Jokes aside, our vaginas and vulva’s Can feel complicated, difficult, and like a 'NO WAY' zone when they are struggling with various complicated issues. A bigger part of the problem is that a lot of the time, information is limited, confusing, or just plain wrong.

So, What is going ON down there?!

We’ve covered things like:

• Prolapse
• The Vagina Aisle of the Pharmacy
• PCOS
• Yeast Infections (twice)
• Interstitial Cystitis
• UTI’s (also twice)
• BV - Bacterial Vaginosis
• Penetration Pain

And many many other topics on our blog…

But recently, we realized we hadn’t covered some of the other issues that can arise in our vulvas, like vaginismus, vulvodynia, and vaginitis - the confusingly similar names don't help make things ANY clearer!

What is Vaginismus?

Vaginismus is the body's automatic reaction to the fear of some or all types of vaginal penetration. Whenever penetration is attempted, your vaginal muscles tighten up on their own. You have no control over it. Occasionally, you can get vaginismus even if you have previously enjoyed painless penetrative sex. It's not always clear which came first, the vaginismus or the anxiety. Some women have vaginismus in all situations and with any object. Others have it only in certain cases, like with one partner but not others. Things like sexual trauma, childbirth, menopause, UTI’s, surgery, painful sex, and STD’s can trigger this fear and anxiety.

Vaginismus is a somatic (body) reaction to a psychological issue; in a nutshell, your body is responding to a perceived fear in your brain - whether or not there actually is pain occurring at that moment, which then causes pain. Unhelpful, we know.

Typically vaginismus is treated psychologically (i.e., cognitive behavioral therapies) first, though at times, dilators or creams can be used to help facilitate penetration.

What is Vulvodynia?

Vulvodynia (vul-voe-DIN-e-uh) is chronic pain or discomfort around the opening of your vagina (vulva) for which there's no identifiable cause and which lasts at least three months. Vulvodynia can be so uncomfortable that some activities can feel unbearable, such as sitting for long periods of time or having sex. Symptoms include burning and rawness in the genital area. Pain may be constant or occasional and can last for months or even years, then vanish as suddenly as it started.

So, this is where things get complicated… because, vulvodynia is more of an umbrella term that can be applied when people (*ahem, doctors*) don’t know what is going on but need to give you terminology so you’ll stop bugging them - sad but true, we know!

Whereas vaginismus typically does have a psychological cause (trauma, injury, assault), vulvodynia can refer to different types of pain - not just tightening of the muscles in the vagina - that has no discernible mental or physical cause. This can include sharp, stabbing pains, tearing sensations, and so on.

If a cause can be identified, such as vaginal atrophy, or UTI’s, etc., then vulvodynia would no longer be the applicable term.

What is Vaginitis (and Desquamative Inflammatory Vaginitis)?

Vaginitis is also somewhat of an umbrella term - Vaginitis is an inflammation of the vagina. Vaginitis may cause itching, burning, a bad odor, or a large amount of discharge. It is one of the most common reasons why women see their obstetrician–gynecologists (ob-gyns). There are many possible causes of vaginitis, and the type of treatment depends on the cause. Vaginitis is usually caused by a change in the normal balance of vaginal bacteria, an infection, or reduced estrogen levels after menopause.

Desquamative Inflammatory Vaginitis is something that occurs primarily in menopausal white women; though uncommon, diagnosis is often missed and it can cause a constant drip of yellowish discharge, dyspareunia (genital pain during or after sex), and generalized irritation. If you have repeat symptoms that get treated and have no relief, it may be worth looking into DIV and getting a second opinion.

I've Heard About Something Called Lichen Sclerosus...

We’ve written at length about Lichen Sclerosus in this blog, but essentially, LS is a skin disease that causes itchy and painful patches of thin, white, wrinkled-looking skin. In women, these may occur on the vulva and/or the skin around the anus. In men, it typically affects the head of the penis. However, this condition typically occurs primarily in girls who haven't started menstruating and in postmenopausal women. Lichen sclerosus can cause discomfort, itching, and easy bruising or tearing of the skin. Some women experience the labia 'fusing' or disappearing altogether, as well as significant clitoral and vaginal atrophy that seems to occur concurrently.

Hormones Play a Role

The vagina is a delicate system with a lot of different elements that need to remain balanced - blood flow, muscle tone, bacterial balance, pH, and yes - hormones. When our hormones get out of balance, vaginal atrophy is more likely to occur, but many other things follow on the heels of atrophy. Once the skin integrity becomes compromised, bacterial imbalances can occur, UTI’s and yeast infections can arise, which then triggers a higher likelihood of vaginismus or vulvodynia. Using low dose topical estriol can help with many issues, and increase overall comfort.

Staying on top of your hormonal balance is key, and a healthy vagina begins with balance!