6 Major Vulvodynia Causes You Need to Know

In this article, you’ll find an overview of 6 major possible causes of vulvodynia (with more coming in the upcoming parts of this series).

You’ll find some of this information familiar while others will be brand new to you. I’ve included everything I’ve seen, heard and gathered over the years that I suffered from vulvodynia. Just like many of my fellow V warriors, I’ve had to connect many dots myself using my research and analytical skills, many of which haven’t been connected before.

Hormones are chemical messengers that travel in your bloodstream to tissues and organs, affecting many different processes in your body. One type is sex hormones (like estrogen, progesteron and testoterone). These hormones mainly affect your sexual function. The proper health of your vestibule (and also your entire vulva and vagina) is super dependent on them¹.

Vulvodynia — and in particular, localized provoked vulvodynia (vestibulodynia) — can be affected by imbalances of sex hormones (especially estrogen, but also progesterone and testosterone).

Vulvodynia warriors often have low estrogen which can affect vestibule tissue making it inflamed, weak, brittle, and lose stretchiness². You may also notice your V feeling dry and even cracking after your period, when your estrogen levels are low.

Here are some natural causes of sex hormone imbalances³ (by “natural” I mean not due to medical examinations or treatments):

• Natural hormonal changes during cycle
• Excessive physical activity
• Physiological stress
• Diet
• Lactation (lactational amenorrhea)
• Anorexia
• Hyperprolactinemia

Similarly, these are some iatrogenic causes (due to medical examinations or treatments) of sex hormone imbalances:

• Hormonal contraception (including pills)
• Prescribed medications like antiestrogenic drugs⁴
• Oophorectomy and hysterectomy (without oophorectomy)

High levels of estrogen helps the brain’s natural pain killer system respond to pain, releasing chemicals like endorphins. When estrogen levels are low this system controls pain less effectively¹⁰, leading to higher pain sensations¹¹.

This could explain why many vulvodynia warriors feel pain just before or during their periods when estrogen levels are low, and some are virtually pain free during pregnancy when estrogen levels surge¹².

A healthy vagina contains a balance of bacteria, and hormonal changes during your cycle can allow some of them to overgrow. This can lead to infections. Infections can then lead to or be misdiagnosed for vulvodynia¹³.

Here are some examples:

• The change in estrogen and progesterone levels when you are pregnant, breastfeeding, using hormone replacement therapy, or taking the pill can lead to vaginal yeast infections¹⁴.
• Yeast infections may flourish during both your ovulation and period because your vaginal environment becomes more alkaline during these times

Studies show that higher estrogen is responsible for more severe allergic reactions¹⁵ (also in your vulva!).

If you suspect that your vulvodynia might be related to allergies then your vulvar symptoms might get worse right before or during your ovulation, or before your period.

Estrogen plays both anti- and pro-inflammatory roles in chronic pain syndromes, including vulvodynia¹⁶.

When your immune system detects a foreign substance (bacteria, viruses or toxins) or an injury, it triggers inflammation — a defense mechanism that helps to fight off invaders and/or aids the healing process. Inflammation can be either acute or chronic.

Acute inflammation is a process that is rapid (happens fast?), may be severe, and lasts for a short period of time. Signs of inflammation include redness, swelling, heat, loss of function and pain, caused by the work of immune cells in the affected area.

Chronic inflammation is inflammation that lasts too long (even months or years) and can have whole-body effects. Unlike acute inflammation it produces a steady, low-level response and can be triggered even when there isn’t a disease to fight or an injury to heal.

Inflammation was once considered to be such a crucial component of provoked localized vulvodynia (aka vestibulodynia) that doctors reflected this in the naming calling it vestibulitis (“itis” means inflammation). Since then, this name has been dropped as researchers have identified other factors contributing to provoked localized vulvodynia¹⁷.

This, however, doesn’t change the significance of the link between vulvodynia and inflammation.

One study shows that vulvodynia warriors have more mast cells¹⁸ (cells responsible for inflammation during allergies or infections) containing inflammatory substances (like histamine or cytokine) in their vulvas¹⁹. This makes them more prone to vulvar inflammation.

Another study shows that their immune systems are less effective in ending inflammation²⁰ which can lead to chronic inflammation (bodywide including vulvar)²¹. They might even be genetically predisposed to it²².

