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9 Most Effective Vulvodynia Treatments

For the live-updated, interactive version of this infographic, click here.

A year ago, we published 7 surprisingly simple treatments for female pain. Vulvodynia (chronic vulvar/vaginal pain) was the first condition CureTogether started with back in 2008, because I live with it. I repeated the analysis today, and found 9 treatments that clearly stand out as most effective.

This chart is based on 1,617 women with vulvodynia who answered 8,434 quantitative questions in CureTogether surveys.

The top 9 most effective treatments for vulvodynia are:

1. Wear loose-fitting clothes
2. Physical therapy
3. Ice
4. No underwear
5. Trigger point therapy
6. Avoid sex (or just avoid penetration)
7. Clitoral distraction with vibrator or by hand
8. Myofascial release
9. Rinse with water after urination

Another new thing on this chart: NuvaRing was added as a treatment, and was rated to make vulvodynia much worse instead of better.

To navigate the graph above:

The top right quadrant shows the most popular and effective treatments (e.g. loose-fitting clothes, avoid sex), and the top left quadrant shows treatments that not many people have tried but that have above-average effectiveness, so they may be options to think about (e.g. trigger point therapy, oatmeal baths).

Treatments in the lower right quadrant are ones that lots of people have tried but that have below-average effectiveness (e.g. Lidocaine, antibiotics), and treatments in the lower left quadrant are reported as neither popular nor effective, so you may want to consider this when choosing a treatment (e.g. NuvaRing, Lanacane).

Where did this data come from? CureTogether members have been anonymously sharing symptoms and treatments for almost 3 years now. We analyzed and visualized the data into infographic form to make it more accessible. To thank everyone for their contributions, we’re releasing this result back to the community for free.

This is part of our regular series of research findings. Of course, with each of these findings, there is a potential bias in patient self-selection and recall. Every research study has some bias, so we present these findings as just what they are – patient-reported data – to stimulate discussion and generate new insights for further research. Stay tuned for more and please let us know in the comments below if this was helpful or interesting for you.

Please tweet, blog, or pass this along to anyone who can benefit or is interested in vulvodynia. Thank you!


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27 Responses to “9 Most Effective Vulvodynia Treatments”

  1. Hi Alexandra -
    Thanks for posting this. I wonder if botox would be in that list if if it was more accessible to patients with vulvodynia. Unfortunately many insurance companies don’t cover it or their doctor’s office doesn’t know how to bill for it so the insurance companies will cover it.
    Botox has been the only thing that helped me and I’ve also chatted with many people on forums who’ve had the same experience. Of course, I realize this is just anec-data!
    But I was surprised to see that botox had only 7 entries in the data set.

  2. Thanks Jenny! Botox must be either something that was recently added to the survey, or just not enough people have tried it. As we gather more data on it, it will be added to the infographic as well. So glad you found something that helps!
    Alex

  3. I used to have unexplained pain (I suspect vulvadynia to some extent, but was never officially diagnosed) and chronic infections and acupuncture has done WONDERS for me. I’m a new woman. I encourage other women with these problems to try acupuncture.

  4. KELLEY TRIMBLE Says:

    STAYING ON A LOW OXALATE DIET AND TAKING CITRACAL HAS HELPED ME TREMENDOUSLY

  5. Jenny,

    How did you get any doctor to try botox for this? What specialty? I have been to a plethora of “experts”, i. e., derms, gynos, etc., professors of their specialties at a University Hospital and tried a host of Rx creams which served only to worsen the problem. How often do you have to repeat the shots? Does it hurt? It would be cash out of pocket for me I am sure but worth a shot (no pun intended).

    Thanks

    Diane

  6. I would like to recommend anal sex. It helps relax and stretch the muscles.

  7. My vulvadynia wound up to be a nicked spinal nerve but I use Lidocaine and inject it into my vagina with a catheter..that helps..
    I do have sex but then soak and use a fan underneath me..
    Stress has so very much to do with my pain..I might look into the acupuncture..but my pain is way up high..Tried spinal injections and nerve blocks but they did not work that well. I am dependant on medication to function..I am moving for I have married..maybe in this new state they will have some better ideas.. Meditation helps ..anything to de-stress myself..Best of luck to us all :)

  8. Anyone had experience with this product: http://www.vulvodynia.com/Store/Products/Featured.htm ?
    I am wondering to order but have no idea is it works for our problem. Please let me know if you have any information about it.

