It's hard to treat vulvodynia, the otherwise unexplained pain, itching, and burning of a woman's exterior genitals. What works for one woman may not work for another, and there are no FDA-approved therapies.
Hope K. Haefner, MD, director of the University of Michigan Center for Vulvar Diseases, says very conservative treatment would include avoiding soap in the vulvar area, wearing cotton underpants, and using water-based vaginal lubricants and cool gel packs to ease the pain.
Or your doctor may recommend a topical numbing preparation, a tricyclic antidepressant ("not to manage depression," says Dr. Haefner, "to manage pain"), anticonvulsants (which can also manage pain), or nerve blocks. Other approaches include physical therapy and biofeedback, both aimed at correcting potential issues with pelvic floor muscles that may be causing or adding to the problem.
Surgery is most commonly considered for women who have pain specifically in the vestibule area at the entrance to the vagina (vulvar vestibulitis syndrome, also called vestibulodynia)and who have not responded to other treatments.
For those women, the surgical removal of the tissue that apparently has an overgrowth of nerves is the most effective treatment, says Irwin Goldstein, MD, director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine.