for Your Visit

Steps You Can Take Before Your Visit

A little preparation helps you get the most out of your medical appointment.

Try these steps before you go:

Track Your Symptoms: Make a list of any discomfort, pain, or changes you have noticed. Write down when these started and if they change at certain times, such as after sexual activity.
List Your Medical History: Note any health problems, surgeries, or treatments you have had in the past.
Write Down Medications: Include all prescription drugs, over-the-counter medicines, vitamins, and supplements. Write the dose for each one.
Prepare Questions: Think about what you want to ask the doctor. Some examples include:
- What could be causing my symptoms?
- Are any tests needed?
- Which treatments work best for my symptoms?
- How soon can I expect to feel better?
- Can I still have sex, or should I change anything about my sexual habits?
- How can I manage my other health issues with this condition?

Bring your lists and questions to your visit for easy reference.

Common Topics the Doctor May Discuss

During the appointment, the doctor may ask questions to better understand your situation.

Being ready for these questions can help you give clear answers.

Pain Details: The doctor may ask about the intensity, length, and type of pain.
Triggers: The doctor often asks if certain actions, like sex, exercise, or using the bathroom, cause pain.
Menstrual Details: You can mention if your cycle affects your symptoms.
Other Health Factors: The doctor may ask about past surgeries, current pregnancy, or history of infections.
Symptom Changes: The doctor may ask what helps or worsens your symptoms.

Vulvodynia – Diagnosis and Treatment