Vulvodynia

What it is

Vulvodynia is chronic vulvar pain — burning, stinging, throbbing or irritation — that lasts at least three months and is not explained by infection, skin disease or another identifiable cause. It can be generalized or localized to the vaginal entrance (vestibulodynia), spontaneous or triggered by touch, tampon use, tight clothing or sexual intercourse, which often becomes impossible. It is estimated to affect one in ten women at some point in life, and diagnosis is often delayed because test results tend to be normal. The assessment includes a detailed history, examination of the vulva with the cotton-swab test, and the exclusion of other causes. Treatment is multidisciplinary and may combine local care, medication for neuropathic pain, pelvic floor physical therapy, topical anesthetics and psychological support or sex therapy.

Most common symptoms

• Burning, stinging or throbbing pain in the vulva for three months or more
• Pain on touch at the vaginal entrance, such as when using a tampon
• Pain or inability to have penetrative intercourse
• Discomfort with tight clothing or sitting for long periods
• A raw, irritated feeling with no visible lesion
• Repeatedly normal test results despite the pain

Causes and risk factors

• Cause not fully understood, involving sensitization of the vulvar nerves
• Tension and hypertonicity of the pelvic floor muscles
• History of recurrent yeast infections or vulvar inflammation
• Hormonal changes, such as those of menopause or contraceptive use
• Emotional factors, such as anxiety and stress, that amplify the pain
• Genetic predisposition and other chronic pain syndromes

How it is diagnosed

The assessment begins with a detailed conversation about the type of pain, when it started, what triggers it, and how it affects sexual life and daily activities. During the exam, your gynecologist carefully inspects the vulva and performs the cotton-swab test, touching specific points to map the pain, along with assessing the tone of the pelvic floor muscles. Discharge tests and, if necessary, a biopsy help rule out infections and skin diseases, since vulvodynia is a diagnosis of exclusion.

How we treat it at Femi Saúde

Treatment for vulvodynia is multidisciplinary and built in stages. The gynecology team at Femi Saúde starts with guidance on local care, such as avoiding irritants and using moisturizers or topical anesthetics, and treats associated conditions such as yeast infections or atrophy. Medication for neuropathic pain may be indicated depending on the case. Pelvic floor physical therapy is one of the pillars, especially when there is muscle tension, and psychological support or sex therapy help address the impact of the pain on intimacy. In selected cases, technologies such as intimate laser may be considered. The plan is individualized and reviewed throughout follow-up.

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