Other studies show that vulvodynia is associated with comorbid conditions linked to chronic inflammation like: IC, BPS, IBS and fibromyalgia. This suggests that the cause of vulvodynia can also be rooted in chronic inflammation²³.

Vulvodynia linked to inflammation can be a result of:

• Frequent or unresolved vulvar infections (like yeast infections)²⁴
• Allergies and irritations
• Poor diet
• Chronic stress
• Weakened immune system
• Hormonal changes

Inflammation can already be pretty painful as it damages vulvar tissue.

However, vulvar pain can become even worse as chronic inflammation may also damage vulvar tissue nerves²⁵. This might have long-term consequences on how your brain processes pain²⁶.

The majority of gynecologists are unaware of the large role that allergies can play in vulvodynia.

But guess what, your vulva and vagina can react to allergies just like your nose, throat, sinuses, eyes and skin do — with itching, burning and swelling. Medicine calls this allergic vulvovaginitis.

Your immune system is built to protect you from harmful substances like viruses and bacteria.

Sometimes however, it defends you against substances harmless to most people. These are known as allergens (like food, pollen, medication, cosmetics) and your body’s adverse reaction to them is known as an allergy.

Allergies can be set off by a minimum amount of allergens and can happen anywhere in your body (yes, including your vulva!).

Your vulvodynia can be connected with many types of allergies like:

• Inhalant allergy
• Pollen²⁷, house dust²⁸, inhaled latex²⁹, and household and work-related toxins that are in spray form (e.g., home-sprayed chemicals, insecticides, pesticides)³⁰
• Oral allergy
• Food, drinks, drugs
• Semen allergy
• Latex allergy
• Skin allergy (called Allergic Contact Dermatitis)
• Topical antibiotics, anesthetic, corticosteroids, antifungals, fabric dyes, spermicides, etc.

Irritation happens when your skin gets damaged by chemical irritants (like steroid creams) or physical irritants (like friction from wet swimming suits).

Irritation doesn’t activate your immune system (like allergy) and it appears at the site where irritants contact your skin. Your skin needs to be exposed to a certain minimum amount of irritants for the reaction to kick in.

Your vulvodynia can be connected with irritations like:

• Skin irritation (called Irritant Contact Dermatitis)
• Laundry detergents, panty liners, feminine hygiene products, toilet paper etc.

Vulvar skin pigmentation (its natural colouring) can make allergies and irritations look differently than on the rest of your skin. Sometimes these reactions may be barely visible or not visible at all, yet still manifest as stinging and burning sensations³¹.

Because of this, your gynecologist (who may not be trained in dermatology) can misdiagnose you with vulvodynia, because from a gynecological perspective everything looks fine.

Sound familiar?

Numerous studies show the connection between vulvodynia and allergies.

One such study shows that methylisothiazolinone, a preservative commonly used in cosmetic and household products, provokes genital pain³².

A second study shows that vulvodynia risk may be increased due to exposure to household and work-related chemicals (e.g., home-sprayed chemicals, insecticides, pesticides, mold deterrent, and mothballs), solvents and paints. Housekeepers, hairdressers, manicurists and dry cleaners, for example, are at higher risk due to their regular use of these toxins³³.

A third study shows that vulvodynia warriors have more mast cells in their vulvas (cells which are responsible for allergies)³⁴.

Finally, a fourth study shows that having a history of allergies like hives, seasonal allergies or reactions to insect stings doubles the risk of vulvodynia³⁵.

There is another link between vulvodynia and allergies. Vulvodynia is connected to vulvar inflammation — and vulvar inflammation can be caused by allergies.

Studies show that vulvodynia warriors have more mast cells (cells responsible for inflammation during allergies) containing inflammatory substances (like histamine)³⁶ in their vulva. This makes them more prone to vulvar inflammation when they have allergies.

Allergic vulvovaginitis is often confused for infections so you can be treated for infections for months without any improvements³⁷. Conversely, long-term unresolved allergic vulvovaginitis can damage your vulvar skin making you more prone to yeast infections³⁸.

By not addressing the underlying allergy, you might suffer from a real yeast infection that can become chronic. These recurrent yeast infections can make you more prone to develop vulvodynia.

Diet is often overlooked as a factor when it comes to vulvodynia. If anything, you may come across the low oxalates diet but even then, its effectiveness is discounted.

What can’t be denied, though, is that more and more V warriors see amazing improvements after adjusting their diets to personal needs.

