Reviewed November 2019

Living with vulvodynia: can I enjoy a healthy sex life?

sex life vulvodynia1200400

Vulvodynia is a condition that many people have not heard of, but if you have the condition, the chances are that it is having a notable impact on your life. For women with vulvodynia, even the gentlest touch in their genital (vulval) area can result in intense, burning pain. The causes of vulvodynia are not fully understood because when women with vulvodynia are examined there are no obvious abnormalities seen.

However, there are a number of theories as to what causes the pain. The main theory is that vulvodynia is caused by irritation or hypersensitivity of the nerve fibres that run through the skin of the vulva.1 This can result in pain, ranging from mild discomfort to severe pain.

Diagnosing vulvodynia

As already discussed, vulvodynia can be difficult to diagnose. As a result, some women may face several years of symptoms and pain before receiving the right diagnosis. If you have been diagnosed with vulvodynia, it may well be that if a delay occurred before diagnosis, and therefore receiving suitable treatments, you may have suffered in silence for quite a while.

To make diagnosis harder, there are a number of other medical problems that can be incorrectly confused with vulvodynia, even though they are caused by something different. For example, chronic pelvic infections (pelvic inflammatory disease or thrush), skin conditions such as lichen planus, or changes in the skin following the menopause (atrophy) may all cause vulvar pain and so be incorrectly labelled as vulvodynia.2

For this reason, before you receive a diagnosis of vulvodynia, it is important that you are examined by your doctor to rule out other possible diagnoses first.

Living with vulvodynia

Vulvodynia is classed as a chronic pain condition, but like other long-term pain conditions you can have good and bad days. Vulvodynia can vary from a mild discomfort to severe pain. Most women learn to manage their symptoms, and in time the condition can resolve for some women: spontaneous remission rates of up to 56% have been reported.3

Experiencing chronic pain can understandably 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 if you have one.

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. If you don’t feel you can talk to your partner or friends, please talk to your doctor. Organisations such as the Vulval Pain Society give good information and also signpost to a number of support groups that are available.

Having sex with vulvodynia

When even the slightest touch can result in a deep burning or stabbing pain, it is understandable why women with vulvodynia can sometimes struggle to enjoy sex, or prefer to avoid it entirely. Here are a few suggestions on how to make things easier. Above all, be honest and talk to your partner, as if they understand it will help remove some of the emotional pressures you feel, and probably make you feel more in the mood for being intimate, too.

If you struggle to have sex for a while due to pain, there are, of course, plenty of other things you can enjoy with your partner without having intercourse. For example, kissing, caressing, whole-body touching, massage, or oral sex.

There are some things you can try to make having penetrative sex easier. Make sure you have plenty of foreplay, find a safe lubricant that you find does not irritate you, and use plenty of it. Some specialists may recommend the use of a local anaesthetic gel, but please only do this on medical advice. If you use this and are having sex with a partner who has a penis, make sure they wear a condom, otherwise local anaesthetic gel will leave them feeling rather numb, too!

Depending on the exact location on your vulva that your vulvodynia occurs, different sexual positions may be more comfortable than others. Most women find that positions with penetration from behind, such as spooning or doggy style, are more comfortable, as these positions usually avoid their most sensitive places. However, the best thing to do is obviously to experiment and find what you are most comfortable with.

Some experts recommend continuing to have regular sex if you can. When you don’t have intercourse for a while, you may become tense and develop involuntary spasms of the vaginal wall (vaginismus), making things even more uncomfortable. However, genital sex may simply not be possible for you — if this is the case, it’s important to recognise your body’s limits and to articulate them when seeking treatment.

Other options include the use of special vaginal dilators to help relax your vaginal muscles. These start off small and come in different sizes so that you can gradually increase what you feel comfortable with. Many women find this useful before intercourse to make penetration more comfortable.

Remember that although vulvodynia is classed as a chronic problem, many women find that their symptoms improve over time or they find treatments make the condition more manageable, meaning that sexual activity becomes increasingly pleasurable again.

What treatments can be helpful for vulvodynia?

Vulvodynia can be a difficult condition to treat, but there are a number of therapies that can be tried. Most women will try localised treatments first. These include using soap substitutes when washing (such as aqueous cream), and applying topical local anaesthetic gels or cooling packs in the location you are experiencing pain. Some women also use TENS machines with good effect,4 which deliver small electrical impulses through electrodes that are attached to a person’s skin and disrupt the pain signals transmitting from the brain.

Relaxation exercises, cognitive behavioural therapy (CBT) and counselling can be very helpful for some women.5 How women with vulvodynia think and feel about their pain can impact their experiences of pain, and both supportive psychotherapy and CBT may work to reduce negative self-perception and thought patterns that can influence how they experience pain.6

If the methods already mentioned do not help, don’t worry, there are a number of other options to try as well. Simple painkillers such as paracetamol are generally not so effective for vulvodynia, but are worth trying initially before you move on to trying other medications.

If you have no success with over-the-counter painkillers, your doctor may prescribe you a specific medication that targets nerve pain (neuropathic pain), for example amitriptyline or gabapentin. These medications can be extremely effective, but it takes time for the effect to build up. Usually, they will reach their maximal effect over the course of a few weeks.

The downside of these medications is that some women experience side effects taking them, such as feeling sleepy, having blurred vision, or becoming constipated.7,8 Symptoms do usually settle over time but please do talk to your doctor if they are troublesome.

Above all please remember you are not alone and make sure you talk to your partner about how you are feeling.

Many women are able to continue to have a good sexual relationships whilst suffering from vulvodynia, but if you are unable to, remember there are many other intimate things that you and your partner can still enjoy until things feel more comfortable again.

Featured image is a woman staring out over her balcony into a garden. The photo is taken from behind, her black dreadlocks and shoulders are in view

Last updated November 2019
Next update due 2021

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. 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.

View more

References

  1. Nagandla, K., and Sivalingam, N., Vulvodynia: integrating current knowledge into clinical practice, The Obstetrician & Gynaecologist, 2014, vol 16, pp 259-267
  2. Ibid
  3. Sadownik, L., Etiology, diagnosis, and clinical management of vulvodynia, International Journal of Women’s Health, 2014, vol 6, pp 437-449
  4. Nagandla, K., and Sivalingam, N., Vulvodynia: integrating current knowledge into clinical practice, The Obstetrician & Gynaecologist, 2014, vol 16, pp 259-267
  5. Sadownik, L., Etiology, diagnosis, and clinical management of vulvodynia, International Journal of Women’s Health, 2014, vol 6, pp 437-449
  6. Ibid.
  7. BNF, ‘Gabapentin’, National Institute for Health and Care Excellence, last updated April 2019, [online] https://bnf.nice.org.uk/drug/gabapentin.html (accessed 24 November 2019)
  8. BNF, ‘Amitriptyline Hydrochloride’, National Institute for Health and Care Excellence, 2019 [online] https://bnf.nice.org.uk/drug/amitriptyline-hydrochloride.html#sideEffects (accessed 24 November 2019)