What are the causes and treatments for vulvar pain?

Studies suggest that up to 16% of females in the United States experience vulvar pain. This can affect a person’s quality of life, and in some cases, it may be an indication of a medical condition that needs treatment.

In other cases, lifestyle remedies can help resolve this symptom.

This article examines various causes of vulvar pain, treatment options, and home remedies that may help ease discomfort.

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The appearance and symptoms of vulvar pain vary depending on their cause. However, people who experience vulvar pain may use the following words to describe it:

• burning
• stinging
• irritated
• rawness
• stabbing
• aching
• throbbing
• itching

Localized pain occurs in one spot. Generalized pain affects the whole vulva.

Various conditions and activities can cause vulvar pain. Pain can result from pressure or touch or occur without any apparent trigger or provocation. The pain comes and goes for some people, but it can be constant for others.

Pain can be general, affecting the entire vulva, or localized, affecting only specific areas in the vulva. It can occur in any of the structures in the vulva, and it can develop for different reasons.

Vestibule

Vestibulodynia is the term for pain and discomfort in the vestibule — the opening of the vagina. The pain usually happens after pressure to the vestibule — provoked vulvodynia — during activities such as:

• sex
• inserting a tampon
• wearing tight or form-fitting jeans
• sitting
• gynecologic examination

Vulvodynia is when a person experiences the pain for 3 months or longer with no identifiable cause.

Vulvodynia and vestibulodynia result from a hypersensitivity of the nerve endings in the skin of the vulva.

A common cause of vulvodynia is erosive lichen planus. It is a chronic skin disorder that causes painful and repetitive skin ulcerations in the mouth and genital areas.

Lichen planus is usually seen in the vagina and vestibule but may extend into the labia minora.

Symptoms include rawness, burning, and soreness around the vulva. If the vagina is affected, sexual intercourse may become painful.

Learn more about vulvodynia and vestibulodynia here.

Labia majora

The labia majora, or the outer lips, are skin folds surrounding the vagina and other vulvar structures. Hair usually covers the outer surfaces.

When bacteria infect a hair follicle, folliculitis may occur. Small, red, painful bumps develop from friction, waxing, or shaving. The affected area is usually tender and painful, with itchy, burning skin.

Other conditions commonly affecting the labia majora include psoriasis, eczema, and contact dermatitis.

These skin conditions may cause weeping, crust formation, and red patches, which can cause extreme itching, burning, and discomfort.

Long-term eczema and contact dermatitis may cause lichen simplex chronicus, where plaques of thickened, scaly skin develop. This can be very itchy. If it affects the vestibule, it may cause burning and stinging.

Labia minora

The labia minora, or the inner lips, 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.

Located in the labia minora are Bartholin glands, which secrete fluid through the vestibule that lubricates the vagina and vulva. Blockage in any of the ducts can cause a cyst, called Bartholin’s cyst.

It does not cause pain when not infected. However, infected cysts can cause pain, especially when walking, moving, or having sex. It can also cause fever and chills.

Clitoris

The clitoris is a small piece of tissue that contains many nerve endings. It swells with blood during sexual stimulation.

Clitorodynia, or the localized pain in the clitoris, is a disabling and distressing sexual pain syndrome. It causes sharp, burning, stinging, or stabbing pain in the clitoris.

Symptoms worsen with touch, walking, wearing tight underwear, and moving at certain angles.

Another condition that can occur in this area is lichen sclerosis, a chronic skin disorder that may permanently alter the vulva. It commonly starts in the clitoral hood and spreads into the labia minora and perineum.

It may cause pain during sex, and the skin may tear easily. People will usually experience burning, intense, intractable itching, and pain.

Conditions affecting the entire vulva

Vaginal infections

Chronic yeast infections affect the vagina and vulva. It may cause no symptoms but often have symptoms that range from mild discomfort to swelling, intense itching, redness, and severe burning pain. A thick or creamy white discharge from the vagina and vulva also characterizes a yeast infection.

Viral and bacterial infections, such as the herpes simplex virus and bacterial vaginosis, can also cause vulvar pain or discomfort.

Cancer

Vulvar cancer occurs when abnormal cells grow in the tissues of the vulva. This can cause pain in the area.

Symptoms of vulvar cancer include:

• itching, burning, and pain
• inflammation
• 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:

• discharge
• 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 consult a doctor to determine the cause.

Vulvar cancer accounts for 0.7% of all cancers in the U.S., and 1 in 333 women will develop it at some point in their lives.

Learn 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 skin color and texture changes. A healthcare professional will likely treat these to prevent cancer from developing in the future.

Other causes

• Chronic conditions: Conditions may cooccur with vulvodynia. These include fibromyalgia, interstitial cystitis, and irritable bowel syndrome (IBS).
• Trauma: Childbirth, sexual activity, and riding a bicycle or horse can damage the vulva and cause pain and discomfort.
• Neurological disorders: Conditions such as neuropathy, nerve injury, pinched nerve, and Tarlov cysts can all cause vulvar pain.
• Hormones: Hormonal changes occur with menopause and menstruation. These changes can cause sensitive tissues to become dry, swollen, or inflamed, leading to dry vagina, vulvar pain, pain during sex, and bladder issues.

Treatment depends on the specific cause of the person’s 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.

Cancer treatment

If there are signs of cancer or precancer, a healthcare professional may recommend surgery and possibly chemotherapy, radiation therapy, or both, depending on the type and extent of cancer.

Non-drug treatments

Other treatment options may include:

Biofeedback

This may help reduce vulvar pain by teaching a person to relax their pelvic floor muscles. Biofeedback can also help people learn to control their body’s response to pain triggers.

Topical anesthetics

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, pelvic floor therapy 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.

Nerve blocks

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 numbing medicine into the nerves that supply the external genitals. This blocks pain receptors and can relieve discomfort in the area.

Similarly, a 2019 study found that injecting Botox effectively treats localized provoked vulvodynia.

Surgery

A 2019 review article cites surgery — specifically a vestibulectomy — to treat provoked vestibulodynia. While a vestibulectomy is not the only option, it is typically reserved for refractory pain.

Several home strategies can help reduce pain or discomfort in the vulva. These include the following:

• Being mindful of hygiene products: People who experience vulvar pain should avoid using products that can irritate the area, such as scented products or strong soaps.
  • A person should also try to choose 100% cotton menstrual pads and tampons and avoid products that contain plastic or synthetic materials.
• Refraining from douching: The vagina is self-cleaning, so there is no need for someone 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: A person can rinse the genital area with warm water and pat it dry with a towel.
• Finding 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 1 teaspoon of Epsom salt can help relieve irritation. Epsom salt is available for purchase online.

Some people may find it embarrassing to talk about vulvar pain or discomfort with their doctor.

It is important for individuals to remember that doctors are trained professionals who can help with all medical issues. However, it may be possible for a person to request a female doctor if it will increase their 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.