Vulvodynia is connected to chronic inflammation and there are certain foods that contribute to chronic inflammation. Based on this logic, there is a pretty high chance that inflammatory foods can cause or worsen vulvodynia.

Interestingly many vulvodynia warriors confirm this, sharing that their symptoms get worse after eating highly inflammatory foods but noticeably improves with diet changes.

Here are some inflammatory foods:

• Sugar and high-fructose corn syrup
  • A lot of vulvodynia warriors notice their symptoms increase after eating sugar (candy, soda, “fruit” juices with added sugar, desserts, pastries, cereals, etc.)
• Alcohol
  • Many vulvodynia warriors notice that their symptoms aggravate after drinking alcohol
• Refined carbohydrates
  • White bread, pasta, flour, rice, etc.
• Processed meat
  • Sausage, bacon, ham, smoked meat, beef jerky, etc.

The low oxalate diet has a mixed reputation when it comes to vulvodynia.
On one hand, skeptics like to remind others that there is no scientific evidence that oxalates, naturally occurring substances found in plants and animals, are a real problem for vulvodynia. They like to point out that the claimed effectiveness of a low oxalate diet comes from a single case report.
On the other hand, proponents recall that the VP (Vulvar Pain) Foundation, together with Clive Solomons PhD, successfully helped hundreds of vulvodynia warriors with a low oxalate diet and several supplements³⁹.

So please kind in mind that the low oxalate diet might help you as each case of vulvodynia is unique.

Your immune system creates immunoglobulins (aka antibodies) to protect you from antigens and allergens. Antigens are harmful invaders (like bacteria, viruses, toxins). Allergens are substances that are typically harmless but trigger an allergy for some people (like certain foods).

There are 5 classes of immunoglobulins but here are the two that relate to nutrition (and vulvodynia):

• Immunoglobulin E (IgE)
  causes food allergies with immediate symptoms (like itching, swelling, hives)
• Immunoglobulin G (IgG)
  causes food sensitivities with delayed symptoms (like headaches, digestive problems)

When you eat something that you are allergic to, your immune system produces IgE antibodies⁴⁰. These antibodies trigger mast cells that release a chemical called histamine. Histamine in turn causes numerous immediate allergic symptoms (like burning, itching, swelling).

And just to repeat: vulvodynia warriors were found to have more mast cells in their vulvas⁴¹!

The top 8 most common allergens are: milk, egg, peanut, tree nuts, wheat, soy, fish and shellfish.

You can also get a food allergy other than by eating if:

• You have contact with the semen of a partner who consumed something that you are allergic to. There are reported cases of women having allergies after they had sex with partners who consumed nuts⁴² and beer prior to intercourse.
• You come into contact with an allergen via your hands, fingers or clothes⁴³.

IgG antibodies (Immunoglobulin G) are responsible for delayed food allergies (aka food sensitivities).

Products that can cause food sensitivities vary from person to person, and may include foods you eat often. Symptoms (like headaches, digestive problems, fatigue, mood changes, body aches) can appear up to 3 days after food consumption and they might be subtle. Because of this, many people with food sensitivities don’t realize they have them for months or even years. And this is bad news because:

• IgG antibodies lead to inflammation (and vulvodynia is linked to inflammation⁴⁴)
• Food sensitivities are often associated with many digestive problems including leaky gut (aka intestinal permeability)⁴⁵. Leaky gut can trigger inflammation and contribute to changes in good gut bacteria. Gut bacteria is super important to your vulvar health and problems with it can contribute to recurrent yeast infections.
• Certain conditions linked to vulvodynia can arise from food sensitivities, such as irritable bowel syndrome (IBS)

Food intolerances aren’t fully understood by medicine. They differ from allergies and sensitivities as they don’t trigger the immune system. They occur when your body has a chemical reaction to certain foods and beverages.

Food intolerances are usually caused by⁴⁶:

• A deficiency of chemicals or enzymes needed to digest a food (like lactose intolerance)
• Reactions to natural and artificial chemicals found in foods and beverages such as:
• Salicylates
• Amines
• Caffeine
• Tyramine
• Sulphites
• Food additives such as preservatives, colouring, emulsifiers and taste enhancers, etc.⁴⁷

Symptoms of food intolerances are often delayed up to 48 hours after eating and dose-dependent (your risk increases with amount). They are also similar to symptoms of food allergies and sensitivities, so people often get them mixed up.

