- 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.1 One randomized, controlled clinical trial found that almost one-third of women who had cognitive behavioral therapy reported a decrease in vulvar pain that occurs with intercourse.3,4
Physical therapy and biofeedback also can be helpful for women with vulvodynia.5 Physical therapy for vulvodynia may include exercise, education, or manual therapies, such as massage, joint mobilization, or soft-tissue mobilization. Other forms of physical therapy can involve ultrasound, electrical stimulation, or biofeedback techniques.
Complementary and alternative treatments, such as yoga6 and acupuncture,7 also may be helpful in managing pain from vulvodynia, but there is little evidence about the effectiveness of these approaches.
Some patients find that following a diet that is low in oxalates and taking calcium citrate supplements is helpful, although the evidence to support this approach is limited.8 Foods that are high in oxalates include greens, nuts, tea, chocolate, and soy products.9 Food high in oxalates may produce urine that is irritating, which contributes to the vulvar pain.2