    Thanks

  9. While this condition and treatment response seems to vary much according to the individual I have found that the pain medication, Tramadol (not an opiod) often helps a lot. The herbal, Christopher’s Comfrey ointment has been very soothing for me. Also a DVD on Guided Imagery for women with pelvic pain, IC and Vulvodynia purchased from the IC Network is calming and relaxing.

  10. I’m confused by the graph. It says that amitriptyline is effective but Elavil is not. Aren’t they generic and brand names of the same medication? What has helped me is getting rid of MSG and other additives and preservatives (including adopting a gluten-free and non-processed food diet, which is difficult but possible). Keeping my urine more alkaline has been huge as well (when I tried cranberry capsules, which are highly acidic, my pain went through the roof). Using compounded estrogen cream has made sex possible and even enjoyable again, so I put that at #1 on the list (for me). It made my vaginal skin thicker which stopped the tearing/bleeding entirely. Testosterone cream made the skin thinner so I stopped that. When I abstained from sex with my boyfriend, it made the pain worse (which was a surprise to me). (I couldn’t have said this had I not also been on the estrogen cream.) Stretches helped a good deal at first, but after I altered my diet, I didn’t need to do them nearly as often. I tried a histamine-free diet when I realized I have issues with proliferating mast cells (chronic patellar tendinitis with visible knee swelling, in addition to vulvodynia), and this was very helpful. I figured out allergies were contributing to my pain when I greatly upped my dosage of glucosamine chondroitan and got *worse* instead of better (another surprisde to me). Stopping this supplement helped enormously. Wearing loose clothing is also very important, as the study indicated. Lubricants are essential, and the silicone ones are the least irritating to me. Trigger point injections made me much worse, but trigger point massage was very helpful. Be your own advocate and do research — don’t rely entirely on medical professionals. I also wonder what effect birth control pills have on this, and look forward to getting a bit older so I can stop them (I do lubricate more normally while off them, but I don’t want to get pregnant and condoms aren’t an option for me). Thanks everyone for your anecdotal input. I’m about 40% better from experimenting with your suggestions.

  11. I agree it would be useful to have Botox on he list here. I had Botox two weeks ago. I do not yet know what the effecs are going to be, but I would have liked to know how it is valuated till now by the (few?) women who got this treatment.

    And thank you very for this list .

  12. I have had unexplained off and on pain for a couple of years and I suspected vulvodynia to some extent, but I am now certain that I am allergic/sensitive to spandex (lycra, synthetics). When I thought that I had nylon panties, I found that they were 11% f spandex, almost every pair of pants is at least 4% spandex, same for jeans and my dresses. I have bought new jeans with 100% cotton and I can wear them!

  13. Considering that elavil IS amitriptyline, yet they’re listed separately in different quadrants, i’m not buying this whole thing..

  14. Also, gabapentin (neurontin) has been helpful for me over the years but i don’t see that on here (or any similar drug like lyrica), and i know it has been helpful for others as well.

  15. Thanks for catching that, Allison! I investigated, and it turns out that Elavil ointment was negatively rated, while Amitriptyline was positively rated. So I’ve updated the chart. As for Gabapentin, it is in the top right quadrant of the chart, as one of the unlabeled dots. Lyrica doesn’t have enough data to show yet. Your careful feedback is much appreciated!
    Alex :)

  16. I’ve had constant pelvic pain for nearly 10 years – diagnosed with vulvodynia and pelvic floor spasms in 2009 by a renowned specialist in this field of medicine. However, the spasms do not show up on sEMG surface readings, even though I feel the spasms very strongly. I’ve tried eight of the nine treatments listed in the chart at the beginning of this blog; in addition to botox injections into the pelvic floor, numerous medications over the years, acupuncture,a TENS unit, a muscle stimulator, dialators, chiropractic treatment, massage therapy, anodyne therapy, several chair pads to assist with the pain while sitting, and several nerve blocks. None of these modalities have helped the pain.

