How to Treat Vulvodynia

Vulvodynia is a chronic condition characterized by pain of the vulva (the external female genitals). The exact cause of pain is unknown but can be triggered by nerve injury, abnormal cell responses, genetic factors, infections, allergies, irritation, hormonal changes, antibiotics or muscle spasms.^{[1]XResearch source} For women suffering from vulvodynia, seeking medical treatment can be profoundly frustrating. Physicians may rule out a long list of possible causes for the pain, then conclude that it must be psychological. Additionally, since specific symptoms can vary and no single method of treatment works for everyone, finding a way to deal with vulvodynia often involves a great deal of trial and error.^{[2]XResearch source}

Method 1

Method 1 of 4:

Getting a Diagnosis

1
Make an appointment with your doctor. You will need to discuss your symptoms with either your primary care doctor or a gynecologist. Don’t be embarrassed to talk about the pain you are experiencing. You need to make sure the pain is not caused by another medical problem before you attempt to treat it.
- Vulvodynia has only one primary symptom – vulva pain. This pain is described differently by different women. It may feel like itching, burning, aching, throbbing, stinging or stabbing in the areas around the labia, clitoris or vaginal opening. It can come and go and be affected by touch or pressure.
- Some women with vulvodynia experience pain only during particular times – while exercising, for example, or during sexual intercourse.^{[3]XResearch source}
2
Undergo testing. If your doctor suspects you may have vulvodynia, he or she will probably perform an examination of your vulva area. There are also a few procedures and tests that the doctor may perform. These procedures can help pinpoint any problems that may be aggravating your symptoms.^{[4]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- It is common for your doctor to order blood tests to check hormone levels, such as estrogen, progesterone, and testosterone.
- The doctor will probably perform a cotton swab test. He or she will use a cotton swab to put gentle pressure on various locations of the vulva. You’ll be asked to describe any pain this test produces and rate its severity.^{[5]XResearch source}
- If any particular parts of your vulva appear to be especially painful, or if the skin looks inflamed or suspicious for any reason, your doctor may decide to take a biopsy.^{[6]XResearch source}
Vulvodynia is diagnosed only after a doctor excludes other diseases and conditions that may produce pain of the vulva. Your doctor may test you for sexually transmitted infections, skin disorders, yeast infections, hormone imbalances and other conditions that could be responsible for your symptoms. If all of these conditions are ruled out, he or she may diagnose you with vulvodynia.
4
Get a specific diagnosis. There are two kinds of vulvodynia: vulvar vestibulitis syndrome and dysesthetic vulvodynia.^{[7]XTrustworthy SourceAmerican Academy of Family PhysiciansOrganization devoted to improving the health of patients, families, and communitiesGo to source} Your doctor will diagnose you with one or the other, depending on what your symptoms are. Be sure to give your doctor as much information as possible.
- Vulvar vestibulitis syndrome (VVS) means you have a painful response to pressure or touch around the vaginal opening. Women with this type of vulvodynia usually experience pain during sexual intercourse, tampon insertion, gynecological exams and at any other time that pressure is placed on the vestibule (the area around the vaginal opening).
- Dysesthetic vulvodynia (DV) means you have a generalized pain of the vulvar area, which may affect the labia majora, labia minora, clitoris, perineum, anus, mons pubis, urethra and/or inner thighs. It can happen suddenly, and while the pain is usually present to some degree, symptoms can come and go. Touch or pressure does not usually cause the pain but can make the symptoms worse.^{[8]XResearch source}
If you don’t think your doctor is taking your symptoms seriously, find a different one. Some doctors do not understand that vulvodynia is a real problem that isn't just in your head. You need a medical specialist who will listen to you, support you and help you find the treatments that work for you. Be persistent in pursuing a diagnosis, and don’t give up.
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Method 2

Method 2 of 4:

