Vulva Burning Sensation – Causes and Treatment

It is also called vulvodynia. This is a common problem affecting many women, almost all age groups. The condition is characterized by pain in the vulva. Burning sensation or itching may or may not be accompanied.

However, on examination, there is no obvious cause of the symptoms. There is no redness, no discharge, no swelling. This makes the picture confusing, as there  is no clue for the presence of any irritation, allergy or infection.

The problem often goes undiagnosed, as nothing is visible on physical examination. The affected area appears normal, though the woman constantly talks about her symptoms.

What Is Vulva?

The region down there is confusing as far as terminologies are concerned. Just to make clear, the internal canal is called the vagina. The area lying just outside it is the vestibule. Vestibule is very sensitive to touches of all kinds.

Outside the vestibule, the area having fleshy lips is called the vulva. Vulva has two inner lips (labia minora) and two outer lips (labia majora).

Hair are present over the outer lips.

Symptoms

• Pain in the vulva region. The pain may be localized at a point or may be widespread. It may be all the time or only in response to some touch or pressure.
• No redness, no swelling down there.
• Itching or burning sensation may be there.
• On physical examination, the area looks healthy.

Types of Vulva Burning

It is basically of two types-

Vulvar vestibulitis syndrome (VVS)– This is a painful response to touch or pressure around the vaginal opening. This pain may be localized at some specific points over the area.

Dysesthetic vulvodynia (DV)– This is generalized pain over the vulva, present all the time. It doesn’t  require any stimulus to initiate the pain. This type of vulva pain is commoner after menopause.

Cause of Vulvodynia

The reason why a normal and healthy looking vulva gives painful is not exactly understood.

However, there are theories to explain it. This has been related to repeated traumas or injuries or irritation this area is subjected to. This may happen while intercourse, masturbating, activities like horse riding or may be by repeated allergies or infections..

This area is soft and sensitive. So, in response to any of the above cause, defense mechanisms get activated.

The muscles of the vulva (inside the lips) contract and come into spasm. This happens so as to shrink, in an attempt to prevent further injury. Sometimes, a small piece of muscle may get twisted or misaligned.

The nerve endings present there become more sensitive, so as to let you know of any further trauma with precision.

The area may become slightly swelled due to engorgement with blood vessels. Signs of chronic inflammation are visible on careful examination.

Management

• Be gentle with the area affected. Avoid wearing tight lowers, which may put pressure on the vulva and give you pain.
• Avoid activities like horse riding or gym exercises which put pressure over the vulva.
• Avoid sex. You may indulge in non penetrating sex for some time.
• Wear loose cotton underwears. Keep the vulva well moisturized. Moisterizing lotions are available for this region.
• Avoid all possible irritants like tampons, douches, soaps etc.
• Anti inflammatory medicines  may be given, since the condition is basically a defensive response of the vulva. High potency steroids may be applied in cream/ ointment form over the vulva. Continue applying for some time.
• Topical nitroglycerine may be used to open up shrinked blood vessels.
• You need to relax. Relaxing in general would help the muscles of this area to relax back. Sometimes, anti depressants may be used. They are observed to relief pain.

Other Vulval Conditions to be Ruled Out

Before confirming the diagnosis, it is essential to rule out the presence of other conditions that affect the vulva and give pain. These include:

• Herpes- There is a burning sensation over the vulva skin. Small clear bumps, single or in groups, may or may not be seen.
• Yeast- The vulva skin is itchy and red. Usually, some discharge from vaginal can be felt.
• Injury- History of injury may be there.
• Sexual assault- Slight trauma keep occurring during intercourse. If the act is done roughly, it may present as painful vulva.
• Skin conditions like psoariasis- Skin disease with lot of itching. The skin may appear red with minute white/ silver flakes over it.
• Pre cancerous states- This may be caused by HPV (human pappiloma virus). The skin of the vulva is affected. Biopsy may show the presence of abnormal cells in the epidermal layer. The woman may complain of itching or burning sensation, with no evident sign of disease.
• Folliculitis- Since the vulva has hair over it, folliculitis can occur. This is the infection of a hair follicle over the vulva. Though a small bump is usually seen. which is red and painful, sometimes the whole of the labia pain with no evident bump. It may take 2 to 3 days for the bump to appear.