Vaginal burning and itching and pain – the many symptoms of vulvodynia
Vulvodynia is defined as “vulvar pain of at least three months duration without clear identifiable cause, which may have associated factors” (link). Vestibulodynia is a subtype of vulvodynia where the pain is confined to the vestibule, the transition tissue at the entrance of the vagina, between the vulva (outside) and vagina (inside). For these patients, the tissue often appears healthy and there are no symptoms other than chronic pain. Based on this definition, diagnosing “vulvodynia” is really just diagnosing a symptom. The diagnosis “vulvodynia” doesn’t tell you anything about the underlying cause. To choose the best treatment, it is important to understand why there is vulvar or vaginal pain in the first place. What is happening that is causing vulvar pain and how can it be fixed?
Vulvodynia and vestibulodynia feel different to different people, and I want to highlight those symptoms here. I want to emphasize that different biological processes can produce the same symptoms. This is important because it means that you can’t count on a treatment that worked for someone else with the same symptoms working for you. It also means that researchers and providers have the important task of figuring out how to differentiate between these very similar symptoms with different causes.
As examples, I will use two common causes of vulvodynia / vestibulodynia: pelvic floor muscle dysfunction and tissue atrophy due to hormone imbalance. Both can cause symptoms shared among many vulvodynia patients, but through very different biological processes.
Vulvar or Vaginal Burning
Many people describe feeling chronic vaginal burning or vulvar burning. For some, the burning is constant, for others it is caused by specific activities, and for others it’s a mix of both. Both pelvic floor muscle dysfunction and tissue atrophy can feel like vulvar or vaginal burning, but for different reasons.
Hypertonic pelvic floor muscle dysfunction is characterized by muscles that are tight, tense, and shortened. Muscles that are chronically tight have less oxygen coming through them, and this can cause lactic acid accumulation in the muscles and nearby tissue. Lots of lactic acid can feel like vulvar and vaginal burning!
Hormones are important signaling molecules for maintaining healthy tissue in the vulva, vestibule, and vagina. Insufficient estrogen and androgen signals can lead to tissue atrophy (a fancy word for cells degenerating and/or dying). Without the proper hormone signals, the surface cell layer thins, the muscles change, and there are less blood vessels. That means the tissue is less elastic and more easily irritated and broken. This can also feel like vulvar and vaginal burning!
Vulvar or Vaginal Itching
Many people describe feeling chronic vaginal itching or vulvar itching. Again, the itching can be constant or intermittent. If you have chronically tight pelvic floor muscles, it can affect the nerves. Irritated nerves can feel like vulvar or vaginal itching. If you have a hormone imbalance causing tissue atrophy, the tissue is less lubricated and more prone to irritation. Dry, irritated tissue can also feel like vulvar or vaginal itching.
Vulvar or Vaginal Pain
In additional to burning and itching, people often describe sharp or stabbing pain, or a sensitive, sore, or tender vagina or vulva. I personally get sharp and stabbing vaginal pain when I have pelvic floor muscle spasms. Because the muscles surround and makeup the vagina, this feels like sudden, sharp vaginal pain. I can also relate to the description of “sensitive vagina.” I recently got a sunburn on my shoulders and the pain reminded me of when I had severe nerve pain in my vestibule at the opening of the vagina. No matter how light the touch, I had searing pain. Tissue that is deprived of oxygen due to constructed, tight muscles or degenerating due to lack of hormone signals might also feel sensitive, sore, or tender.
Vulvar or Vaginal Pain with Intercourse, Tampons, Sitting, or Tight Clothing
Another shared symptom among patients is pain triggered or made worse by certain activities. Often patients talk about vulvar or vaginal pain with penetrative sex or tampon use, wearing tight clothes, or sitting too long or on a hard seat. In all of these cases, the unifying action in contact or pressure on the vulva or vaginal opening. Once again, tissue that is damaged might hurt when touched or when pressure is applied. Either pelvic floor dysfunction or tissue atrophy could cause pain with sex, pain from tight clothes, or pain when sitting too long.
How to Determine the Cause of Vulvar or Vaginal Pain
I hope that these examples have illustrated that patients with vulvar or vaginal pain, burning, and/or itching can have these symptoms for completely different reasons. I chose to highlight pelvic floor muscle dysfunction and hormonally-mediated tissue atrophy, but there are many more possible causes. Because diagnosis of the underlying cause of the vulvar or vaginal pain is crucial, but cannot be based on symptoms alone, it is important to find a trained specialist to help. Leading researchers have made connections between certain sets of symptoms, timing of symptoms, and patient history in order to more accurately diagnose the underlying cause of pain. Progress is being made in defining subtypes of vulvodynia based on the underlying cause and there are doctors who can help you find the right answer.
Important Postscript
It is important to point out that if you have vulvar or vaginal pain, (1) it is very real, (2) it is very treatable, and (3) you can feel better. Check out my other pages and resources for more on treatment options and how to find a specialist.
It would be irresponsible of me not to point out that vaginal pain, burning, and itching are also symptoms of other important conditions, like vulvar cancer, autoimmune disorders, and vaginal infection. Sometimes these symptoms actually are common infections that gynecologists can diagnose quickly and treat effectively, e.g. vaginal yeast infections or bacterial vaginosis (BV). However, if you have repeated infections or test negative for all the common infections, keep looking for a better answer. Vulvodynia patients are often misdiagnosed and repeatedly treated for non-existent infections, which can make things worse. Dr. Jill Krapf does a fantastic job on her Instagram of providing information about less common infections and how to diagnose and treat them, as well as providing in-depth information about women’s sexual medicine more broadly, including all the things in this post. Definitely check out her awesome page!!