Vulva pain is nearly always infection

This may be very obvious as in the "raw beef" perineum. Vulva pain here is likely due to thrush from undiagnosed or uncontrolled diabetes with Candida albicans infection.

This is when you are red, swollen, itchy and in pain down below. You may have an opaque white discharge.

Genital herpes is quite the opposite, often causing very minor little splits or cracks, not even blisters. It is certainly painful during attacks.

One in five Americans have genital herpes but only about 10% of them are diagnosed. This is the story for most sexually transmitted diseases, including wart virus and Chlamydia, that most people have no symptoms from the infection.

HSV is detected by PCR test on a swab. This needs to be taken as soon as the attack begins.

A recent investigation¹ of 4 women involved daily swabs from seven different genital locations , for a month. Three of these women had HSV for less than a year, and the most recent infections accounted for most of the positve swabs.

There was something to see on their skin on only 35 of the 44 positive swab days.

Bartholin's abcess is another very obvious infection. Your Greater Vestibular glands are beside the opening of your vagina, and now one is swollen and vey painful.

This needs urgent surgery, to release the pus.

Vulvodynia and Vulvar Vestibulitis Syndrome

Here there may be chronic pain and even exquisite tenderness, with little to see. My experiene of this is quite limited, but as with all pain syndromes I would check the sacroiliac and lumbar spine joints as part of the examination.

Guidelines for the management of vulvodynia have just been published², mentioning a trial of topical local anesthetic (applied to the painful area,) amitriptyline, nortriptyline, gabapentin or pregabalin and acupuncture.

Local provoked vulvodynia, where a small area is exquisitely tender, may be treated by injections here or even surgical excision.

The review authors emphasized the need for team care, involving psychosexual medicine, physiotherapy, and pain management teams.

Dyspareunia- pain on sexual penetration

Otherwise healthy postmenopausal women often have discomfort from thinning of the skin of the vagina.

One's vagina can feel (and be) dry. lubrication during intercourse may be inadequate, causing discomfort now.<span style='font-size: 50%'>#

Oestriol (E3) cream from a compounding chemist, may be a good option now, as it is much weaker than the other two main oestrogens, and may be more prone to target this area of your body, rather than breasts and uterus.

If you have plenty of fat tissue, your oestrogen levels may still be even a third of premenopausal levels, and rather than oestrogen replacement, progesterone may work well.

Natural progesterone, but not synthetic progestins (progestogens,) help one's oestrogens to work, and may then be a better alternative, as there is no worry about ones breasts and uterus.

Oestriol cream is used on the target area, but progesterone cream is used over another area where there is plenty of underlying adipose tissue, such as one's tummy.

If you are already taking oestrogen hormone replacement therapy, and are starting progesterone cream, it is best to halve the dose of oestrogen.
Progesterone increases the sensitivity of oestrogen receptors, and could now result in oestrogen dominance, felt as...
Fluid retention, oedema (swelling and weight gain)
Breast swelling and tenderness

Before you start progesterone, consider your thyroid status . It's best to start any needed thyroid hormone replacement first, if both are warranted. Otherwise reduced liver clearance of progesterone could cause unexpectedly strong effects.

Saliva levels of progesterone are the best pathology test, for diagnosis and checking the dose during treatment.

Vulva pain in Lichen Sclerosus

Kraurosis vulvae, or Lichen Sclerosus et Atrophicus is an intensely itchy shriveled up vulva with ivory-white areas.
The diseased tissue is brittle and splits or cracks readily.
These fissures can be tender and painful, on passing urine, using bowels or making love.

References for vulva pain page

1. J Infect Dis. Published online January 20, 2010. Print publication February 15, 2010;201:486-487, 499-504.

2. D. Mandal et al, Br J Dermatol. 2010 Mar 16

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From vulva pain page back to pelvic pain page

HSV is Herpes simplex virus type 1 causes cold sores and type 2 causes genital herpes, largely. The test for this is a polymerase chain reaction test to detect its DNA.


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