10 treatments for vaginal pain

If you’re plagued by the persistent pain and burning irritation of vulvodynia, you know how it can take its toll both on your physical and emotional health.

Yet many women still suffer in silence. In fact, according to a study in the American Journal of Obstetrics and Gynecology, 25 percent of women experience vulvar pain at some point in their lives, yet only about 2 percent seek treatment.

Although vulvodynia can be difficult to treat since there is no identifiable cause, there are many treatments available. Here, read on to find out what some of those are and if they can help you.

1. Physical therapy
Although there isn’t one cause of vulvodynia, there are many contributing factors that vary from woman to woman, said Dr. Sydney Osborne, DPT of Stride Strong Physical Therapy in Portland, Ore. For example, an injury to the pudendal nerve from childbirth or surgery, a sports injury, disc rupture, and arthritis should all be taken into consideration.

A physical therapist will likely ask about your entire medical history to understand potential factors, do a postural and structural assessment to look at your alignment and all of the tissues involved, perform an exam to identify where the pain and trigger points are, and determine if there is tightness and weakness in the pelvic floor.

There are several techniques physical therapy uses. Some include joint mobilization, trigger pain release, ultrasound, and soft tissue mobilization, a manual therapy which is helpful for neurological pain problems, Osborne said.

2. Medication
Topical medications that desensitize the vulva may help but they’re not ideal because they simply mask the symptoms and don’t address the source of the pain, said Dr. Antonio Pizarro, a board-certified urogynecologist and gynecologist in Shreveport, La.

Plus, these medications are often temporary, lasting just a few hours. They may also cause side effects in other parts of your body. Nevertheless, if you do opt for medication, it can be a good adjunct to other treatments, Pizarro said.

3. Treatment for other sources of pain
Certain conditions like fibromyalgia and depression, chronic stress, trauma from childbirth or reproductive surgery, as well as physical and emotional abuse, can all heighten the pain response and should be addressed with a physician or health practitioner.

4. Acupuncture
According to a recent study in the Journal of Sexual Medicine, acupuncture may be effective at helping to reduce the pain of vulvodynia and improve sexual function.

5. Cold or heat.
Cold packs or heating pads used throughout the day can help decrease pain.

6. Biofeedback
If the pelvic floor muscles are tight and weak because they’re reacting to chronic pain, biofeedback can work to lengthen the pelvic floor, Osborne said. Internal electrodes measure the muscle activity of the pelvic floor and using a computer, teach women how to relax and strengthen their pelvic floor.

7. TENS
TENS, transcutaneous electrical nerve stimulation, is an electrical stimulation that can help the chronic pain cycle due to an over-firing of the neurological system, Osborne said.

8. Psychotherapy
“Even though it’s not all in your head, you can use mental and behavioral changes to decrease pain and improve functioning,” said Dr. Erica Marchand, a licensed psychologist in Los Angeles who specializes in sexual and relationship issues. In fact, according to a recent meta-analysis in the Journal of Sexual Medicine therapy was found to be an effective way to reduce sexual pain or improve sexual functioning.

Excess stress and distress about vulvar pain impact how a woman processes the pain in her brain. So one of the goals of therapy is to decrease the severity of the pain and decrease the impact that the pain has on her life.

Vulvodynia also takes a toll on a woman’s sexuality, her relationships and day-to-day life.

“Understandably, women start to develop a set of thoughts, feeling and behaviors associated with vulvodynia,” Marchand said.

Psychotherapy can help women reduce negative thoughts, feelings and avoidance behaviors so they can engage in their lives again.

9. Lifestyle modifications
Fabric blends can be irritating, so 100 percent white cotton underwear can help the tissue to breathe more easily, Pizarro said. Opt for organic tampons and always choose 100 percent cotton pads for menstruation or urinary incontinence. Also avoid other irritants like deodorants and certain soaps.

10. Surgery
Surgery is rarely effective and is usually the last option, Pizarro said. It may be appropriate for women who have a lesion, scarring or a specific type of vulvodynia known as vestibulitis syndrome, which causes pain in a localized area of the vulva.

Studies show surgery is effective in the right patient, although it could cause scarring or pain in other areas of the vulva so you should weigh the benefits and risks with your physician.