{"id":22654,"date":"2025-05-27T08:00:00","date_gmt":"2025-05-27T13:00:00","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=22654"},"modified":"2025-08-05T15:25:26","modified_gmt":"2025-08-05T20:25:26","slug":"vulvodynie-vestibulodynie","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/fr\/vulvodynia-vestibulodynia\/","title":{"rendered":"La douleur \"en bas\" peut en fait \u00eatre une vestibulodynie et non une vulvodynie."},"content":{"rendered":"\n

Amidst all the negatives of social media, one positive is open discussion around topics that have historically (but unnecessarily) been considered taboo. Vulvodynia is one such topic, as 60,500 people Google search the topic each month. In an instructive interview<\/a> on the Beyond Basics Physical Therapy\u2019s The Pelvic Messenger<\/em> podcast, Dr. Jill Krapf (a board-certified OB\/GYN and women\u2019s sexual health expert with The Centers for Vulvovaginal Disorders) covered what women need to know about vulvodynia, including why vestibulodynia <\/em>is actually the proper term for the vulvar pain many women experience with sex and tampon insertion.  <\/p>\n\n\n\n

What is vulvodynia?<\/span><\/h2>\n\n\n\n

According to Krapf, vulvodynia refers to an \u201cabnormal pain response of the vulva, which is the outer part of the female genitalia. And that includes the opening of the vagina as well, that we call the vestibule.\u201d Essentially, vulvodynia refers to chronic pain of the vulva, lasting more than 3 months, Krapf specified.\u00a0<\/p>\n\n\n\n

And while a majority of women, if they\u2019ve heard the term at all, have heard the term \u2018vulvodynia,\u2019 Krapf clarified that most women who present with vulvar pain specifically have a more localized version called vestibulodynia, pain at the opening <\/em>of the vagina. Clitorodynia, pain of the clitoris, is another, less common, possibility. But each of these terms, Krapf explained, only tell us where<\/em> the pain is located, not why<\/em> it\u2019s occurring.\u00a0Infact these conditions are not a disease in themselves, and many factors contribute to pain in these locations.<\/p>\n\n\n\n

How do you know you have vestibulodynia?<\/span><\/h2>\n\n\n\n

The preeminent symptom of vestibulodynia is pain, i.e., pain when anything is inserted into or removed from the vagina (think: tampon insertion and removal, and sexual intercourse or a vaginal dilator). Pain may also occur with tight-fitting clothing or prolonged sitting. <\/p>\n\n\n\n

Vestibulodynia may be primary, meaning that sex, tampon insertion, etc., has always <\/em>been painful, or it may be secondary, meaning that these things didn\u2019t cause pain formerly, but due to some triggering event, they cause pain now. (Dr. Krapf gave an allergic reaction to a yeast infection medication as an example of a “triggering event.”)<\/p>\n\n\n\n

How is vestibulodynia diagnosed? <\/span><\/h2>\n\n\n\n

As Vestibulodynia is not a disease with a specific cause it’s diagnosed <\/a>based on symptoms, visual assessment, pelvic exam and the \u2018cotton swab touch test.\u2019 Dr. Krapf explained that, \u201cWe can usually see on exam that those glands that produce our natural lubrication\u2013which are located at the opening area on each side of the urethra, where the urine comes out, and then down at the bottom, tucked into your hymenal tags\u2013those can be red and irritated.\u201d\u00a0<\/p>\n\n\n\n

She described the cotton swab touch test, noting \u201cAnd then when we touch them with a Q tip, they\u2019re uncomfortable. And we can touch [as little as] a millimeter outside of that area and it\u2019s not<\/em> uncomfortable. So we know that there\u2019s something [going on] with the glands that help to maintain that tissue of the vestibule.\u201d <\/p>\n\n\n\n

What causes vestibulodynia?<\/span><\/h2>\n\n\n\n

Hormonal birth control is the most common culprit behind vestibulodynia pain in young women<\/span><\/h3>\n\n\n\n

Vestibulodynia is most commonly hormonally driven, and this is called hormonally-mediated or hormonally-associated vestibulodynia. This can occur during major hormonal transitional times in a woman\u2019s life, like during postpartum and lactation and during menopause. Still, hormonally mediated vestibulodynia is most often caused by hormonal birth control<\/a> use [1].<\/p>\n\n\n\n

According to Herman & Wallace Pelvic Rehabilitation Institute,<\/a> “The most common cause of Hormonally-Mediated vestibulodynia in younger women (under the age of 25) is systemic birth control (i.e. oral contraceptive pills (OCPs), depo-shot, NuvaRing).” And while patients may be educated on birth control\u2019s more common side effects like nausea and mood swings, many are not told that birth control \u201ccauses vestibulodynia, decreased vaginal lubrication, decreased thickness of labia minora, and decreased vaginal introitus size, all leading to dyspareunia (painful sex).\u201d <\/p>\n\n\n\n

What\u2019s more, \u201c[t]hese changes can occur as early as 90 days after starting OCPs or with long-term use.\u201d Risk is higher <\/a>among girls who start birth control before the age of 17, as noted by a 2010 case study [2].<\/p>\n\n\n\n

