Tips for Chronic Vulvar Pain Management

Background

Vulvar pain or burning can be caused by several different conditions. The term vulvodynia just means pain and does not indicate what the cause of the pain is. Sometimes vulvar pain is due to chronic recurrent yeast vaginitis and vulvitis. At other times the pain may be due to a chronic irritant vulvitis in which the skin has been subject to toxic or topical allergens or even chronic urinary leakage that inflames the skin of the vulva. There may also be conditions that produce chronic pain such as vulvar vestibulitis or lichen sclerosis of vulva. In almost all of these conditions there can be a secondary yeast or bacterial inflammatory process that causes the vulvar skin to hurt. Sometimes in conditions such as vulvar vestibulitis or unexplained vulvodynia, there is thought to be nerve pain in which the basic process is more an inflammation of the nerves that causes pain as opposed to an inflammatory process of the skin.

Reducing Vulvar Skin Irritation

Many products have chemicals in them that will irritate the sensitive vulvar skin. Soaps, douches, bubble baths, condom lubricants, creams, and even scented sanitary napkins and pads. Once a woman has vulvar irritation she should avoid putting any products on the vulvar area that may contain chemicals. We suggest using only water to wash the vulva with and not even a mild soap. The vulvar should then be air dried after washing or lighted patted dry with a cotton towel. No rubbing should take place.

Vaginal secretions may contain bacteria and usually are acid pH. These secretions can further irritate the already inflamed or painful skin. Sometimes a tampon can be used in the vagina to block secretions so that they do not get on the outside. This will diagnose if the vaginal secretions are the main problem. Another prevention treatment may be to protect the vulvar skin with a petroleum based ointment. Obviously the skin can also be sensitive to an ointment so this is not the first choice to protect the vulva but if urine is dripping over the vulva with bladder incontinence episodes or the vulvar skin is rubbing together because of sweating, exercise, tight underwear pants or pantyhose, then a mild ointment may be used. Plain Vaseline or a vegetable based oil ointment may be preferable unless a woman knows that she has sensitivity to that.

Moistness of the vulvar skin per se does not cause inflammation, however if the skin stays moist because of sweating or constant vaginal or urine discharge, skin bacteria proliferate and may cause a secondary dermatitis. It is recommended that women use full cotton undergarments which help absorb any excess moisture or sweat. They should also refrain from using any tight clothes that keep the legs together such as bluejeans or pantyhose. Women with vulvar skin irritation should also avoid crossing their legs because that puts opposing skin surfaces together and worsens irritation. While it is not necessary to sit with the legs wide open, any opportunity to keep the legs slightly apart will help keep the vulvar skin dry and clean from proliferating body bacteria.

Women who are having any moderate or severe of the vulvar area, any chaffing or splitting of the vulvar skin should avoid vaginal intercourse while pain is present. The friction of vaginal intercourse only makes the skin irritation worse. If a woman has mild irritation and wants to use a lubricant, this is allowed. A non-scented mineral or vegetable oil serves as a very good lubricant. Also, bioadhesive vaginal lubricants can be used on the vulvar area.

Women who have vaginal intercourse in spite of feeling a fair amount of vulvar pain are much more likely to develop involuntary vaginal muscle contracture called vaginismus. They may also develop loss of sexual desire because of the fear of pain with intercourse. This is especially true after the menopause when more natural dryness takes place. Painful intercourse leads to fear of intercourse and a decreased sexual desire. If the vulvar pain is a chronic long standing problem, a woman and her partner will need to discuss non-intercourse methods of sexual satisfaction.

For conditions of vulvar vestibulitis or unexplained vulvodynia in which the skin does not show an inflammatory response, medical therapies as well as other procedural therapies may need to be considered in order to lessen the pain from nerve involvement. Be sure to discuss these with the doctor. Building Up or Thickening the Vulvar Skin Sometimes the vulvar skin becomes very thin and thus more susceptible to any sort of irritation or inflammation. This is much more common after the menopause or in any hypoestrogenic states. The skin just outside they hymeneal ring at the entrance to the vagina is usually not very sensitive to estrogen treatment. Sometimes the estrogens can produce more vaginal secretions and thus help the vulvar skin, but for the most part topical estrogens do not tend to thicken the skin outside the hymenal ring. Testosterone, 2% in an ointment base may sometimes help to thicken the skin in this area. If you think that the skin is overly dry and thin you might want to discuss the use of a topical testosterone ointment with your physician. Topical steroid creams will thin the skin in this area should be used only sparingly as your doctor prescribes.

Only water - no soap - on the vulva and avoid pads. Use tampons to prevent vaginal discharge as the vulvar irritant or use an ointment to protect against urine or sweat as a skin irritant. If intercourse is painful avoid if altogether while working with your doctor and partner for treatment and alternatives.