Vulvodynia Overview

Vulvodynia is characterized by pain or discomfort in the vulva that lasts for at least 3 months. People with this condition have described the pain in varying ways (e.g., burning, stinging, itching, aching), and the pain may be sporadic or constant. Vulvodynia can also be described by the location of the pain (generalized or localized vulvodynia) or whether the pain is triggered by contact with the vulva or not (provoked or spontaneous vulvodynia).¹ This condition can impair a woman’s quality of life by making certain activities, including having sex, using a tampon, or even sitting, difficult.²

Vulvodynia does not have a clear cause, and diagnosis is often delayed because other potential causes of vulvar pain must first be ruled out.³ Some potential causes or contributing factors that have been suggested include injuries to the nerves of the vulva, a history of physical or psychological trauma, dysfunction or hypertonicity of the pelvic floor muscles, changes to hormone receptors, a history of recurrent vaginal infections (e.g., yeast infections), lipid dysbiosis, heightened innervation of the vaginal tissue, or increased activity and density of nociceptors.^{1 , 4 - 7} Genetic factors, such as inherited mutations in the genes that are involved in immune recognition, may also play a role.^{7 , 8}

Treatment for vulvodynia will vary between individual patients, and most women will probably require a combination of treatments. Some of the medications that are used to treat vulvodynia include tricyclic antidepressants, antihistamines, anticonvulsants (e.g., gabapentin), topical medications (e.g., lidocaine, hormonal creams), or injected medications (e.g., botulinum toxin).^{3 , 9 - 11} Specific types of physical or psychological therapy (e.g., cognitive behavior therapy) may also be part of a treatment plan.^{3 , 12 , 13} Surgical removal of vestibule tissue may be necessary if other therapies fail.¹⁴

Researchers are working to expand our understanding of vulvodynia in order to improve treatments for this disease and for common comorbid conditions, such as depression. Other active areas of research include developing reliable diagnostic tests, identifying quantitative outcome measures that can be used to evaluate potential treatments, and recognizing the modifiable environmental triggers of vulvodynia.

At NIH, research support for female pelvic pain comes primarily through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). One NICHD-supported study is focusing on identifying new therapeutic targets for women with localized, provoked vulvodynia. The research team has singled out one likely target, transient receptor potential vanilloid receptor 4 (TRPV4), and is now exploring the role that this receptor and its signaling pathway play in vulvodynia and other pain conditions.¹⁵