Vulvodynia is a chronic pain condition affecting the vulvar region, the external female genitalia. This diagnosis is given when discomfort, often described as burning or stinging, persists for three months or more without an identifiable infectious, inflammatory, or neurologic cause. Individuals experiencing vulvar pain often seek clarification on associated symptoms, particularly changes in vaginal discharge. This article addresses whether vulvodynia directly causes vaginal discharge and details the symptoms truly associated with the disorder.
Defining Vulvodynia
Vulvodynia is clinically defined as chronic vulvar pain that is not the result of an infection, skin disorder, or other specific disease. The pain is believed to originate from the sensitization of nerve fibers in the vulvar tissue, leading to an overreaction to stimuli that are normally not painful. The condition is complex and is classified based on the pain’s location and whether it occurs spontaneously or is triggered by touch.
The condition is broadly categorized into two main types based on location. Generalized vulvodynia involves pain felt across various areas of the vulva, sometimes shifting location over time. Localized vulvodynia, often called vestibulodynia, restricts the pain to a specific area, most commonly the vulvar vestibule around the vaginal opening.
Addressing the Discharge Question
A direct answer to the question is that vulvodynia itself does not cause abnormal vaginal discharge. Vulvodynia is a pain syndrome linked to nerve sensitization, not an infectious or inflammatory disease process characterized by fluid production. The vulvar tissue in a person with vulvodynia typically appears normal upon examination, lacking the visible signs of infection or inflammation that lead to discharge.
If a person diagnosed with vulvodynia experiences an unusual discharge, it indicates a separate, co-existing condition that requires an independent diagnosis. Common causes of abnormal discharge include bacterial vaginosis, candidiasis (yeast infection), or a sexually transmitted infection. Since chronic inflammation can sometimes trigger nerve sensitization, it is possible for a recurrent infection to precede a vulvodynia diagnosis.
Primary Symptoms of Vulvodynia
The defining characteristic of vulvodynia is the pain itself, which is often described using intense sensory language. Patients frequently report a feeling of burning, searing, rawness, or stinging in the affected area, which can be constant or intermittent. Other common sites include the labia, the clitoris, or the perineum.
The location of the pain helps differentiate between the two main categories: provoked and unprovoked. Provoked vulvodynia means the pain is only triggered by touch or pressure, such as during sexual intercourse, tampon insertion, or wearing tight clothing. Unprovoked vulvodynia involves constant or spontaneous pain that occurs without any physical contact or pressure. Many people experience a mixed form, where they have spontaneous pain that intensifies when touched.
This hypersensitivity, known as hyperalgesia, means that a mildly painful stimulus is perceived as severely painful. In some cases, a non-painful stimulus, like light touch, is perceived as painful, a phenomenon called allodynia.
Diagnostic Process and Exclusion
Diagnosing vulvodynia is a clinical process, meaning it relies heavily on the patient’s history and a physical examination after other conditions have been ruled out. It is considered a diagnosis of exclusion because no single laboratory test or imaging study can confirm its presence.
This exclusionary process involves testing for infectious, inflammatory, and neoplastic causes, such as fungal infections, herpes, and skin conditions like lichen sclerosus. Swabs are typically taken to test for common infections like yeast and bacterial vaginosis. Ruling out these conditions is a mandatory step that confirms the pain is not due to an underlying infection.
A common tool used during the physical examination is the cotton swab test, sometimes called the Q-tip test. A healthcare provider uses a moist cotton swab to apply light, targeted pressure to various points on the vulva and vestibule. The patient rates the pain intensity on a scale of zero to ten, which helps map the exact locations of tenderness and confirms the presence of hyperalgesia or allodynia. A pain score greater than three out of ten is considered a positive result consistent with provoked vulvodynia.