  17. I have had vulvodynia for 20 years. I have tried all of the above mentioned treatment/modalities. I am at the point now that I can only sit propped up on one side or the other and can’t do that for long. I have been on Clobetasol oint. for 4 1/2 years. Use it twice a day. Still have some burning. It is all of the vulva (inner and outer) and extends past my anus and up the gluteal crack. My skin is very thin and tears easily. I have to watch every step I take. Surgery has been suggested but I don’t want to do it because of the low success rate. I haven’t worked for 4 yrs. I spend most of my time laying on my side in bed. I’m desperate for help.

  18. I’ve had vulvodynia since 1987. Tried many treatments. This graph is very interesting and informative!

    I do recall specialized pelvic floor rehab physical therapy as being highly effective. I also had to get candida under control. However, that diet was also gluten-free by association, and I may’ve been avoiding foods I was slightly allergic to as well. A relatively low oxalate diet is helpful at least in avoiding flare-ups, but I find my diet needs to be low ACID overall: coffee, tomatoes, and citrus are not high in oxalate but still extremely bothersome. Citracal made me a little worse and I assume it was the citric acid component that was contributing, so I had to stop taking it.

    Never had any surgery nor tried antidepressants; I don’t want the side effects.

    I used Mycolog cream a long time ago and it was okay up until the point it burnt holes in my skin. :\ I’ve tried many a cream and none has been helpful, although I’m considering a little coconut oil as a trial.

    Clitoral distraction?? Seriously?! That would send my pain through the roof! (Some of us have “upside-down vestibulitis” and the clitoris is the most sensitive and painful area, not the lower vaginal opening like it is in many other women.)

    Antihistamines help, but the first generation, highly sedating types do work better. Allegra and the like are okay and not as sedating, so I use them when needed.

    Acid controlling medications seem to help. Protonix, Nexium, Tagamet, etc.

    Avoiding chlorine, other chemicals and scented products have definitely helped at least to avoid more problems. Rinsing off after certain activities, too, but I’ve found that trying to stay TOO clean and dry can actually make it worse. Loose clothes, all-cotton/organic panties, etc.,– absolutely!

    I’ve never been sure of any hormones. Estrace didn’t help; testosterone cream may’ve helped a little years ago but the effects didn’t last long. Estrogen itself usually makes it worse and I’m not sure if it’s because I’m a little allergic or because it makes candida worse.

    One major culprit and contributor in my experience has been STRESS. Not that it *causes* the pain directly, but many times it has exacerbated things. So anything that helps eliminate or reduce and calm down stress does help to reduce pain.

    My pain has been mostly under control for years but I am still plagued with flare-ups periodically. It’s usually when I get really busy and distracted and stop being as careful about these things as I usually am. ;)

    I’m considering acupuncture next!

  19. I’ve had pelvic pain off and on for 30 years. Thankfully, I’m doing better now. Estrace cream applied topically, emu oil and Acupuncture have helped me a lot as far as burning goes. I also apply Clobetasol ointment once a week b/c I was diagnosed with Lichen Sclerosis originally. My vulvar skin is still thin though and I get fissures if I’m constipated, ride the stationary bike or try to have sex. Stress affects my pain too. When we were on a short vacation, I had 0 pain even though I walked a lot and sweated, ate whatever I wanted, etc.

  20. PLEASE TRY THIS! gabapentin 6% in a dermabase applied topically has changed my life. nothing has ever worked this well for me. my doctor says 50% of women she gives it to have success with the cream. taking it orally has many side effects apparently. worth a try! wish i knew about it 15 years ago, i would have had a much better life. nerve block shots in my tailbone to calm my pudendal nerve also helped too. stay away from dr. gay rodke (her nurse practitioners are dangerous) and dr. monica peacocke in ny, dr. andrea rapkin and dr. mcdonald in la are better. dr. andrew goldstein performed my surgery, it helped, but may not have needed it if i had the shots and cream earlier!!! i can not seem to stop the endless cycle of vaginal infections which flair up my pain. any advice? i take enteric coated acid. pearls everyday. thanks, emily

