There's no question that cycling releases loads of feel-good endorphins and activewear is designed to help you move well and look good. However, for 16% of womxn in the US, sources of pressure such as biking and tight clothing can trigger symptoms of vulvodynia (chronic vulvar pain).
Vulvodynia encompasses a spectrum of symptoms associated with vulvar pain and discomfort, namely burning, itching, rawness, and other unpleasant sensations. These symptoms are not explained by another condition or treatment (e.g. nerve compression, chemotherapy, recurrent infections, direct injury, etc.) and last for 3 months or more. While the exact cause of vulvodynia is unknown, causes may include irritation or injury to vulvar and vaginal anatomy or hormonal changes.
Localized Vulvodynia is pain in one specific area of the vulva, most commonly the vestibule (the space around the vaginal opening). The pain is often provoked or worsened by certain activities that put pressure on the vulva, such as biking, tight underwear or pants, and sexual intercourse.
Generalized Vulvodynia is defined by pain in many different areas of the vulva. The pain is near constant, but can also be provoked or worsened by activities that put pressure on the vulva.
Sometimes, vulvodynia symptoms extend beyond the vulva and cause pain in the perineum (the area between the vagina and anus) and the inner thighs.
Think of the vulva as the part of your genitals you can see from the outside – everything that gets covered by the front half and gusset (the extra fabric pad) of your underwear. The vulva is made up of other structures including the mons pubis, labia (lips), clitoris, urethral opening (the hole that pee comes out of!), and vaginal opening.
Ice pack: Applying an ice pack to the vulva for 10-15 minutes every 4-6 hours can minimize burning sensations. Just be sure not to apply ice directly to the skin to avoid further irritation!
Topical medications: Applying lidocaine 2% or 5% ointment before or after activities that typically provoke pain can reduce the discomfort associated with vulvodynia. Lidocaine is favored by doctors and patients alike because it is relatively inexpensive, has few side effects, and can be applied in a targeted way.
Pelvic floor therapy: Given that many people with vulvodynia carry extra tension in their pelvic muscles and experience heightened pain when pressure is applied to those muscles, pelvic floor physical therapy is recommended as an initial treatment for vulvodynia. During the course of treatment, a pelvic floor therapist will work with you to stretch and strengthen muscles in your pelvis, back, and abdomen. Check out this list of pelvic floor therapists near you for more information!
Talk therapy: Vulvodynia is not a psychological disorder, and the pain you’re feeling is definitely not “all in your head”. That said, along with treatments that directly target the physical causes of your symptoms, therapy can help you learn coping strategies to minimize pain. Cognitive behavioral therapy (CBT) is the type of therapy most often used to treat chronic pain by addressing the feelings, thoughts, and behaviors associated with the pain.
Nerve blocks: Nerve dysfunction is thought to play a role in vulvodynia and other chronic pain conditions. Nerve blocks can prevent pain signals from being transmitted. During the procedure, local anesthetic is injected where the dysfunctional nerve passes through the muscles, leading to immediate dulling of pain and instant relief.
Surgery: Surgery is reserved for cases of localized provoked vulvodynia in which oral, topical, and injectable medications haven’t worked. The surgery performed is called a vestibulectomy, during which painful areas of tissue are removed from the vestibule (the part of the vulva surrounded by the labia minora). The procedure is not recommended for those whose vulvodynia is located outside the vestibule.
Antidepressants: While vulvodynia is not a psychological disorder, associated symptoms can cause you to feel sadness or anger. The role of antidepressants in the treatment of vulvodynia is not to directly target these feelings, but rather to target the neurotransmitters and ion channels involved in a variety of chronic pain disorders. In fact, the doses of these medications needed to treat vulvodynia are typically much lower than those used to treat depression. Tricyclic antidepressants (TCAs) and Selective Norepinephrine Reuptake Inhibitors (SNRIs) are the two classes of antidepressants that have been shown to have the most efficacy in managing chronic nerve pain such as vulvodynia.
Prescription pain medication: While antiseizure medications were initially developed to treat people with epilepsy, their ability to modulate the activity of nerves allows them to help quell the burning, stabbing, or shooting pain caused by vulvodynia. Of the three antiseizure medications FDA-approved to treat neuropathic pain — gabapentin, pregabalin, and carbamazepine — gabapentin has shown the most promise in treating people with vulvodynia, with some studies showing up to 80 percent reduction of symptoms with use of the drug.
This article was researched and written by folks in the medical profession (authored by Avanti Rangnekar & Charissa Iluore, reviewed by Dr. Peter Vasquez MD), but does not substitute for medical consultation. Eztia is here to give you tools to have informed conversations about your body. We encourage you to discuss with a clinician regarding any symptoms you may have, as you take charge of your health!
