Why do I have pain at the entrance to my vulva?

Intimate health is an essential aspect of our personal well-being, but it is often overlooked due to social taboos and the embarrassment it can cause. If you experience pain at the entrance of the vulva during sex, know that you are not alone and that it is a fairly common problem that many people face. This article aims to shed light on the causes and possible solutions, providing you with the information and support you need, without any judgement.

What causes pain at the entrance to the vulva?

The discomfort you are experiencing may be due to vulvodynia, especially if the pain is concentrated at the entrance to the vulva and occurs during penetrative sex. Vulvodynia is characterized by discomfort or pain in the vulvar area with no apparent cause. This pain may manifest as a burning, tingling, or itching sensation. It is important to note that vulvodynia is usually diagnosed after other possible causes of vulvar pain have been ruled out.

Additionally, the pain may be generalized or localized.

Generalized vulvodynia is usually associated with diffuse pain or discomfort that occurs in different areas of the vulva at different times, experienced in the absence of a stimulus. The pain may be constant or intermittent. Localized vulvodynia, on the other hand, is usually associated with pain localized to a specific area of ​​the vulva, such as the vestibule (the entrance to the vagina). A common form of localized vulvodynia is vestibulodynia, formerly known as vulvar vestibulitis syndrome, which results in pain felt when pressure or friction is applied to the vestibule area.

It is crucial to consult a healthcare professional without delay if you suffer from vulvar pain, to determine the cause. These may include:

• Infections: Yeast or bacterial infections can cause inflammation and discomfort.
• Skin conditions: Conditions such as eczema or psoriasis can cause localized sensitivity and pain.
• Hormonal changes: Fluctuations, especially during pregnancy, postpartum, perimenopause and menopause, can affect the sensitivity of the vulva.
• Physical factors: Insufficient lubrication or pelvic floor dysfunction may be involved, making intercourse painful or uncomfortable.
• Psychological Factors: It is important to recognize that emotional and psychological factors can also play a significant role. Stress, anxiety, and past trauma can manifest as physical pain during intercourse. Recognizing and addressing these factors is an important step toward healing.

Possible treatments for pain at the entrance to the vulva

If you experience pain during intercourse, it is important to consult a healthcare professional. They will be able to make an accurate diagnosis and explain your symptoms in detail. Do not hesitate to get a second opinion if you do not feel listened to or supported by your first doctor or midwife.

There are several treatment options for people with vulvar opening pain. They range from medication to therapy to surgery. Here is a look at some of the possible treatments that may provide relief from vulvar pain:

1. Drug treatments

Healthcare professionals may prescribe a number of medications to help relieve vulvar pain. These include topical oestrogen creams, which are used when hormonal changes, particularly during menopause, contribute to vulvar pain.

They may also prescribe lidocaine, a numbing cream, to apply to the area where you feel pain before sex to numb it and reduce the pain.

Finally, low doses of antidepressants can also help treat chronic pain by acting on the central nervous system, while some anticonvulsants, generally used to treat epilepsy, can help treat neuropathic pain. As we can see, there is no universal solution, hence the importance of consulting a specialist.

2. Perineal rehabilitation

Pelvic floor muscle rehabilitation involves exercises and techniques to strengthen or relax the muscles of the pelvic floor. A hypertonic (overly tight) pelvic floor, for example, can contribute to vulvar pain. Treatment may include:

• Biofeedback: To help patients learn to control pelvic muscles.
• Manual therapy: Gentle, light internal and external massages and targeted stretching to relieve muscle tension.
• Specific exercises: To strengthen or relax the pelvic muscles and to improve their functions .

3. Surgical treatments

In very rare cases, when localized vulvodynia (such as vestibulodynia) does not respond to other treatments, surgery to remove part of the affected area (vestibulectomy) may be considered. However, this is usually a last resort, requiring a thorough consultation with a specialist.

Finally, other treatments may include therapy and psychological support, cognitive behavioral therapy, dietary changes, acupuncture, etc.

Are there any natural or over-the-counter treatments for vulvar pain?

We’re glad you asked! Many of us have experienced occasional vulvar pain. It can come on spontaneously and last – sometimes for months – then go away. Vulvar pain during pregnancy can be particularly worrying, as the thought of childbirth can bring fear of even more intense pain. There are over-the-counter treatments – which should always be taken in consultation with a healthcare professional – that can be helpful for people with vulvar pain. Below are some tried and tested ones:

Boost Hydration with the Help of a Natural Lubricant

Natural intimate lubricants can be especially helpful for people who experience pain at the entrance to the vulva. Here's how they can help:

Moisturizing protection: Natural lubricants provide a moisturizing barrier that can reduce friction during intercourse or other forms of physical activity that can lead to vulvar pain. They can provide significant pain relief by preventing further irritation of sensitive tissues.

Healing properties: Some natural lubricants contain ingredients such as aloe vera, which is known for its soothing and healing properties. These can help soothe irritated areas and promote healing of skin tissues.

Anti-inflammatory properties: Certain ingredients such as vitamin E as well as certain natural oils can help reduce inflammation, thereby relieving the pain and discomfort that can result.

For all these reasons, natural, water-based lubricants and vaginal moisturizers can be helpful for people with vulvar pain. But not all lubricants and moisturizers are created equal. It’s important to choose ones that contain ingredients that are gentle on the intimate area, as people with vulvodynia may have even more sensitive skin and mucous membranes that react poorly to the harsh chemicals found in some synthetic lubricants. A suitable natural lubricant will also have a pH level that’s appropriate for the vulvovaginal area, which will help prevent discomfort and bacterial infections that can exacerbate pain.

Using vaginal dilators to improve intimate comfort

Vaginal dilators can help improve comfort and reduce pain associated with vaginismus and vulvodynia in several ways:

• Progressive stretching: Vaginal dilators are designed to gradually stretch the vaginal muscles and surrounding tissues. This controlled relaxation helps reduce muscle tension and can relieve pain over time, especially in cases of vaginismus, when the vaginal muscles are contracted involuntarily.

• Desensitization: Regular use of dilators can help desensitize the vaginal area to touch and penetration. This may be helpful for people with vulvodynia, a condition characterized by hypersensitivity of the nerve endings in the vulvar area, causing pain with even light contact.

• Promote healing: When adhesions (scar tissue) contribute to pain (for example, after surgery or radiation therapy), the use of dilators can help keep vaginal tissues supple and prevent the formation of adhesions (restrictive scar tissue) that can exacerbate pain.

• Therapeutic exercises: Vaginal dilators may be used as part of a broader therapeutic program, often including pelvic floor rehabilitation. These exercises strengthen and relax the pelvic muscles, improving pain management and sexual function.

• Psychological comfort: Becoming familiar with the insertion and use of dilators may also provide psychological benefits, reducing fear or anxiety associated with penetration that can accompany or exacerbate vulvar pain.

Vulvar entrance pain can be caused by several factors and unfortunately there is no miracle cure, but there are a number of possible therapies for the many people who suffer from it. If you are one of these people and do not know where to start to treat vulvodynia or any other condition that causes you intimate pain, we recommend that you talk to a health professional. If your partner is supportive, we also recommend that you involve them in exploring other forms of intimacy and practices that do not cause you pain, while waiting to find an effective treatment, appropriate for your case.

Conclusion