Vulvodynia Treatment

Vulval pain persisting three months or longer, without an identifiable cause on examination or testing. It may be provoked — triggered by contact, intercourse, tampon use or sitting — or unprovoked and present at rest. It may be localised to one area, often the vestibule, or generalised across the vulva.

Those distinctions are not academic. Provoked and unprovoked pain behave differently, respond differently, and are worth naming precisely when you describe it to anyone.

It is a diagnosis of exclusion, which means everything else has to be ruled out first — and each of those exclusions is a separate appointment, often with a separate clinician who did not see the previous result.

Infection is investigated first and usually repeatedly. Dermatological causes — lichen planus, lichen sclerosus, contact dermatitis — come next, and each is treatable in its own right, which is why finding one is a better outcome than the vulvodynia label. Hormonal causes are third.

The delay is structural rather than anyone's failure, but it is spent by you.

Because there is nothing to see. Patients are commonly told the examination is normal, with the implication left hanging that the pain therefore is not.

A normal examination is consistent with this diagnosis rather than contradicting it. The absence of a visible cause is part of the definition. Being investigated repeatedly for infection you do not have is not evidence that nothing is wrong; it is evidence that the wrong thing was looked for.

The first requirement is a proper diagnostic workup, and if that has not been done then it should be, before anything else is attempted. A treatable dermatological or hormonal cause found now is worth more than any protocol we could offer.

Where those have been excluded, our approach is the same as everywhere else on this site: identify which drivers are present in your case — inflammatory load, hormonal status, pelvic floor and nervous-system involvement — and treat those rather than the pain in isolation.

Assessment is by video consultation. There is no examination requirement here, which for this condition specifically is worth saying: you have likely been examined enough.

We have not published outcome data for vulvodynia and we are not going to imply that we have. What this page describes is how we would assess and approach it. If that is not what you need, we would rather you knew now than after three months.

Vulvodynia frequently responds best to multidisciplinary care — pelvic floor physiotherapy and pain management in particular. We would support that alongside treatment rather than position ourselves as an alternative to it, and if you are not already under someone for the pelvic floor component, that is worth arranging regardless of what you decide about us.

Lichen Planus · PCOS · Menopause