The term "vulva" refers to the collective external female genital organs.

The vulva is a multifunctional anatomical region: it protects the internal genital organs, contains the urethral opening, and plays an obvious and fundamental role in sexual intercourse. As it surrounds the vaginal vestibule, it is easy to understand how its overall health contributes to the proper experience of sexual pleasure during coitus.

At times, the vulva and the tissues adjacent to the vaginal opening—such as the vaginal vestibule, the clitoris, and the labia minora and majora—can be affected by conditions characterized by tenderness, which may be accompanied by inflammation or overt pain. Often, no other types of lesions are visible in this area; for this reason, the condition is considered an "invisible" disorder, even though it has a profound impact on a patient's quality of life. This condition is known as vulvodynia.

Symptoms of Vulvodynia

As the name itself suggests, the typical symptoms of vulvodynia include pain—often chronic and generalized throughout the entire vulvar region—frequently accompanied by pain during penetration (dyspareunia).

However, vulvodynia should not be confused with other pathological conditions affecting the vulvar area—terms that are often incorrectly used as synonyms—namely, vestibulodynia and vulvar vestibulitis.

Vestibulodynia is a disorder characterized by pain felt in a well-defined area, limited exclusively to the tissues of the vaginal vestibule—the anatomical region surrounding the vaginal opening.

Vulvar vestibulitis, by contrast, refers to an inflammatory condition, which is not necessarily associated with pain.

Causes

Although a precise etiology for vulvodynia has not yet been definitively established, the root cause of chronic vulvar pain appears to be, primarily, immune hyperreactivity, characterized by a state of prolonged inflammation.

In addition to this pathophysiological basis, there are other conditions that can significantly exacerbate the existing impairment:

• Hypercontractility of the musculature surrounding the vulvar and perianal area
• Hyperstimulation of the nerve endings responsible for pain perception
• Chronic or recurrent vaginal and bladder infections
• Injury to the pudendal nerve resulting from childbirth or trauma

Let’s look at the main causes in detail:

Pelvic floor hypertonia

Vulvodynia can be fostered by a persistent muscle spasm resulting from a reflex tightening of the vagina—a condition that may precede the onset of vulvodynia (as is typical in cases of vaginismus).

It may also be linked to concurrent dyspareunia (painful intercourse) experienced by the woman. This contraction can, in itself, become a source of pain, further contributing to the condition becoming chronic.

Physiological predisposition

Factors that may predispose an individual to the development of vulvodynia include:

• Microtrauma associated with vaginal dryness
• Use of inappropriate hygiene products
• Immune disorders (allergies, lichen sclerosus, eczema, etc.)
• Neuropathies
• Psychosexual or relational factors

Remedies and Treatments

The treatment strategy often consists of making the pain progressively weaker and less disabling.

Combinations of pharmacological therapies, natural products, and behavioral adjustments are frequently used; we will examine the main ones below.

Pharmacological treatment:

• Application of topical medications to the vulvar area to modulate pain. This includes substances such as lidocaine (a local anesthetic) or sodium cromoglicate (which stabilizes the membranes of white blood cells, thereby interrupting the neurogenic inflammation underlying the condition)
• Use of specific analgesics, such as amitriptyline or gabapentin, as well as systemic medications (e.g., tricyclic antidepressants, anticonvulsants, etc.) to suppress the signals transmitted by the nerve fibers responsible for the perception of chronic pain

Pelvic floor rehabilitation

Women with hypertonia of the vaginal muscles may benefit from physical therapy (pelvic floor training) and self-relaxation techniques that teach them how to control muscle contractions—and, consequently, the pain these contractions cause.

Diet and lifestyle

To alleviate the symptoms of vulvodynia, it is essential to follow a few strict behavioral guidelines.

Intimate hygiene must be careful and thorough in all circumstances; however, it should not be harsh, as this could disrupt the physiological balance of the external genital tissues.

It is recommended to use products with a gentle pH for daily cleansing and care. Avoid highly alkaline cleansers or those containing dyes; instead, opt for products with active ingredients that mimic the properties of the mucosa—substances that hydrate, soothe, protect against pathogens, and help repair tissue trauma.

Products such as deodorant sprays, scented intimate wipes, and hair-removal creams should be avoided in the vulvar area.

Panty liners and synthetic underwear should be used sparingly, as they are occlusive and prevent the skin from breathing.

Finally, it can be helpful to drink plenty of water and prioritize a diet low in sugar and free from yeast.