: I’ve been using tampons since I started having my periods, but lately everything in that general area “down there” just hurts. I can’t wear tampons any more as my body just seems to want to expel them and I’m now dreading sex. Intercourse is just so painful, no matter how ready my body is for it. What could this be? —Charlene Mills, Toronto
: For some women, sex hurts. It really hurts. It hurts so badly that you cry. And based on the situation you’ve described, you may even be avoiding a gynecologist visit, as many women who have pelvic pain tend to do. The clinical name for pelvic pain is vulvodynia, and it includes any serious pain around the opening of your vagina. Vulvodynia affects women of all age groups, beginning as early as adolescence.
According to a Harvard University study funded by the National Institutes of Health, almost 16% of American women suffer from vulvodynia at some point in their lives, with more than 90% reporting ongoing pain for many years. The pain can occur suddenly, for seemingly no reason, and it can continue for years. Some women describe it as burning, sharp, prickly or even itchy. It can be present constantly, no matter what you do or don’t do, or only during activities that affect your pelvic area such as sex, bike or horseback riding, inserting a tampon, wearing tight jeans or even just sitting for long periods.
The diagnosis struggle
By the time women are diagnosed, they’ve often been dealing with the problem for years. The Harvard study showed that most women who received a diagnosis had previously gone to at least three different healthcare providers already. Along the way they were typically treated repeatedly for vaginal yeast infections and also tested for sexually transmitted infections; in many cases it’s likely that all of these tests were negative.
Some 40% of women who seek treatment for pelvic pain remain undiagnosed with vulvodynia because the condition is under-researched and misunderstood, researchers speculate. But vulvodynia isn’t an infection or a sexually transmitted disease. Experts believe that vulvodynia is caused by irritation or injury to the nerves in the vulva or by infection, trauma or weakness in the pelvic floor muscles. The exact cause has yet to be found.
Easing the symptoms
Currently, there’s no cure for vulvodynia. If you’re experiencing this pain, avoid using feminine hygiene products and harsh soaps in the vulvar area, and wear only cotton underwear.
Treatment for the pain is targeted at symptom relief through the use of tricyclic antidepressants, such as amitriptyline (Elavil). These drugs are helpful in some women, but the frequent side effects, including dry mouth, fatigue, constipation and weight gain, can be too bothersome for others.
In that case, your healthcare provider may suggest a selective serotonin reuptake inhibitor (SSRI) such as venlafaxine (Effexor). Another drug that has also shown some promise is the anti-seizure drug gabapentin (Neurontin), but you may need too high of a dose for it to be useful.
Skip the Advil or Tylenol. So far, research has shown that common anti-inflammatories and pain killers aren’t helpful with vulvodynia, and neither are steroid injections, which are sometimes advised.
What may help is numbing the vulvar area with a local anesthetic, such as lidocaine. Surgery is an option for very severe cases but should only be tried when all else has failed.
Fortunately, some women find that it simply goes away as unexpectedly as it appeared. But don’t suffer in silence—talk to your healthcare provider and don’t stop asking for help until you get it.