Here are some examples of where symptoms can manifest⁴⁸:

• Skin
  • Rashes, hives, swelling, itchiness, eczema (yes, these can also show up in your vulva)
• Gastrointestinal tract
  • Abdominal cramps, nausea, gas, diarrhea, constipation
  • Food intolerances are associated with irritable bowel syndrome (IBS), which is linked with vulvodynia
• Respiratory tract

Comorbidites (coexisting conditions) is a tricky topic. It’s even unclear for researchers if they are the cause, result or if they are only associated with vulvodynia⁴⁹.

What’s clear is that going down this path may lead to a solution for your vulvodynia; something that works for a coexisting condition might also end up working for your burning vulva. Even when this isn’t the case, comorbidities can still be a useful hint in your (what-is-my-pain?) scavenger hunt by helping you narrow down a shared origin.

Chronic pain conditions often occur together and if you have vulvodynia, your chances of having another chronic pain condition are 2 to 3 times higher⁵⁰. In fact, almost 50% of vulvodynia warriors report having at least 1 more condition.

There are a handful of chronic pain conditions that often coexist and this phenomena is called Chronic Overlapping Pain Conditions (COPCs). Unfortunately, vulvodynia is one of them⁵¹.

Other chronic overlapping pain conditions (COPCs):

• Temporomandibular Disorders
• Myalgic Encephalomyelitis / Chronic Fatigue Syndrome
• Irritable Bowel Syndrome (IBS)
• Interstitial Cystitis (IC) / Painful Bladder Syndrome
• Fibromyalgia
• Endometriosis
• Chronic Tension-Type Headache
• Chronic Migraine Headache
• Chronic Low Back Pain

In addition to the COPCs, here are some other comorbidities and pain syndromes that coexist with vulvodynia:

• Autoimmune disorders
• Orofacial pain
• Anxiety and depression⁵²
• Urethral syndromes
• Subclinical hypothyroidism⁵³
• Complex regional pain syndrome (CRPS)⁵⁴

Here are some comorbid conditions and how they are thought to be linked to vulvodynia:

• Interstitial Cystitis (IC) / Painful Bladder Syndrome
  • Vulva and bladder develop from the same tissue, and so might be predisposed to similar symptoms⁵⁵
  • Bladder pain can lead to clenching pelvic muscles which can also result in vulvodynia
• Irritable Bowel Syndrome (IBS)
  • Because the organs are so close to each other, irritation of one set of nerves can lead to irritation of the other set of nerves, changing how these organs feel and behave⁵⁶
• Fibromyalgia
  • Fibromyalgia may result when the same type of oxalate crystals that cause vulvar pain lodge in muscle tissue⁵⁷
  • All vulvar pain may be a manifestation of fibromyalgia⁵⁸
  • Chronic inflammation has been proposed as a shared common cause
• Complex regional pain syndrome (CRPS)
  • Some sources actually mention CRPS as a direct cause for vulvodynia. When you suffer from infection, irritation or trauma in the vulva the area becomes inflamed, nerve endings become hypersensitive, blood vessels shut down (to prevent possible infection from traveling to the rest of the body) and pelvic floor spasms which reduce blood flow and produce further inflammation⁵⁹.

Genetic factors can help you better understand why your body might behave the way it does.

Vulvodynia researchers have mainly focused on localized provoked vulvodynia (vestibulodynia) and have found that vulvodynia warriors have a genetic predisposition to:

• Prolonged and severe inflammation (including vulvar inflammation)⁶⁰
  • One study shows that their immune systems are less effective in ending inflammation⁶¹ which can lead to chronic inflammation, increasing pain sensitivity (bodywide including vulvar)⁶².
• Increased chances of hormonal changes caused by the pill
• Greater risk of candidiasis and other infections, and the inability to combat them
• Chronic widespread pain⁶³
  • Including vulvar pain: One study shows that some vulvodynia warriors have a female relative with dyspareunia or tampon intolerance⁶⁴

In this post, you have learned about 6 major possible causes of vulvodynia:

• Hormones
• Inflammation
• Allergies & Irritations
• Food & Diet
• Comorbidities
• Genetics

What did you think of this post? Is there anything else you would like to know about these 6 possible causes?

What has your experience been like with any of these causes? Have you come across other issues during your research?

Please feel free to share with me your thoughts, experiences, and questions via Instagram or Facebook. You can also reach me via the Contact Form or by email (at hello@meandmyv.com).