Vestibulodynia And Its Impact On Mental Health

Overview

Vestibulodynia is defined as a type of chronic pain and discomfort experienced around the vaginal opening. This area inside the inner lips of the vulva is known as the vestibule.¹ The exact cause is not yet known. The pain commonly occurs during the insertion of tampons, during sex or when tight clothing is worn around the area; the degree of pain varies among individuals. The chronic condition has been previously referred to as vulvar vestibulitis syndrome (VVS).²

The condition is not commonly known among the general public resulting in many experiencing anxiety and depression following diagnosis.³ Support groups and therapies are available for help.

Understanding vestibulodynia

Vestibulodynia is a type of vulvodynia, wherein both occur seemingly without an apparent cause.¹ It has been suggested to be the result of hypersensitive nerve endings in the area, with many experiencing a sudden onset of symptoms following events such as an infection of childbirth. 

Symptoms of vestibulodynia include 

• Pain or discomfort during physical activities such as jogging or cycling
• Painful burning or discomfort when the vestibule is touched, for example during sex or an examination
• Redness and a tender vestibule
• Stinging and irritation of the vestibule 
• Pain when wearing tight clothing

Some individuals also experience clitorodynia or vaginismus alongside vestibulodynia. 

If you are experiencing any or all of these symptoms please consult your GP or gynaecologist. 

Prevalence and demographics 

Although no specific cause has yet been identified, most cases are reported following childbirth or infections in the genital area. However, there is advice that avoiding the following things could help reduce the risk of developing vestibulodynia:

• Avoid using heavily scented products near the genitals
• Avoid tight-fitting leggings or tights and opt for looser cotton underwear, loose-fitting pants or shorts
• Use unscented sanitary products
• Avoid spermicides and contraception foams as they can irritate

Avoid bubble baths or heavily scented bath salts and oils.

Vestibulodynia and mental health 

As with any form of chronic pain, vestibulodynia is often life-changing and mental health support is regularly offered in addition to physical health support. 

The psychological impacts of chronic pain

Chronic pain sufferers are at a heightened risk for mental health problems, ranging from depression, anxiety and substance abuse.⁵ It's reported that depression affects 5% of the general population but among chronic pain sufferers this figure rises to 30%-45%.⁵ 

This is often the case as those suffering from chronic pain report much higher levels of stress and disrupted sleep. The stress has been found to arise from social anxiety, financial worries and general anxiety.^5,6 It has been recommended that healthcare providers should initiate conversations about managing mental health with chronic pain patients at the time of diagnosis rather than waiting for the patient to report any symptoms. 

Contact your healthcare provider if you believe your chronic pain is causing strain on your mental health. 

There are lots of mental health support options available ranging from therapy to medication, consult a healthcare professional to find out the best option for you. 

Coping strategies and support

Treating vestibulodynia 

Current treatment options only involve relieving and managing the symptoms of vestibulodynia. No current treatment options are available to eradicate vestibulodynia. 

Some examples of non-medical treatment methods include:

• Numbing creams 
• Pelvic floor exercises 
• Cognitive behavioural therapy (CBT), couples therapy or sex therapy 

Some examples of medical treatment methods include:

• Pain relievers (eg Paracetamol)
• Antidepressants 
• Nerve pain medication 
• Nerve blocks 
• Steroid injections
• Topical hormone creams 
• Surgery - Vestibulectomy

In some cases, vestibulodynia is so painful or uncomfortable that intercourse and other forms of physical activity are avoided altogether. This has been known to cause some distress among patients with therapies such as CBT being recommended. 

Can surgery treat vestibulodynia?

In cases of severe pain, a procedure known as a Vestibulectomy is an option. This surgery removes the affected skin and tissue and is performed as an outpatient procedure. However, this procedure is only possible if pain is in one small area of the vulva. It cannot be done for situations where chronic pain is felt throughout the entire vulva region.⁷

Effects on relationships and sex

Due to the pain often caused by sex in sufferers of vestibulodynia, it is sometimes avoided altogether. This often leads to stress and guilt, especially in situations such as sexual relationships. In these cases, individual counselling, couples counselling or sex therapy may provide some help. 

It should be noted that there is no link between vestibulodynia and STDs.¹ There are however some similarities in symptoms with STDs such as chlamydia. Always seek advice from a healthcare professional to determine the cause.

Support groups and resources

There are many resources in which you can receive advice and support. 

• The British Society for the Study of vulval disease - https://bssvd.org/
• The Vulval Pain Society - https://vulvalpainsociety.org/
• National vulvodynia Association - https://www.nva.org/
• International Society for the Study of Vulvovaginal Disease - https://www.issvd.org/resources
• Your local healthcare providers (Doctors, dermatologists, pharmacists or mental health professionals) 

If you live in the UK the Vulval Pain Society offers support both online and all over the UK. They also offer support groups globally. 

Addressing stigma and misconceptions

Vestibulodynia and other similar genital afflictions are not considered general knowledge unless one is personally affected or knows someone who is. This often means that those diagnosed report feelings of loneliness and confusion following their diagnosis. 

Immediate reactions and concerns are commonly surrounding sex, pain levels and symptoms vary from person to person so it should not be automatically assumed that sexual activities are not possible. As these concerns can add to the anxiety surrounding chronic pain, this should always be discussed with a relevant healthcare provider. 

Support groups and resources are available for support and to answer any questions. Check online for groups near you or in the set of links provided above. 

Raising awareness and education

It is reported that 1 in 7 experience some type of vulval pain in their lifetime with many not even aware until diagnosis.² The lack of general awareness surrounding vulval pain means many suffer for long periods before receiving medical attention due to stigma. This is why multiple charities and organisations have been founded to spread awareness.

Summary

Vestibulodynia is a type of chronic pain experienced around the vaginal opening. Although no direct cause has been found it's commonly seen following traumatic events such as infection or childbirth. Treatment focuses on symptom alleviation and varies from medicinal options such as painkillers to non-medical options such as therapy. As a form of chronic pain, those diagnosed are more likely to experience depression or anxiety during their lifetimes, for this healthcare professionals can suggest a variety of therapies from individual to couples counselling. To reduce the stigma surrounding pelvic pain conditions, charities and support groups that offer help and advice have been set up globally. 

If you experience any pain or discomfort in your genital areas, consult a healthcare professional to receive appropriate advice and treatment options. 

It is suggested that the more general awareness there is about conditions such as vestibulodynia the less those affected will be likely to develop severe mental illnesses. 

FAQs

When should I call the doctor?

You should contact your healthcare provider if you are experiencing:

• General itching in the genital area 
• Painful urination and intercourse 
• Signs of a UTI or other infection
• Unusual discharge 

Do STDs cause vestibulodynia?

There is no reported link between STDs and vestibulodynia. However, some symptoms are similar to STDs like chlamydia so seek assistance from a healthcare provider to determine the best cause and treatment plan. 

What should I do if I need mental health assistance?

Always speak to your healthcare provider to see what can be offered to you through them. Depending on your circumstances you could be offered therapy or medication. 

There are also multiple online and in-person support groups available for those suffering from Vestibulodynia. 

How can I prevent vestibulodynia?

Unfortunately, vestibulodynia is not completely avoidable but there are steps you can take to lower your risk. For example, by wearing loose-fitting clothing around the area and avoiding heavily scented products. 

Is vestibulodynia the same as vulvar vestibulitis syndrome (VVS)?

Yes, although originally called vulvar vestibulitis syndrome (VVS) it is now referred to as vestibulodynia.