Vulvodynia, also known as vulvar dysesthesia, literally means pain, or an unpleasant altered sensation, in the vulva. It is characterized by itching, burning, stinging or stabbing in the area around the opening of the vagina. Pain can be unprovoked, varying from constant to intermittent, or occur only on provocation such as attempted vaginal penetration with sexual intercourse (dyspareunia), a condition also known as vestibulodynia, or vulvar vestibulitis syndrome (vvs).
Symptoms may be highly localized at certain points or may be quite diffuse and may range from mildly irritating to completely disabling. While a distinct sore, or area of redness may be visible, often thevulva and the vagina show no abnormalities or infections on gynecological and/or dermatological evaluation. Unfortunately, many doctors are unaware that these conditions even exist, and may mistakenly suggest to patients that this is a psychological condition. It is common for women with vulvodynia to suffer for many years and see many doctors before being correctly diagnosed.
Vulvodynia, simply put, is chronic vulvar pain without an identifiable cause. The location, constancy and severity of the pain vary among sufferers. Some women experience pain in only one area of the vulva, while others experience pain in multiple areas. The most commonly reported symptom is burning, but women’s descriptions of the pain vary. One woman reported her pain felt like “acid being poured on my skin,” while another described it as “constant knife-like pain.”
There are two main subtypes of vulvodynia, which sometimes co-exist:
Vulvar Vestibulitis Syndrome
(aka Provoked Vestibulodynia)
As shown in the diagram below, vulvar vestibulitis syndrome (VVS) is characterized by pain limited to the vestibule, the area surrounding the opening of the vagina. It occurs during or after pressure is applied to the vestibule, e.g., with sexual intercourse, tampon insertion, a gynecologic examination, prolonged sitting and/or wearing fitted pants.
VVS is further classified as Primary or Secondary. Women with Primary VVS have experienced vestibular pain since the first attempt at vaginal penetration. Women with Secondary VVS have experienced pain-free sexual intercourse prior to the development of pain.
For women with generalized vulvodynia (GV), pain occurs spontaneously and is relatively constant, but there can be some periods of symptom relief. Activities that apply pressure to the vulva, such as prolonged sitting or simply wearing pants, typically exacerbate symptoms.
Some women experience pain in a specific area, e.g., only in the left labia or near the clitoris, while others experience pain in multiple areas, e.g., in the labia, vestibule, and clitoris. In the latter group, pain may also occur in the perineum and inner thighs, as demonstrated in the diagram on the right.