Overview

Vestibulodynia, also known as vestibulitis or vulvar vestibulitis syndrome is a chronic pain condition that is characterised by discomfort around the vaginal opening – the vestibule.^1,2 To better understand this condition, we will begin by providing a brief overview of the external region of the female reproductive organs, the vulva. 

“Vulva” is an umbrella term used to refer to the components of the external female reproductive organ, of which the vestibule is part. As such, the term vestibulodynia is often used interchangeably with the term vulvodynia, whereas vulvodynia refers to pain affecting any part of the vulva. Vestibulodynia specifically refers to localised pain which affects the vestibule region of the vulva.^1,2 Vulvar pain can be provoked or unprovoked (spontaneous) and is estimated to affect between 10-28% of women.^1,2 Those affected by unexplained vulvar pain may experience difficulties in performing normal functions such as sitting and cycling, and women across all age groups and ethnicities can be affected.^1,4 The condition’s origins are diverse, including neurological dysfunctions.⁵ This article will guide you through the causes and symptoms of vestibulodynia, as well as outline its known exacerbations and guide you to further resources.

Provoked vestibulodynia

As stated above, vestibulodynia can be provoked. Provoked vestibulodynia occurs when there is an external trigger, such as a tampon insertion, and it is thought to be the most common subtype of vulvodynia.^1,2,5 A genetic predisposition has been seen in some women with provoked vestibulodynia (PVD).^1,3 This means that their genes render them more susceptible to developing the condition after encountering stimulants.¹ The hypersensitivity. Irritants that may provoke or exacerbate vestibulodynia may include:⁴

• Tight clothing
• Harsh soaps, including: detergent, shampoo and, body wash
• Scented products
• Douches
• Dyed toiletries

Spontaneous vestibulodynia

When vestibulodynia occurs without a clear, identifiable external stimulant, it is referred to as spontaneous vestibulodynia (formerly unprovoked vestibulodynia).¹ Spontaneous vestibulodynia differs from provoked vestibulodynia in that it does not have a discernible trigger. Additionally, its ambiguous nature can pose a challenge to daily activities due to unpredictability. A woman may also simultaneously have provoked and unprovoked vestibulodynia (known as mixed vestibulodynia).^1,4

Causes

The exact cause of Vestibulodynia is unknown. It is important to note that pain in the vaginal area might not always be caused by vestibulodynia and could instead be vulvar pain caused by yeast and bacterial infections, sexually transmitted diseases (STDs), vulvar skin conditions, or in severe cases certain cancers.² Although the causes of vestibulodynia are difficult to identify, some research suggests that the condition likely has multiple biological and environmental contributing factors that include: ^1,4,5

• Genetics
• Immune factors
• Hormones
• Inflammation
• Pelvic floor dysfunction
• Neurologic disorders, including hypersensitive nervous systems and overgrowth of nerve endings at the vaginal opening
• Childbirth

Symptoms of vestibulodynia

Vestibular pain may come and go. Hypersensitivity in the vaginal opening - pain during sexual activity - is the hallmark of vestibulodynia and is a common way to discover and identify the condition.^4,6 Symptoms are painful and require careful management by avoiding the exacerbating environmental irritants outlined above. 

It is important to note that although daunting, vestibulodynia symptoms can often be put into remission.⁷ The elusive nature of vestibulodynia can be both physically and emotionally taxing for those affected. Some people may experience worse symptoms than others however, differences in attitudes towards pain may influence personal reporting of the condition's severity.⁶ Commonly reported symptoms of vestibulodynia symptoms include:^1,2,4

• Itching
• Burning
• Stinging
• Pain during sexual intercourse
• Knife-like or sharp pain
• Excessive pain on contact
• Redness

Are there any long-term risks of vestibulodynia?

Long-term risks for women with vestibulodynia may include an impaired quality of life due to the pervasive nature of a chronic condition. Feelings of inadequacy may result from relationship strain and psychological distress from prolonged discomfort. Pain during intercourse may cause sexual dysfunction to hamper sexual activity and by extension, create barriers to conceiving.¹ 

It is important to understand that there is no shame in seeking support for this as the condition affects so many women, and you are not alone. Clinicians are specifically trained to help, not to reproach.

FAQ’s

I am worried I might have vestibulodynia, who can I speak to?

According to the NHS and a 2015 consensus by experts from the organisations listed below, specialists who may be able to assess and treat vulvar pain may include gynaecologists, dermatologists, physiotherapists, vulvar pain specialists, and psychologists.

How long does vestibulodynia last?

The affliction can last between a few months to years.

Can vestibulodynia go away on its own?

Spontaneous remission in vestibulodynia is not uncommon however, the condition has a high probability of relapse, known as transient vestibulodynia.

Can psychological factors contribute to vestibulodynia?

Anxiety, depression, post-traumatic stress, and childhood maltreatment are associated with increased prevalence of both vestibulodynia and vulvodynia.

Summary

Vestibulodynia is a subtype of vulvodynia which is characterised by chronic pain at the vaginal opening. Vestibulodynia can be provoked or unprovoked; transient or continuous; localised, generalised, or a combination of both. Although vestibulodynia is characterised by pain at the vaginal opening, it might not always be the sole cause. During health assessments, mimicking disorders including certain cancers and infections will be ruled out. The condition is not age-specific, it can affect women in multiple ways at various stages of their lives, and being affected by vestibulodynia can be confusing and isolating. 

Research into vestibulodynia continues to improve our well-needed awareness and understanding of the condition. Due to the diversity in the disorder’s effects on women, the definitive cause is difficult to ascertain, particularly due to the subjective nature of its symptoms, including differences in pain perceptions. The lack of awareness by clinicians may exacerbate the challenges in understanding its causes and symptoms. It is therefore crucial to understand and recognise vestibulodynia-specific symptoms to minimise the misdiagnosis of an already under-recognised condition.