The most common cause of Hormonally-Mediated vestibulodynia in younger women (under the age of 25) is systemic birth control… birth control \u201ccauses vestibulodynia, decreased vaginal lubrication, decreased thickness of labia minora, and decreased vaginal introitus size, all leading to dyspareunia (painful sex).\u201d  <\/p>Herman & Wallace Pelvic Rehabilitation Institute<\/a><\/cite><\/blockquote><\/figure>\n\n\n\n

The hormone behind hormonally-mediated vestibulodynia isn\u2019t the one you’d expect<\/span><\/h4>\n\n\n\n

Fascinatingly, estrogen drives the health of internal vaginal tissue, but testosterone<\/em> drives the health specifically of the vestibule area, the opening of the vagina. Dr. Krapf shared, \u201cThe key is that anything that decreases our testosterone-or the ability of hormones to get to that tissue-is going to have a negative effect on those glands.\u201d <\/p>\n\n\n\n

When the liver breaks down hormonal birth control, sex hormone binding globulin (SHBG) is produced. SHBG in turn attaches to testosterone and inactivates it, preventing it from acting on the glands at the vestibule. This leads to \u201ctissue discomfort, breakdown, [vaginal] fissures, increased infection, [and] increased urinary tract infection.\u201d <\/p>\n\n\n\n

Other causes of vestibulodynia<\/span><\/h3>\n\n\n\n

Vestibulodynia may also be caused by muscle issues, nerve issues, or whole-body inflammation. Dr. Krapf noted that often a combination of causes are at play. For example, tight and weak pelvic floor muscles can lead to the inability of hormones to reach the vestibule, causing vestibulodynia.  <\/p>\n\n\n\n

How do you treat vestibulodynia?<\/span><\/h2>\n\n\n\n

Behavioral modifications<\/span><\/h3>\n\n\n\n

The most basic interventions for vestibulodynia involve lifestyle changes like wearing loose-fitting clothing and avoiding sitting for prolonged periods of time. Women with vestibulodynia are also encouraged to avoid use of any scented products (think scented pantiliners, douches, or vaginal deodorants) and to use a lubricant with sexual intercourse. Reducing constipation may also indirectly reduce pain. <\/p>\n\n\n\n

Pelvic floor physical therapy<\/span><\/h3>\n\n\n\n

The most important and effective piece of vestibulodynia treatment is pelvic floor physical therapy <\/a>(PFPT). PFPT addresses muscle weakness and tightness, helping to restore blood flow to the vaginal area, which ultimately leads to reduced pain and increased ability to accept a tampon or participate in sexual intercourse. It\u2019s crucial to seek care from a physical therapist who specializes in the pelvic floor. PFPT is not a quick fix, and may take months to reach peak impact.  <\/p>\n\n\n\n

Medications<\/span><\/h3>\n\n\n\n

Dr. Krapf noted that medications are often part of the treatment plan, especially in the short term until PFPT makes a difference. Topical anesthetics may help with vestibulodynia. Topical hormonal creams may help with hormonally mediated vestibulodynia such as is caused by hormonal birth control. Oral tricyclic antidepressants may also be prescribed because they numb the nerves that cause pain. When these medications are used for vestibulodynia, however, they\u2019re prescribed at much lower doses than would be used for depression. The Centers for Vulvovaginal Disorders, Dr. Krapf\u2019s employer, has an in-depth article<\/a> on medications for vestibulodynia, and additionally weighs in on medications that are unlikely to be helpful or may even be harmful. <\/p>\n\n\n\n

The bottom line on vestibulodynia<\/span><\/h2>\n\n\n\n

While it is an undoubtedly painful condition, vestibulodynia is a highly treatable one. Finding a healthcare professional specifically trained in recognizing and treating vulvar disorders is key. If you experience chronic pain with sex, tampon insertion, etc. you may want to start out with a pelvic floor physical therapist (though some will require a referral). She is likely to know the most experienced health care clinicians in your area for treating pelvic floor issues. In the absence of a local expert, consider utilizing telehealth for treatment guidance from a vaginal health expert, such as one trained through the International Society for the Study of Women\u2019s Health<\/a>. <\/p>\n\n\n\n

<\/p>\n\n\n\n

References:<\/span><\/h4>\n\n\n\n[1] Aerts L.,Pluchino N., Hormonal contraception and vulvodynia: an update, GREM Gynecological and Reproductive Endocrinology & Metabolism <\/em>(2021); Volume 2 – 3\/2021:156-161 doi: 10.53260\/GREM.212034<\/p>\n\n\n\n[2] Goldstein A, Burrows L, Goldstein I. Can oral contraceptives cause vestibulodynia? J Sex Med. 2010 Apr;7(4 Pt 1):1585-7. doi: 10.1111\/j.1743-6109.2009.01685.x. Epub 2010 Jan 25. PMID: 20102483.<\/p>\n","protected":false},"excerpt":{"rendered":"Surtout s'il s'agit de douleurs lors des rapports sexuels et\/ou de l'insertion d'un 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