Burning sensation during sex? It may be vulvodynia

Burning sensation during sex- It might be vulvodynia 1200400

Vulvodynia is defined as persistent, unexplained pain in the vulva, the skin surrounding the entrance to the vagina. Vulvodynia — also known by health professionals as vulvular dysaethesia —  is usually a burning pain, most common in older women, although it can affect women of all ages. It is classed as unexplained pain because, by definition, there is no obvious cause found on examination. However, despite this, the pain is very much there and can have a significant impact on a woman’s life.

When the sensation of burning and soreness is continuous, it is known as unprovoked vulvodynia. When it occurs only on light touch, such as during intercourse or use of tampons, this is known as provoked vulvodynia. Many women have symptoms that overlap between the two conditions. As such, we will look at them together due to the similarities in causes, symptoms and treatments available.

Do I have vulvodynia?

Vulvodynia is thought to be caused by irritation of the nerve fibres in the skin of your vulva. The irritated nerve fibres produce sensations of pain, either spontaneously (unprovoked) or on light touch.  As such, there is a chance that you may have vulvodynia if you are suffering from burning or stinging pain of the vulval area on a regular or constant basis in the absence of other symptoms. The pain can be localised to a small area, or be more spread out, and is usually described as a burning or stinging sensation. The pain of vulvodynia is often likened to the pain of shingles — neuropathic (nerve) pain.

Symptoms can vary from mild discomfort to severe, constant pain, and can differ from day to day. For some, it affects sleep and daily activities. For others, it is not so bad. The pain is not always restricted to the vulval area, and may radiate to other areas such as your thighs or around your anus as well.

Vulvodynia is classed as a form of chronic pain. Chronic pain may affect your behaviour, activities and relationships. In particular, it may affect your sex drive or cause you to feel depressed. If you feel low in mood or depressed, please make sure you see your doctor or counsellor. Pain in the genital area especially is often difficult to talk about with family or friends, so you may be feeling isolated which makes the problem feel even worse.

Who is at increased risk of developing the condition?

As already mentioned, we don’t know the exact cause of vulvodynia, but it is thought to be a problem with the nerves supplying the vagina. What we do know is that certain women are at increased risk of developing it. These women include those with a history of genital tract infections (including severe thrush), and those who have used oral contraceptives in the past. In addition, women with a previous history of surgery or childbirth are at increased risk. The reasons why is not fully understood, but there is a theory that infections or trauma can affect or damage the nerves in some way.

Vulvodynia is a condition that sometimes presents in individuals who already have other medical problems, including interstitial cystitis (a painful urinary and bladder problem), irritable bowel syndrome, and painful periods.

What else could it be?

There are a number of other conditions that can cause discomfort around the vulval area. This is why it is so important to see your doctor to be reviewed and diagnosed initially or if your symptoms change. Your discomfort may be caused by vaginal thrush or other infections, hormone changes (especially around the menopause) causing vaginal dryness, or even contact sensitivities — a reaction to something that touches the vulva such as creams, bubble bath, or soap.

Your doctor may wish rule out some other conditions, such as lichen planus or lichen sclerosis. These are skin conditions that can cause localised irritation and soreness and need specific treatment. Occasionally, vulval pain can be indicative of more systemic problems such Bechet’s disease (an inflammatory condition of the blood vessels that may result in ulceration in the genital area).

Surprisingly, back problems in the form of a slipped disk may also present as vulvodynia. The slipped disc can cause spinal nerve compression resulting in pain being transferred to the vulval area (referred pain).

Deep dyspareunia is classed as a deep pain on intercourse and is different to vulvodynia (which is around the skin surface). This is more likely to be caused by conditions such as pelvic inflammatory disease, endometriosis, or inflammatory bowel disease (such as Crohn’s disease). Your doctor may need to rule these out as well.

It is less likely (but not impossible) that you have vulvodynia if you have the following symptoms: intense itching, profuse, bad smelling, or unusual coloured vaginal discharge, a deep pain or bleeding during or after intercourse, or bleeding in between your periods. Please make sure you see a doctor if you have these problems.

Which treatments work?

Most women try localised treatments to reduce symptoms first. These have mixed results, but are worth trying. Some women find vaginal lubricants useful during intercourse, and also using an emollient (such as aqueous cream) instead of soap when showering, as this is kinder to the skin. Bath additives such as Oilatum, a moisturising bath additive used especially in children with eczema, may be useful.

Others find that applying an anaesthetic gel (lidocaine) to their vulva before sex, or regularly, to relieve pain is helpful. If you are using this, make sure you use latex-free condoms during intercourse because lidocaine causes latex condoms to disintegrate. Tubes of 5% lidocaine gel and cream can be bought over the counter, but check with your doctor before trying it.

What if local treatments don’t help?

Simple painkillers such as paracetamol are not that effective for vulvodynia as they work by reducing inflammation, which is not the problem in this case as by definition there is no inflammation. Nonetheless, they are worth trying first as you may benefit. Make sure you follow the dosing instructions on the box and do not exceed the recommended daily limit. If these do not help, your doctor can try some other medications.

Some women find they get relief from medications that target nerve pain, for example amitriptyline or gabapentin. Amitriptyline is a type of medication called a tricyclic antidepressant, but is used at a much lower dose than when used in the treatment of depression. Gabapentin and pregabalin are actually medications to treat epilepsy, but have been found to have a very good effect for people affected by nerve pain too. These medications are very effective but can take weeks to reach their maximal effect.

Other treatments vary, ranging from physiotherapy to vaginal desensitisation. This involves using a set of vaginal trainers of increasing size and length that can be used at home to build up confidence. Some physiotherapists also advocate the use of a TENS machine, often used by women in labour, as well. Some women find that relaxation exercises, cognitive behavioural therapy (CBT), or counselling may be useful to help manage the problem of vulvodynia and to limit the impact it has on their life, but it does not remove the problem itself.

Self-care tips

Wearing 100% cotton underwear and loose clothing, and avoiding scented feminine hygiene products may make you feel more comfortable. Some women find applying cool gel packs to the area helpful too.

Sitting on a doughnut shaped cushion can be helpful for symptomatic relief.

Where to look for help

At already mentioned, vulvodynia is a chronic problem but you may feel you are unable to speak to family and friends. Please seek advice from your doctor first or if your symptoms change because vulvodynia is not a condition that can be diagnosed until other diagnoses are excluded.

If you have already been diagnosed with vulvodynia there are support groups that provide a lot of helpful information. These include the Vulval Pain Society, and the Pelvic Pain Support Network.

References

  1. G. Fischer, ‘Management of vulvar pain’, Dermatological Therapies, vol. 17, no. 1, 2004, pp. 134 – 149.
  2. H.I.  Glazer and W.J. Leger, ‘Clinical management of vulvodynia’, Review of Gynaecological Practice, vol. 2,  2002, pp. 83 – 90.

Dr. Jennifer Kelly MBChB(hons) MRCGP DRCOG

Jennifer is a General Practitioner, medical writer, parent, and founder of the Grace Kelly Ladybird Trust, registered charity for childhood cancer awareness and research (www.gracekellyladybird.co.uk). She also has a particular interest in women’s and children’s health, and enjoys medical writing, particularly helping make medical information easily accessible to those who want to find out more.

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