Using Medical Treatments

1
Try topical medications. Local anesthetics may provide temporary pain relief from your symptoms. You can use an ointment with 5% lidocaine applied in a thin layer several times a day as needed. EMLA cream, which is 2.5% lidocaine and 2.5% prilocaine, is generally applied in a thin layer 15-20 minutes before sexual activity to prevent pain.^{[9]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Do not apply local anesthetics to broken or irritated skin.
- Local anesthetics will increase the likelihood of condom failure because the alcohol in the anesthetic can cause latex to tear. Make sure you and your partner have been tested for sexually transmitted infections, and use a back-up method of birth control.
- Patients with long-standing vulvodynia that does not respond to local anesthetics may get relief from receiving a nerve block.^{[10]XTrustworthy SourceAmerican College of Obstetricians and GynecologistsProfessional association of OB/GYNs focused on education and public outreat initiativesGo to source} Talk to your doctor about getting evaluated for a nerve block and see a trained anesthesiologist if you are considering this option.
2
Ask your doctor about hormonal treatments. Some patients with vulvodynia find relief with estrogen tablets or creams.^{[11]XTrustworthy SourceAmerican College of Obstetricians and GynecologistsProfessional association of OB/GYNs focused on education and public outreat initiativesGo to source} Applying estrogen products can relieve pain, itching, dryness, redness, urinary symptoms and pain during sexual intercourse.
- Estrogen therapy can be helpful for vulvar pain caused by atrophy (thinning of tissues and drying out).^{[12]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} Your doctor may recommend a 1% estradiol cream if other estrogen measures are not as helpful. However, some medications, such as oral contraceptive pills (OCP), can cause atrophic changes and lead to increased pain.
3
Consider antidepressants. Antidepressant medications are sometimes used successfully to treat chronic pain conditions that do not have a clear cause, such as vulvodynia.^{[13]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} Your doctor may suggest antidepressants (typically tricyclic antidepressants, or TCAs, which alter the way that the neurotransmitters in your brain transmit the signal of pain) as a possible treatment for vulvodynia.
- Amitriptyline, a TCA, is one of the most commonly prescribed medications for vulvodynia. Generally, patients start with a small dose of 10 milligrams taken orally at night. This dose is increased by 10 milligrams per week until you achieve an effective dose (never exceeding 150 milligrams). Your doctor will likely recommend that you stay at the effective dose for 3 months before tapering off the medication. In some women, the symptoms of vulvodynia do not reappear after treatment.
- Be aware of antidepressant side effects. Side effects of TCAs include drowsiness, weakness, fatigue, dry mouth, headache, and constipation. Notify your physician if these effects persist or worsen. Always seek immediate medical attention if you experience rashes, itching, swelling or difficulty in breathing while taking any medication.
- Effexor and Cymbalta (a separate class of drugs) have also been used for vulvodynia treatment.
4
Ask about anticonvulsant medications. Anticonvulsant medications can work to manage chronic pain conditions, including vulvodynia.^{[14]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} The most commonly prescribed medication in this class is called gabapentin. It works by altering the transmission of pain signals in the brain.
- Gabapentin dosages can vary considerably. Patients usually start with 300 milligrams orally each day, then gradually increase to reach an effective dose (never take more than 3600 milligrams a day). Common side effects include drowsiness, dizziness, headache, fatigue, nausea, dry mouth, constipation, unsteadiness, and fever. Notify your physician if these effects persist or worsen.
- Other medications include pregabalin which is similar to gabapentin. It is approved for postherpetic neuralgia it is now being used as an off-label drug for vulvar pain. Your doctor may start you on 50 mg of pregabalin three times a day. Your doctor may increase your dose to as much as 600 mg per day divided into three doses if you tolerate the drug and it is helping.
Your doctor may suggest that you try corticosteroids or antihistamines if you have itching, swelling or inflammation.^{[15]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} You may also be prescribed fluconazole to treat any yeast infections. Talk to your doctor to be sure that you are taking all your medications safely.
6
Discuss surgical treatment with your doctor. Surgery should only be considered when every possible alternative diagnosis has been ruled out and all other treatment options for vulvodynia have been exhausted. Furthermore, it may only be effective for women with vulvar vestibulitis syndrome.^{[16]XTrustworthy SourceAmerican College of Obstetricians and GynecologistsProfessional association of OB/GYNs focused on education and public outreat initiativesGo to source}
- See multiple specialists. Many physicians may not be well-versed in all treatment options for vulvodynia. See a second (and even a third) physician before agreeing to try surgery.
- Consider a vestibulectomy. If you have tried all other treatment options and sought a second opinion, you might consider a surgery called vestibulectomy.^{[17]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} This procedure involves the removal of the painful tissues of the vaginal vestibule (the area around the vaginal opening). This surgery is usually performed under either spinal or general anesthesia.
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Method 3

Method 3 of 4:

Trying Alternative Therapies

1
Find a physical therapist. Ask your doctor or gynecologist for a referral to a physical therapist with experience treating vulvodynia. A good physical therapist can use gentle manual manipulation to help you strengthen your pelvic floor muscles and deal with tension and pain.
- Some patients find that physical therapy alone reduces or eliminates their symptoms. However, you can certainly try physical therapy in combination with medication and other treatment options.
2
Try biofeedback. Biofeedback therapy is a technique in which patients learn to control and manipulate physical processes that usually occur involuntarily. Through biofeedback, patients with vulvodynia can learn to contract and relax the pelvic floor muscles voluntarily. ^{[18]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} This allows the patient more control over the way this area of the body responds to pain signals.
- Some patients find relief with biofeedback alone, but you can also combine the technique with medication or other treatment options.
Acupuncture is a medical technique that involves inserting very thin needles into specific points on your body. There is some evidence that it can relieve acute and chronic pain. It has been used to treat migraines, muscle problems, neurological conditions, reproductive ailments, and rheumatic diseases. Some patients with vulvodynia report that acupuncture relieves symptoms.^{[19]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source}
4
Find a counselor. Counseling can provide an important source of support, increasing your knowledge about your condition, helping you develop coping mechanisms and giving you a place to express your feelings about your condition. Vulvodynia can be stressful and upsetting, affecting your quality of life by limiting activities and making sexual and romantic relationships difficult. Counseling will help you deal with all of this.
- Note that counseling tends to be non-directive. Your counselor will listen to you and help you make your own decisions, but he or she will not typically give direct advice or suggest particular treatment options.
5
Consider cognitive-behavior therapy (CBT). CBT is a specific form of counseling that focuses on practical coping strategies. A cognitive-behavioral therapist will help you understand the way that you think, feel and act. He or she will then offer strategies for modifying your behaviors. For patients with vulvodynia, this can be an effective tool for dealing with symptoms.
- There is evidence that cognitive-behavior therapy, when adapted particularly for women with vulvodynia, can help you take control of your pain. This self-management therapy allows you to recognize the connection between your thoughts, feelings, and behaviors regarding pain, sexuality and emotional function.
In addition to counseling, consider other forms of support, such as support groups in your area or an online support group. It can be helpful to find others dealing with the same problem. Check your local hospital for information on support groups nearby.
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Method 4

Method 4 of 4:

Making Lifestyle Changes

1
Eat a diet high in probiotics. Daily probiotics have been shown to fight many digestive tract and genital tract infections. They can help to maintain a healthy level of good bacteria in your vagina and this may prevent infections.^{[20]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source} For patients with vulvodynia, a diet rich in probiotics may help fight inflammation and infections.
- Foods rich in probiotics include yogurt, kefir and sour cream. Look for yogurt that contains live and active cultures. You can also take probiotic supplements.
- In addition, you can also consume foods rich with pectin. Foods high in pectin enhance the work of probiotics by making digestion work more smoothly. Apples and citrus fruits are the best sources but berries, peaches, apricots, cherries, and grapes are also high in pectin.
2
Practice good hygiene. Wash your vulva with gentle, unscented soaps and rinse well. If urinating seems to increase your symptoms, rinse your vulva with cool water after you go to the bathroom.^{[21]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Avoid irritants. Replace any scented soaps, sprays, and lotions with unscented, chemical-free products. Similarly, replace nylon underwear (which traps moisture and can irritate your skin) with 100% cotton.
Some activities, such as bicycling and horseback riding, can trigger vulvar pain. Pay attention to physical activities that seem connected to your symptoms. Once you know which activities are contributing to the problem, try to avoid them as much as possible.^{[22]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
4
Try cold compresses. Applying a cold compress can also help with vulvar pain. Cold slows down blood flow and circulation. This can reduce pain and inflammation. Make a cold compress by wrapping ice in a towel or cloth and applying it to the affected area.^{[23]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Never apply ice directly to your skin.
Lubricants can help with vulvar pain during sex. If you are able to have sexual intercourse, look for a water-soluble lubricant rather than an oil-based lubricant. An oil-based lubricant may contain chemicals that can aggravate your symptoms. Avoid any lubricants with added sugars or glycerin because these can also irritate your skin.^{[24]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
6
Take a sitz bath (a sitz bath is a warm water bath used for healing or cleansing purposes. the water covers only your hips and buttocks) with oatmeal or baking soda. Oatmeal contains anti-inflammatory substances called avenanthramides. These substances can reduce pain, irritation, and itchiness. Also, try baking soda--it is alkaline and can help regulate vaginal pH levels. This may correct excess acidity that can contribute to itching and burning.^{[25]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- For an oatmeal bath, dissolve one sachet of powdered oatmeal into your bathwater and bathe for 20 minutes.
- For a baking soda bath, mix 4 to 5 tablespoons (59.1 to 73.9 ml) of baking soda into your bathwater and bathe for 15 to 20 minutes.
7
Consider trying a low-oxalate diet. Oxalates are compounds found in plant foods that bind to minerals and reduce their absorption. Some doctors recommend a low oxalate diet for vulvodynia because foods high in oxalates can produce urine that is irritating, and this may contribute to vulvar pain.^{[26]XTrustworthy SourceAmerican Academy of Family PhysiciansOrganization devoted to improving the health of patients, families, and communitiesGo to source} Talk to your doctor about your urine oxalate levels, and consider modifying your diet accordingly.
- Foods high in oxalates include chocolate, berries, spinach, and nuts.
- You can also take a calcium citrate supplement. Calcium citrate may inhibit the growth of oxalate crystals, relieving pain and itching. Consider taking 200-250 milligrams of calcium citrate 3 times daily.
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Expert Q&A

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Question
Is Epsom salt effective for treating vulvodynia?
Chris M. Matsko, MD
Family Medicine Physician
Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017.
Chris M. Matsko, MD
Family Medicine Physician
Expert Answer
No, but baking soda is a good alternative for a sitz bath. It helps control the pH of the vagina.
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