The vulva is the name of the external genitalia in females. Pain or discomfort in these sensitive tissues can result from various factors, ranging from riding a bicycle to cancer.
Studies suggest that up to 15% of females experience vulvar pain. This can affect quality of life, and in some cases, it may indicate a medical condition that needs treatment.
In other cases, lifestyle remedies can help resolve this symptom.
In this article, we look at a variety of causes of vulvar pain, the treatment options available, and home remedies that may help ease the discomfort.
The vulva is the area comprising the external genitals in females. It contains several different structures, including:
The labia majora, or outer lips: These skin folds surround the vagina and other vulvar structures. Hair usually covers the outer surfaces.
The labia minora, or inner lips: These are the smaller, inner skin folds. They do not have hair on them. The labia minora meet at a small structure known as the prepuce, or the hood, which protects the clitoris.
The clitoris: The clitoris is a small piece of tissue that contains many nerve endings. It swells with blood during sexual stimulation.
The vestibule: The opening of the vagina, or vestibule, contains small Bartholin glands. These secrete a fluid that acts as a lubricant during sexual activity.
Vulvar pain can occur in any of these structures, and it can develop for different reasons.
Females who experience vulvar pain may use the following words to describe it:
Localized pain occurs in one spot. Generalized pain affects the whole vulva.
Pain can result from pressure or touch, or it can occur without any apparent trigger or provocation. For some females, the pain comes and goes, but for others, it can be constant.
Activities that can trigger vulvar pain include:
- sexual activity
- inserting a tampon
- wearing tight or form fitting jeans
Vulvodynia and vestibulodynia result from a hypersensitivity of the nerve endings in the skin of the vulva. Learn more about these conditions here.
Vulvar pain has many possible causes, including:
Chronic yeast infections and bacterial infections can both cause pain that ranges from mild discomfort and itching to severe burning or throbbing.
Tissue and nerve damage
The vulva contains sensitive tissues and nerve endings. Childbirth, sexual activity, and riding a bicycle or horse can all damage these nerve endings, possibly resulting in pain and discomfort.
Tarlov cysts occur at the base of the spine, where they either affect or involve nerve roots. They can also cause vulvar pain.
Chronic pain conditions
Research suggests that women who have vulvodynia are more likely to also have another chronic pain condition.
Allergies to soaps or hygiene products can cause pain, discomfort, and irritation in the genital area. Inflammation may also occur.
Hormonal changes occur with menopause and menstruation. These changes can cause sensitive tissues to become swollen, inflamed, or dry and uncomfortable.
Some females may also develop genitourinary syndrome after menopause. Symptoms of this condition include a dry vagina, vulvar pain, pain during sex, and bladder problems.
What makes sex painful? Find out more here.
A number of skin problems can also lead to vulvar pain.
Folliculitis: When bacteria infect a hair follicle, small, red, painful bumps can develop.
Contact dermatitis: Itching, stinging, and pain can result from using some soaps, fabrics, and perfumes.
Bartholin gland cyst: A blockage in one of these glands can cause a cyst, which may be painful.
Lichen simplex chronicus: A person with long term contact dermatitis or another skin condition can develop plaques of thickened, scaly skin that can be very itchy.
Lichen sclerosus: This can cause the skin to change in color and texture. There may also be pain during sex, and the skin may tear easily.
Lichen planus: The skin may develop a white surface or white streaks, and there may be pink bumps or lumps.
Symptoms of vulvar cancer include:
- itching, burning, and pain
- lumps, which may have a wart-like or raw surface
- open sores that last for a month or more
- changes in skin color
- thickening of the skin
Depending on the type of cancer, there may also be:
- changes in the shape, size, or color of a mole
- red, scaly skin, which may indicate Paget's disease
Various conditions can give rise to genital warts. These are usually benign, but some can be cancerous. Anyone with new or unexplained changes to the skin of the vulva should see a doctor to find out what is causing them.
Vulvar cancer accounts for 0.7% of all cancers in the United States, and 1 female in 333 will develop it at some point in their lives.
Find out more about the symptoms, causes, and treatment of vulvar cancer here.
Vulvar intraepithelial neoplasia
Vulvar intraepithelial neoplasia refers to cell changes that are not cancer but could become cancerous in the future.
The condition can cause itching, burning, and changes in skin color and texture. A healthcare provider will likely treat these to prevent cancer from developing in the future.
Treatment depends on the specific cause of the vulvar pain.
A doctor may prescribe:
- medication to treat an infection
- pain relief medication to ease discomfort
- topical steroids to relieve allergies
- hormone therapy to manage menopause-related changes
- surgery to repair an injury
A therapist or physical therapist can help relieve tight muscles and address chronic pain or anxiety.
Other options for treatment may include:
This may help reduce vulvar pain by teaching a person how to relax their pelvic floor muscles. Biofeedback can also help a person learn to control their body's response to pain triggers.
These are usually ointments that numb the nerves. A person can apply these 20–30 minutes before sexual activity to prevent or relieve feelings of pain or discomfort.
Pelvic floor therapy
In some cases, this can help relax the muscles in the pelvis and relieve muscle pain and tension. Strengthening these muscles supports the organs in the pelvis, including the bladder, uterus, and rectum. It also helps relax them.
Other physical therapy strategies include exercises, massage, soft tissue manipulation, and joint mobilization.
A nerve block may help if the pain interferes with a person's daily life, and if other treatments or therapies do not help.
A health professional will inject a numbing medicine into the nerves that supply the external genitals. This blocks pain receptors and can relieve discomfort in the area.
Several home strategies can help reduce pain or discomfort in the vulva. These include the following.
Being mindful of hygiene products: Females who experience vulvar pain should try to avoid using products that can irritate the area, such as scented products or strong soaps.
They should also try to choose 100% cotton menstrual pads and tampons and avoid products that contain plastic or synthetic materials.
Not douching: The vagina is self-cleaning, so there is no need to use douches or other cleansers. These products can be irritating, especially when vulvar pain or discomfort is present.
No cosmetic product is suitable for putting into the vagina.
Bathing the vulva: Rinse the genital area with warm water and pat it dry with a towel.
Getting support: Vulvodynia can affect a person's self-esteem and intimacy with others. Support groups and therapists can help people and their partners learn to manage the condition. A doctor can advise on local contacts.
Avoiding tight clothing: Wearing tight clothing and synthetic fabrics, such as spandex or Lycra, can trigger vulvar pain. Loose fitting, cotton clothes are least likely to trigger symptoms.
Using sitz baths: Sitting in a few inches of warm water with a teaspoon of Epsom salt can help relieve irritation. Epsom salt is available for purchase online.
Some may find it embarrassing to talk about vulvar pain or discomfort with their doctor.
It is important to remember that the doctor is a professional and is trained to help with all medical issues. However, it may be possible to request a female doctor if it will increase patient comfort during the appointment.
Vulvar pain can affect quality of life. In some cases, it can indicate a condition that needs medical attention, such as an infection or cancer.
A doctor can recommend effective treatment options for most causes of vulvar pain.