Vulvar and Vaginal Pain

Houston Methodist helps women who have struggled for months or even years to find relief from vulvar pain and other chronic pain conditions of the vulva and vagina. Our OB-GYN specialists diagnose and treat autoimmune disorders, inflammatory skin conditions, nerve pain and vaginal conditions that many patients live with long before finding real answers, treatment and support.

We routinely help women who travel throughout the southeastern United States in search of care for untreated conditions that have left them feeling misunderstood and frustrated. We get to know our patients and their medical histories, providing compassionate and individualized care, as well as improving their quality of life.

What Is Vulvar Pain?

Vulvar pain is any pain, burning, stinging, rawness or soreness in the vulva, the external genital area that includes the labia minora, clitoris and the opening of the urethra. Pain and inflammation may also extend into the vagina. It can be constant, or it may come and go. This type of gynecologic pain has a wide range of possible causes, from skin conditions to nerve pain and infection. One of the most common underlying causes is vulvodynia, a chronic pain condition. However, not all vulvar pain is due to vulvodynia, so an accurate diagnosis prior to treatment is critical.

Why Choose Houston Methodist for Vulvar Pain Care

Living with a chronic pain condition that other doctors have dismissed or misdiagnosed takes a toll, and finding a specialist who takes that pain seriously is often the hardest part of getting better.

Look for an OB-GYN or pelvic health specialist with specific experience in vulvar and vaginal pain conditions, and not just general gynecology. Houston Methodist’s expert team of specialists combines that focused experience with the compassionate, individualized care patients need to finally get answers.

Common Causes of Vulvar Pain and Inflammation

Vulvar pain is more than an annoyance. It’s typically a symptom of an underlying condition that can have a dramatic impact on a person’s quality of life, affecting their self-esteem, mental health and sexual intimacy. Conditions that typically lead to vulvar or vaginal pain and inflammation include:

• Lichen planus: An inflammatory skin and mucous membrane condition causing discharge, pain, burning and itching
• Lichen sclerosus: Causes thin, shiny white patches and soreness in the genital area
• Lichen simplex chronicus: Persistent itching and scratching of the vulvar skin, often creating a cycle that’s hard to break without treatment
• Recurrent vaginal infections: Including chronic yeast infections and repeat urinary tract infections (UTIs), both of which can mimic or worsen vulvar pain
• Vaginismus: Involuntary muscle spasms of the pelvic floor muscles that cause vaginal squeezing or tightness in anticipation of penetration
• Vulvodynia: Chronic pain, burning or stinging in the vulva lasting three months or longer with no other identifiable cause

Signs and Symptoms of Vulvar Pain and Vulvodynia

Vulvar or vaginal pain and inflammation may be symptoms of an underlying condition, or it could be the condition itself. Many conditions that affect the vulva and the vagina have similar signs and symptoms, which may include the following:

• Burning and stinging: Not all vulval pain is the same. Instead of an ache or a sharp pain, most patients report a burning or stinging sensation that can happen while at rest or as a result of touching the affected area.
• Rawness and soreness: Many women describe their vulva area as feeling raw or sore to the touch. Some say it can feel similar to a friction injury, even though there has been no external action to cause it.
• Throbbing pain: While burning and rawness are more common, some patients say they experience a throbbing ache that may be triggered by touch, but can linger even while they’re at rest.
• Painful intercourse: Dyspareunia, or painful intercourse, is one of the most disruptive symptoms of vulvar pain. It is also what most frequently prompts a woman to see a specialist.
• Difficulty with touch: Any type of pressure to the vulvar region can trigger pain or discomfort. This may include tampon insertion, sitting for long periods or wearing clothing or underwear that is tight-fitting. External pressure can be a major trigger for vestibulodynia (pain at the vestibule, or entrance to the vagina) or vaginismus.
• Swelling and irritation: Inflammation of the vulvar skin or the vagina can cause significant pain and irritation, and accompanies many of these gynecological conditions, particularly lichen sclerosus and lichen planus.

How Vulvar Pain Is Diagnosed

Because vulvar pain has many possible causes, diagnosis often means ruling out conditions one by one before confirming what’s actually behind the pain.

• Pelvic exam: A physical exam of the vulva and vagina to check for visible skin changes, infection or other abnormalities.
• Cotton swab test: A gentle touch test used to map where and how intensely the pain occurs, often used when vulvodynia is suspected.
• Biopsy: A small tissue sample may be taken if a skin condition like lichen sclerosus or lichen planus is suspected.
• Ruling out other conditions: Your specialist may also screen for yeast infections, urinary tract infections and, when relevant, endometriosis, since these can cause overlapping symptoms.

Treatment Options for Vulvar Pain

There are many ways to treat vulvar pain and vaginal inflammation, though the best course of treatment will depend on the diagnosis and specific type of condition. Most OB-GYNs will take a conservative approach to start, though surgical procedures may be recommended in rare and severe cases.

Non-Surgical Treatment

This is nearly always the first course of action for most causes of vulvar pain, and may include:

• Topical medications, including estrogen creams for vaginal dryness related to menopause and numbing agents for localized vulvodynia
• Oral medications, including antidepressants and anticonvulsants used to calm nerve-related pain
• MonaLisa Touch®: A minimally invasive laser treatment for vulva disorders and vaginal discomforts (dryness, burning) commonly experienced by women due to a decline in estrogen levels during menopause or after childbirth. This simple in-office procedure (typically three short treatments over 18 weeks) resolves estrogen drops in the vaginal wall tissue by reactivating the production of new collagen and reestablishing healthy conditions in the vaginal mucosa.
• Nerve blocks
• Pelvic floor physical therapy and exercises
• Lifestyle changes, such as switching to cotton underwear and using a gentle lubricant during intercourse
• Cognitive behavior therapy
• Sexual counseling

Surgical Treatment

Minimally invasive surgery may be recommended for structural or skin-related causes of pain.

• Vestibulectomy: Surgical removal of painful tissue in the vestibule, generally reserved for localized vulvodynia that hasn’t responded to other treatments.