Causes of Vulvar Vestibulitis Pain and Its Treatments

Vulvar vestibulitis, also known as vulvar vestibulitis syndrome (VVS) or vestibulodynia, refers to a kind of vulvodynia (pain around the vulva) that occurs in the vulvar vestibule. The vulvar vestibule is the area of the vulva behind the clitoris and between the labia minora. 

Vulvodynia describes vulvar pain that has continued for at least three months and isn’t caused by a particular underlying condition or event, such as a sexually transmitted infection (STI) or injury. For many people, the pain gets worse during pressure or penetration, such as when inserting a tampon, riding a bicycle, or having sex. 

Causes & Risk Factors

It’s not clear exactly what causes pain around the vulva. However, researchers have identified several potential underlying causes and risk factors, such as:

• Neuropathic problems, such as nerve injuries or the hyper-proliferation of nerve fibers in the vulva (an increase in the number of nerve cells)
• Hypersensitivity due to previous issues, such as injuries or vaginal infections
• Chronic allergies
• Hormonal imbalances
• Problems such as weakness within the pelvic floor (a group of muscles and tissue that support the organs in the pelvis)
• Genetics, which may make you more prone to inflammatory issues

How Symptoms Feel and Look

The pain associated with vulvar vestibulitis has been described as:

• Aching
• Burning
• Irritating and “raw”
• Itching
• Sharp
• Sore
• Stabbing
• Stinging
• Throbbing

While your skin may feel swollen, the condition usually doesn’t change your vulva’s appearance.

The pain often gets worse during certain activities, such as:

• Exercising
• Having sex
• Inserting a tampon
• Riding a bike
• Sitting for a long time
• Using the toilet (urinating or having a bowel movement)
• Wearing tight clothing

Sex and Intimacy

One of the main symptoms of vulvar vestibulitis is dyspareunia, which is pain during or after sexual intercourse. This can cause problems in relationships, stress, and sexual dysfunction, including emotional distress and lowered sexual satisfaction. Even if you want to have sex, you may feel hesitant to do so because of the potential pain. Over time, people with vulvar vestibulitis may associate sex with pain, leading to fear and anxiety around sexual relationships and arousal. 

Sexual partners of people with vulvar vestibulitis may also be affected. Research suggests that they are more likely to experience erectile dysfunction (ED) and report less sexual satisfaction as well.

Treatment to Manage Pain

If you are diagnosed with vulvar vestibulitis, your care team may include any or all of the following healthcare providers:

• A gynecologist or ob-gyn (obstetrician-gynecologist)
• A mental healthcare provider
• A pain specialist
• A physical therapist

Treatment options may include:

• Topical medications, such as pain-relieving creams or estrogen cream
• Oral medications, such as anti-seizure drugs or antidepressants
• Injectable medications, such as local anesthetics and steroids
• Physical therapy to make the pelvic floor muscles stronger
• Ultrasound or electrical stimulation to reduce pain
• Trigger point massage
• Cognitive behavioral therapy (CBT) or other forms of psychotherapy (talk therapy) if you are experiencing emotional distress
• Couples counseling if you are experiencing sexual dysfunction in your relationship
• A nerve block to relax the pelvic floor muscles
• Surgery, known as a vestibulectomy, to remove the painful tissue in the vulva if other treatments fail to provide relief

You may also be advised to manage your symptoms at home by:

• Applying cooling gel packs or cold compresses to the vulvar area
• Applying petroleum jelly to the affected area after bathing
• Avoiding potentially irritating cleansing products
• Not douching
• Patting your vulva dry after urination
• Using pads instead of tampons, and cotton pads if others are irritating
• Using plenty of vaginal lubricant when you have sex
• Wearing loose clothing
• Wearing only cotton underwear and not wearing any underwear when you sleep

A Word From Verywell

Vulvar vestibulitis caused by irritants can be treated by removing the trigger and applying topical steroids. Cases due to low estrogen can be improved by applying topical estrogen creams. For neuropathic causes, pelvic floor physical therapy and medical management may be needed. Severe cases may require surgery.

How It Is Diagnosed

If you think you might have vulvar vestibulitis, your healthcare provider may rule out other potential causes of the pain, such as a urinary tract infection (UTI), with tests like a cotton swab, urine test, and/or biopsy (removing a sample of tissue to be analyzed in a lab). Alongside a physical and visual examination and a review of your symptoms, a provider might also ask about your medical and sexual history.

Can Vulvar Vestibulitis Go Away?

The symptoms of vulvar vestibulitis are usually chronic, meaning they continue long term, although they may come and go. However, they may go away on their own in some people. They can also be managed and reduced with the help of treatment and self-care methods.

When to See a Provider

You should consider seeing a healthcare provider if you experience any persistent pain in your vulva, especially if it’s affecting your daily functioning or sex life. In particular, reach out to a healthcare provider immediately if your pain gets worse or more frequent.

Summary

Vulvar vestibulitis is a kind of vulvodynia, chronic pain in the vulva with no exact known cause, that is localized in the vulvar vestibule. The pain often gets worse during sex or when applying pressure to the area, such as by inserting a tampon. 

Many different treatment options include oral and topical medications, physical therapy, and trigger point therapy. Psychotherapy, such as cognitive behavioral therapy, can help with the mental and emotional symptoms of chronic pain and sexual dysfunction. Surgery may be necessary if other treatments fail.