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What are the treatments for vulvodynia?

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A variety of treatment options may be presented to patients, including:1

  • Topical medications, such as lidocaine ointment (a local anesthetic) or hormonal creams
  • Drug treatment, such as pain relievers, antidepressants, or anticonvulsants
  • Biofeedback therapy, intended to help decrease pain sensation
  • Physical therapy to strengthen pelvic floor muscles
  • Injections of steroids or anesthetics
  • Surgery to remove the affected skin and tissue in localized vulvodynia
  • Changes in diet (for example, some physicians may suggest a diet low in oxalates, which can form crystals in the body if they aren't filtered out by the kidneys)
  • Complementary or alternative therapies (including relaxation, massage, homeopathy, and acupuncture)

Types of Treatment for Vulvodynia

Lifestyle Changes and Therapy

Gentle care of the vulva can help provide pain relief:2,3

  • Wear 100% cotton underwear (no underwear at night).
  • Avoid tight-fitting undergarments and pantyhose.
  • Avoid douching.
  • Use mild soaps for bathing and clean the vulva with water only.
  • Do not use vaginal wipes, deodorants, or bubble bath.
  • Do not use pads or tampons with deodorants.
  • Use lubrication for intercourse.
  • Apply cool gel packs to the vulvar area to reduce pain and itching.
  • Avoid exercises that put pressure directly on the vulva, such as bicycling.

Vulvar pain can have an emotional or psychological aspect, and some women benefit from psychological counseling, sex therapy, or both. Referral for therapy does not mean that the pain is "all in the head." Sex therapy can provide education and information for individuals or couples. Psychological treatment can provide techniques for relaxation or coping with pain or an opportunity to explore other conditions that may relate to the pain.4 A randomized, controlled trial found that women who had cognitive behavioral therapy reported a 30% decrease in vulvar pain that occurs with intercourse.5

Physical therapy and biofeedback can be helpful for women with vulvodynia.6 Physical therapy for vulvodynia may include exercise, education, or manual therapies, such as massage, joint mobilization, or soft-tissue mobilization. Other methods of physical therapy can involve ultrasound, electrical stimulation, or biofeedback techniques.

Other complementary and alternative treatments, such as yoga7 and acupuncture,8 may be helpful in managing vulvodynia, but there is little evidence about these approaches.

Some patients find that following a diet that is low in oxalates, along with taking calcium citrate supplements, is helpful, although the evidence to support this approach is limited.9 Foods that are high in oxalates include greens, nuts, tea, chocolate, and soy products.10 Food high in oxalates may produce urine that is irritating, which contributes to the vulvar pain.11

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Medical Treatment

Antidepressants, corticosteroids, and topical pain relievers have all been suggested for treatment of vulvodynia. However, the results of clinical research studies have not supported the use of these treatments. For example, NICHD-funded research found that amitriptyline (a tricyclic antidepressant) with or without topical triamcinolone (a corticosteroid used to treat skin conditions) was no more effective than self-management approaches (which included components of education and cognitive-behavioral, physical, and sex therapy) in managing vulvar pain, although the number of people in the study was small.12 Other NICHD-supported investigators conducted a randomized, controlled trial and found that oral desipramine (a tricyclic antidepressants) and topical lidocaine (an anesthetic), alone or in combination, were no better than placebos in helping women with vulvodynia.13

Research sponsored by the NICHD is evaluating the use of gabapentin, a drug that helps control epileptic seizures, for women with provoked vestibulodynia (or vulvar vestibulitis syndrome) in a randomized, controlled trial.14 The findings may also shed light on treating other chronic pain syndromes.

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Surgical Treatment

Surgery may be an option for women with severe pain from vulvar vestibulitis who have not found relief through other treatment options.15 A vestibulectomy (pronounced ve-STIB-yuh-LEK-tuh-mee) removes the painful tissue of the vestibule and may help relieve pain and improve sexual comfort. However, surgery is usually considered a last resort and is not recommended for women with generalized vulvodynia.16


  1. Haefner, H. K., Collins, M. E., Davis, G. D., Edwards, L., Foster, D. C., Hartmann, E. H., et al. (2005). The vulvodynia guideline. Journal of Lower Genital Tract Disease, 9, 40-51. [top]
  2. American College of Obstetricians and Gynecologists. (2011). Vulvodynia. Frequently Asked Questions (FAQ 127). Washington, DC: American College of Obstetricians and Gynecologists.[top]
  3. Haefner, H. K., Collins, M. E., Davis, G. D., Edwards, L., Foster, D. C., Hartmann, E. H., et al. (2005). The vulvodynia guideline. Journal of Lower Genital Tract Disease, 9, 40-51. [top]
  4. Haefner, H. K., Collins, M. E., Davis, G. D., Edwards, L., Foster, D. C., Hartmann, E. H., et al. (2005). The vulvodynia guideline. Journal of Lower Genital Tract Disease, 9, 40-51. [top]
  5. Bergeron, S., Binik, Y. M., Khalifé, S., Pagidas, K., Glazer, H. I., Meana, M., & Amsel, R. (2001). A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain, 91, 297-306. [top]
  6. Reed, B.D. (2006). Vulvodynia: Diagnosis and management. American Family Physician, 73, 1231-1238. [top]
  7. Ripoll, E., & Mahowald, D. (2002). Hatha yoga therapy management of urologic disorders. World Journal of Urology, 20, 306-309. [top]
  8. Curran, S., Brotto, L. A., Fisher, H., Knudson, G., & Cohen, T. (2010). The ACTIV study: Acupuncture treatment in provoked vestibulodynia. Journal of Sexual Medicine, 7, 981-995. [top]
  9. Reed, B.D. (2006). Vulvodynia: Diagnosis and management. American Family Physician, 73, 1231-1238. [top]
  10. Mayo Clinic. Kidney stones: Prevention. Retrieved March 30, 2012, from http://www.mayoclinic.com/health/kidney-stones/DS00282/DSECTION=prevention External Web Site Policy [top]
  11. American College of Obstetricians and Gynecologists. (2011). Vulvodynia. Frequently Asked Questions (FAQ 127). Washington, DC: American College of Obstetricians and Gynecologists. [top]
  12. Brown, C. S., Wan, J., Bachmann, G., & Rosen, R. (2009). Self-management, amitriptyline, and amitriptyline plus triamcinolone in the management of vulvodynia. Journal of Women's Health, 18, 163-169. [top]
  13. Foster, D. C., Kotok, M. B., Huang, L . S., Watts, A., Oakes, D., Howard, F. M., et al. (2010). Oral desipramine and topical lidocaine for vulvodynia: A randomized controlled trial. Obstetrics & Gynecology, 116, 583-593. [top]
  14. Brown, C. A controlled trial of gabapentin in vulvodynia: Biological correlates of response. NIH Project 1R01HD065740-01A1. [top]
  15. American College of Obstetricians and Gynecologists. (2011). Vulvodynia. Frequently Asked Questions (FAQ 127). Washington, DC: American College of Obstetricians and Gynecologists. [top]
  16. Reed, B.D. (2006). Vulvodynia: Diagnosis and management. American Family Physician, 73, 1231-1238. [top]

Last Updated Date: 11/30/2012
Last Reviewed Date: 04/22/2013
Vision National Institutes of Health Home BOND National Institues of Health Home Home Storz Lab: Section on Environmental Gene Regulation Home Machner Lab: Unit on Microbial Pathogenesis Home Division of Intramural Population Health Research Home Bonifacino Lab: Section on Intracellular Protein Trafficking Home Lilly Lab: Section on Gamete Development Home Lippincott-Schwartz Lab: Section on Organelle Biology