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Understanding subtleties:
V.Vestibulitis, Vulvodynia, Dyspareunia or Vag ?

Difference between vaginismus, vulvar vestibulitis (v.v.) and vulvodynia

As one woman in our forum shared with us, the difference between vaginismus, vulvodynia and v. vestibulitis can be a puzzling one, even for doctors!
So this is how she explained it in simple terms for us:

Briefly, Vaginismus is when the vagina tightens up to not let something in which can be a dilator, vibrator, penis, tampon, and/or speculum.

Vulvar vestibulitis is when the vestibule of the vagina (kind of like the entrance) is chronically painful. Often it looks red but now always.

Vulvodynia means having pain around the vulva. Sometimes vulvodynia is used to refer to pain that is not just in the vestibule but around the whole vulva. In this usage, even the labia majora (where the pubic hair is) can be tender and painful. Sometimes these folks are diagnosed with just vulvodynia or vulvodynia and vulvar vestibulitis. In this sense, vulvar vestibulitis can be seen as a subset of vulvodynia.
However some people just use the terms interchangably.

To make it even more confusing v.v./vulvodynia can cause vaginismus. So often you can have both. If you have pain whenever something goes in, your vagina learns to try to protect itself by tightening up which can make putting something in impossible or possible but even more painful.

Vulvar Vestibulitis

V.V. is a chronic pain condition where the nerves start sending a normal pain signal but for some reason the signal keeps being sent over and over and over again and the nerve basically gets stuck sending the pain signal forever which is no fun. For me I also had urinary involvement so my bladder hurt a lot and I had to pee all the time and could never tell if my bladder was full. I think that I probably always had low level v.v. and then all that motion and perhaps an allergic reaction to a new lube caused a really terrible "flare-up."

There are lots of different things that you can do to try to control v.v. Go to this new page on our site first ( Vulvar Vestibulitis and Vaginismus ) to read the different approaches to VV and in which order you should try them.
Then get back here to get some more scattered details from my story:

Something else that worked for me, for example, was:

- Never wear jeans. Okay, well I do every now and then but I try not to
- Wear skirts as much as possible. The waist band on pants hurts the bladder sometimes and the seam in the crotch can also irritate.
-Don't wear underwear as much as possible (at least around the house!)
-Only wear comfortable, cotton underwear and no thongs of course. (Okay, so I cheat on this one sometimes too! )

So now my v.v. is pretty well under control and hubbie and I can have intercourse. The vaginismus is totally gone. It still surprised me but he can just slip it right in and out without my PC muscles tightening.

As for medications, your doctor may tell you to apply a specially compounded medicine twice a day that has estrogen and lidocaine in a neutral base and you can use a syringe and mirror so that you apply it in exactly the right place.
(This is different from the regular lidocaine that you can get at any pharmacy. Regular 5% prescription lidocaine is in an acidic base that can burn some people (it burns me badly!) so my doctor wrote a prescription for specially compounded lidocaine that has the estrogen in it and the neutral base keeps it from burning.)
One warning: According to my pharmacy, the lidocaine that I use is NOT condom compatible because the base can break down the latex.
-The doctor may also prescribe a tricyclic antidepressant (a.k.a. amitryptiline) that is also used for chronic pain.

But different things work for different people so do what works best for you. These are just advice that you may find helpful or you may suggest them to your doctor in case anything else didn't work..

How to apply the compound to the painful areas and the Q-tip test

You can get oral syringes for free at the pharmacy. You can also buy insulin syringes at the phramacy and rip off the needle but be careful not to stick yourself.
Then with one hand you separate your labia. For some, the problem area is right between the hymenal tags and the labia. If you don't pull it apart with one hand, that part is completely hidden. That's why doing the q-tip test on yourself doesn't always work because you poke around but on some people this area is hidden and you don't poke there.
Then with the syringe you carefully apply the medicine to all the read areas which means starting at 6:00 (towards the rear) and then along along the sides.

Vulvodynia: Links

We hope this information helps. If not, the following looks like good links where you can find support for this specific problems and good information:

Vulvodynia and Vulvar Vestibulitis Syndrome FAQ by Camilla Cracchiolo, RN

Vulvar Pain Forum

Dyspareunia and Vaginismus

Dyspareunia simply means painful sex. So vaginismus is a kind of Dyspareunia, but it is not the only medical problem which can cause painful sex.
So a woman presenting with complaints of painful sex may simply have vaginismus and by solving vaginismus, she will stop experiencing that pain.

However, some women may have other health problems causing them painful sex, and in turn their body may develop vaginismus as a protective mechanism against that original pain.

In these cases the symptom can be easily misdiagnosed for the cause and so women have been diagnosed with vaginismus when they really had interstitial cystitis, for example.
Vice versa, the causative factor of painful sex may be diagnosed and fully treated (cystitis again for instance), but by then vaginismus may "continue as a conditioned response to anticipated pain", so if that's not diagnosed too, the woman will keep hurting. [Reissing 1999]

Possible causes of painful sex

The following is a partial list of the main health reasons that possibly cause dyspareunia, which a doctor will need to rule out before treating vaginismus, especially if you have been diagnosed with secondary vaginismus:

" Abdominal disorders

" Pelvic Inflammatory Disease

" Endometriosis

" Congenital factors

" Gastrointestinal disorders

" Lubrication inadequacy

" Urologic disorders (ex. Cystitis)

" Uterine and Ovarian disorders

" Pelvic scarring

" Vulvar disorders (in particular: Vulvar Vestibulitis and Vulvodynia)


Please check this medical article for a comprehensive list of all the mainsymptoms causing painful sex:

Canavan Timothy P., MD; Heckman Celeste D., MD. (2000) Dyspareunia in women: Breaking the silence is the first step toward treatment. POSTGRADUATE MEDICINE. VOL 108 / NO 2.
Retreived 21 October 2006 from


Gynaecological (Un)awareness

It has been reported in the literature that women with Vulvar Disorders (from vulvodynia, to dyspareunia etc.. ) often go undiagnosed simply because vulvar disorders, just like vulvar cancers, are still not covered thoroughly in medical textbooks, since they have been 'discovered' only recently.

When I wrote a critical analysis of post-2000 gynaecological textbooks found in the medical library of an Australian University, I found that only 2 out of my sample of 13 books found, were dealing with vulvar disorders or dedicated more than a line or two to them. And those 2 books were written by female gynaeologists...

So it's understandable that gynecologists often won't know how to diagnose a woman with Vulvar Vestibulitis and Dyspareunia because they will have never studied that, which is a problem that my friend, the founder of GAIN (Gynaecological Awareness Information Network) has been trying hard to bring to light, even to politicians, because the need to educate gynaecologists about vulval conditions and vulval cancers and is great and long due...
Check out GAIN's helpful information pack and their fact sheets. And if you are in Australia, why not join them in their activism!

So if you are a doctor, we encourage you to learn more about these conditions if you have many patients with vaginismus who may also have other vulval problems. And PLEASE remind your patient that she can always join a support group or our forum, and that she's not alone.
Thank you.

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DISCLAIMER: This site is not designed to provide medical advice. All material is gathered from the experience of hundreds of women who experienced vaginismus but it is for information only and is not intended to be a substitute for professional or medical advice, diagnosis, and treatment. Please review the information contained on vaginismus-awareness-network.org carefully and confer with a health care professional specialized in vaginismus, as needed.