Many medical conditions can cause vulvar symptoms and it is important for you to report any abnormal feelings you are experiencing, especially when they are worrisome and causing difficulties. Some common vulvar symptoms include pain in the vulva, itchiness, and an abnormal sensation such as vulvar burning.
Vulvar pain is the most commonly reported symptom and has a variety of different characteristics. It can be sharp, stabbing, stinging, or even burning. Pain in the vulva may be constant or intermittent. It may also be characterized as generalized, where the pain is felt in the entire general area of the vulva or localized to a specific area of tissue. Women often use words like dull, sharp, throbbing, aching, raw, prickly, cramping, gnawing, sore, stretching, stabbing or paper cut-like when using adjectives to describe vulvar pain.
Pain can be divided into two types: acute and chronic. Acute vulvar pain may mean that an immediate injury has occurred and once the condition is addressed or treated, the pain is diminished. Acute pain may resolve in a short period of time. Chronic pain is more often characterized by a long-term experience.
Since pain is a personal experience, it may be helpful for you to draw a pain diagram to give to your health care professional so that he or she may better understand where you are experiencing discomfort. The National Vulvodynia Association recommends recording your pain with a Visual Analogue Scale (VAS) on which pain is rated on a linear scale from 0 (no pain) to 10 (excruciating pain). A pain diary will be helpful and you should record the location, date, time, pain rating from 0-10, and aggravating or alleviating factors. Be sure to bring your records and medical pain record to your medical visits as your provider will use this information to better understand the severity of the symptoms.
Itchiness in the vulva is characterized by an irritation of the vulvar tissues and an intense desire to scratch the affected area. Scratching may, in fact, exacerbate the condition. Many researchers believe that a chemical called histamine is released during the physical act of scratching and this may trigger a circular pattern of itch-scratch-itch pattern. Chronic itchiness may lead to skin changes and a variety of chronic vulvar skin conditions. An itchy vulva may be very distressing and can impact activities of daily living. There are many common conditions which are known to cause vulvar itchiness. Some common causes include:
- Vulvar infections: Vulva-vaginal infections, including common yeast infections, can cause itching and are usually brought on by antibiotic and oral contraceptive use, menstruation, pregnancy, uncontrolled diabetes or an immune-deficient condition like HIV (disease/infection). Other infections like sexually transmitted infections may also have itchiness as a symptom.
- Chemical Irritants: Harsh chemicals like detergents, feminine sprays, perfumes, douches, foams or even latex or seminal fluid /sperm sensitivities can all affect and irritate the vulvar tissues.
- Menopause: When a woman stops her period at menopause, she may develop atrophic vulvar changes due to a gradual decline in circulating estrogen levels, which may in fact cause the vulvar tissues to thin and be more susceptible to trauma. The excessive dryness may also present an itchiness on the exterior genitals.
There are other less common causes of vulvar itchiness and they include cancerous and precancerous conditions and pinworms for young girls.
Vulvar burning may be described as complete or partial numbness or the feeling of pins and needles that are pricking the vulvar skin. Some women report a burning feeling or a decreased sensation of the tissues. Others report numbness and lack of feeling in this area. Some women may note that the vulvar tissue may become especially sensitive to touch while others report distressing heightened sensitivity in the vulvar area. Many women report the inability to wear undergarments that even gently touch the skin as clothes because they may amplify the burning sensation.
Severe burning of the vulvar tissues can directly impact a woman’s quality of life; it is not uncommon to report that activities of daily living, including wearing pants, crossing legs, or even walking have become distressing. Some common causes of tingling or burning in the vulva may include: vulvar vestibulitis, nerve damage or injury (pressure or injury directly placed on the nerves), diabetic neuropathy or more serious conditions, including multiple sclerosis.