A good place to start is defining what the vulva consists of. In short, the vulva is the external pelvic organ extending from the pubic bone to the tailbone. Essentially, it is anything you can touch on the outside- it is not the vagina or the bladder as these are internal organs. More specifically, the vulva consists of the mons pubis located over the pubic bone, the labia majora and minora ( also commonly referred to as the “lips”), the clitoris ( area of arousal just above the urethra where urine comes out), the vestibule which is the area around the vaginal opening, the urethra, and the perineum (area between the vagina and the anus). The main nerve supply to the vulva comes from the sacral spine called the pudendal nerve.
Unfortunately, despite the vulva being the most easily examined pelvic organ because it is on the outside, the vulva is the least examined and least discussed pelvic organ. Women commonly go to many doctors in search of help for vulvar pain before seeing a clinician trained in vulvar care. We at MNCOG are specialists in vulvar pain and want to take this opportunity to shed some light on the subject. So, let’s start a discussion about this important medical condition!!!
The prevalence of vulvar pain during some point in a woman’s life is about 8-28%. That’s a lot of women! Please note that while vulvar pain is usually associated with sexual pain, the specific topic of sexual pain is discussed in a separate write up on our website
There are two main types of vulvar pain. The first is vulvar pain related to a specific underlying condition such as infection, inflammation, cancer, nerve problem, injury, medication side effect, or hormone related. The second type of vulvar pain is vulvodynia. This is pain of at least three months duration without an identifiable cause. The pain can be localized and occur with/without contact or at random intervals. There is a high association of vulvar pain with other medical problems such as painful bladder syndrome. Genetics can play a role in vulvar pain as can one’s history of pelvic/back pain, injury or allergy history.
What occurs during a consult for vulvar pain? So much of the consult is spent listening to the patient and getting a good history. There are two vulvar pain specific questionnaires given to our patients to review. The exam consists of an abdominal exam, back exam, examining muscles of the vulva, a gentle q tip test of the vulva for “pain mapping”, getting a vaginal pH swab and swab for vaginitis, possibly a very careful exam of the vulva with a microscope called a colposcope, a vaginal exam using a very small speculum and a single finger pelvic exam palpating each of the pelvic floor muscles gently as well as urethra, under the bladder and uterus/ ovaries if applicable.
What is the treatment? In short, it depends on what is felt to be the cause of the pain that best fits the patient’s history and physical. Fortunately, there are so many options and treatments available:
- Removing all irritants to the vulva including vast majority of soaps, pads, vagisil. Taking care to wash towels in very hot water and dry completely.
- Using medications that work on pain fibers including certain antidepressants.
- Utilizing pelvic floor physical therapy if overactive pelvic floor muscle spasm to help relax the pelvic floor. This is incredibly helpful.
- Nerve blocks.
- Sacroneuromodulation
- In a small portion of vulvar pain patients, an outpatient surgery may be recommended.
- Complementary medicine like acupuncture
Vulvar pain is an incredibly valid, debilitating, real and important condition. If you are suffering with vulvar pain, please consider making that first step to visit with one of us at MNCOG as so often this problem can be treated,
