Vulvodynia psychosomatics
Vulvodynia is pain or burning in the vulva, the outer part of the genitals, that lasts at least three months and has no obvious cause. According to the NHS the pain is real, not imagined, and treatment can help. If burning or stabbing pain does not go away, or gets in the way of sex or tampons, book a visit with a gynaecologist. The Ladder method helps you notice how you protect yourself, and it does not replace a doctor.
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When to see a doctor
A gynaecologist. You can ask for a female doctor and for someone close to you to be in the room (NHS). The doctor will ask questions, examine you and take a swab. If no cause is found, they may refer you to a pain specialist. Come if the pain lasts or keeps coming back, inserting a tampon hurts, or sex causes burning.
In the Ladder method
In the Ladder method vulvodynia is not explained by old grievances and is not split into "it is your own fault". It is not your fault and you are not making it up: the pain is real, and the cause is still unknown. A gynaecologist comes first, and questions to yourself go alongside treatment, not instead of it.
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In the method this part of the body fits the image of personal boundaries: how safe you feel around closeness and when your body tightens. This is an image, not the cause of the pain, and it does not replace treatment.
On the ladder this shows up as the rungs "I am not allowed to say no" and "I have to put up with it". You can work through them at your own pace while doctors find the right treatment.
These are questions for reflection, not an explanation of what causes the condition and not a treatment.
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How it shows up
Book a doctor’s appointment if you notice:
- Burning in the vulva
- Stabbing or throbbing pain
- Pain when inserting a tampon
- Pain or burning during sex
- Pain that comes and goes, or stays constant
- Pain that interferes with sleep and focus
What medicine knows
The vulva is the outer genitals around the entrance to the vagina. Vulvodynia is pain there that lasts at least 3 months and has no specific cause. The pain can be burning, throbbing, stabbing or feel raw like a graze (NHS).
On the outside the vulva usually looks as it always does. The pain can be constant or come and go, and can cover the whole area or only part of it. Sometimes it appears on touch: when inserting a tampon or during sex. It can spread to the thighs, the anus and the urethra (NHS).
The exact cause is unknown. Among possible factors the NHS names damage, irritation or oversensitivity of the nerves of the vulva, past vaginal infections, hormone changes such as oestrogen, and weak pelvic floor muscles. This kind of pain can affect sleep, concentration and relationships.
Similar pain can come from vaginitis, vaginismus and sexually transmitted infections, so a doctor rules them out first: they ask questions, gently touch with a cotton bud to find tender spots, and take a swab (NHS). Several specialists usually treat it: a gynaecologist, a physiotherapist, a psychotherapist, a pain specialist. Numbing creams, nerve pain tablets, pelvic floor exercises, vaginal trainers, cognitive behavioural and psychosexual therapy can help. There is no single remedy for everyone, so treatment is chosen together.
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Frequently asked questions
Is vulvodynia dangerous?
It is not life-threatening and it is not contagious, but it can strongly affect sleep, concentration and relationships (NHS). Treatment helps manage the pain, so do not suffer in silence.
Can vulvodynia come from nerves?
The exact cause is unknown. The NHS names sensitive nerves, past infections, hormones and a weak pelvic floor. You cannot say "it is just nerves" until a doctor has ruled out infections and skin conditions. In the Ladder method the pain is a reason to ask yourself about boundaries, and this does not replace a doctor.
What can I do myself?
The NHS advises wearing loose cotton underwear, choosing pads instead of tampons, not douching, avoiding scented products and hot baths, and not sitting in one position for long. During sex other positions and lubricant help.
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Answers to common questions
Psychosomatics does not replace tests and treatment. Only a doctor can make a diagnosis.