  21. Please help me !
    im 15 and recently think i have vulvodynia,
    its makin me feel really uncomfortalble at school and just at home.
    i dont know what to do :(

  22. Claire, have you stopped wearing tight pants and use cotton underware only? Avoid anything that will irritate your skin (like riding a bike sex). You need to see a physician, though most of them don’t know much. They usually give you a cream and tell you it will be better in a few days. Sometimes it is. Read everything you can on the internet so that you will understand what is happening. The attached article and the other blogs are also very helpful. It will be good to take this article with you to the doctor. Good luck!

  23. Thank you so much for publishing this study! I was surprised that the Elavil ointment was negatively rated. I felt that it was one of the few things that helped me (but I only have the experience of one person). Physical therapy made the most dramatic difference for me, and the combination Elavil/baclofin cream also helped me. It took me a few years to find the right the right treatments and get better, but now I feel 95% better. I hardly even think of vulvodynia anymore. Every day of work used to be a huge struggle. I would work sitting on my knees and soak in an oatmeal bath the minute I got home. But now I am working with considerably less pain and thinking of getting an MBA. Anyway, I think that this study will help direct women to treatments with a better track record.

  24. @Theresa

    Be very very careful with clobetasol. It’s in the superpotent class of steroids and not meant to be used on sensitive skin for an extended period of time (over two weeks), unless you’ve been diagnosed with lichen sclerosis via a biopsy. Basically clobetasol will cause thin skin and atrophy when used for more than two weeks consecutively and may be exacerbating your problem?

    I’m still figuring out my vulvodynia, but I’ve found Dr. Andrew Goldstein (New York and DC) to be helpful, if pricey, and I highly recommend that everyone see a specialist about their issues. Regular gynecologists aren’t well trained on this condition and will put you on at least ten different creams and pills before concluding that they don’t know what the cause is.

  25. I havent gone to the OB to be actually ‘diagnosed’… but i do lots of research before I go see a physican anyway. Im pretty certain this is my ailment. Thank you ladies for not being afraid to express what youve gone through.. i wouldnt know if not for ya’ll. Has anyone notice that wearing a thong can trigger the pain??

  26. I had throbbing vulvar pain and burning for 7 months. I felt like acid had been poured on my vagina. I went several times to the emergency room, saw four gynecologists, and again and again went to my physician, pleading for help. Everyone’s diagnosis was “Oh, that’s anxiety!” They did not know how to treat it. I did research and discovered there was a condition called Vulvodynia and thousands of women suffer from it. My physician’s only remedy was Xanax, which I became addicted to, and ended up for a short time in a mental rehab. While visiting his office, a short time after, one of the medical assistants thought he was talking privately to another, and referred to me as the “mental”!(I’m a retired teacher) Then I saw the doctor, and he made fun of the whole situation. I was appalled. There is still so much ignorance in the lay and medical community regarding this disease.As though it’s not horrific enough to deal with this pain but then we have to endure the chauvinistic ridicule of ignorant people. A neurologist to whom I finally went, put me on Baclofen (10 mg) 3 times a day, and was also advised to limit sugar in the diet because many times Candida Yeast is the causative agent of this horrible disorder.

  27. Chemicals! I am convinced that Chemicals are the cause of vulvodynia. There are 4000 chemicals used to create scent in North America. We put scent on all our clothes with fabric softener and fabric softener contains many toxic chemicals. The residue in these products remain in fabrics. The genital skin is FIVE (5) times more absorbent than other areas of the body. Stay away from chemicals and scents completely. It doesn’t matter how much cotton underwear you wear if you use chemically-scented laundry detergent and fabric softener. To Check out all the sensitizing and immune compromising chemicals in fabric softeners and laundry detergents google Dr. Anne Steinemann and her research on these chemically-loaded products. Someday I suspect Vulvodynia will be discovered to be a major and on-going Allergic reaction to chemicals. Just as a chemical burn is hard to treat I suspect the same would be true of a chemical allergy.

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