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Vulvovaginal Disease Explained

Vaginal pain can result from a number of conditions in women. If you’re experiencing burning, stinging, and other forms of discomfort not associated with the menstrual cycle, it could indicate vulvovaginal disease. This refers to any condition that affects the external part of the female genitalia (the vulva). The vulva can be affected by infections, dermatological issues, cancer, or hormonal issues often associated with aging.

If you’re dealing with vaginal pain associated with vulvovaginal disease or other conditions, Dr. Neeraj Kohli and Boston Urogyn, with four locations in the Boston, Massachusetts, area, have years of experience helping women cope with their urogynecology needs.

Here are some examples of vulvovaginal diseases:


This refers to chronic pain around the opening of the vagina that can last at least three months (but can last years), from causes that have yet to be identified. The pain, burning, and irritation can complicate simple movements like sitting down and make sex difficult to enjoy. With vulvodynia, symptoms may not be visibly apparent and pain may be localized or affect the whole vulva.

Vulvar intraepithelial neoplasia

Also known as VIN or dysplasia, this precancerous skin condition happens when the skin cells covering the vulva change, resulting in mild to severe pain. It isn’t cancer, but it can lead to cancer over time if left undiagnosed. The exact cause isn’t yet understood but has been linked to other conditions like human papillomavirus (HPV), herpes simplex, granuloma inguinale (a sexually transmitted disease), chronic vulvar irritation, immunosuppression, and smoking. Typical symptoms include chronic itching, burning, tingling, soreness, redness, discoloration, raised skin lesions, and painful intercourse.

Lichen sclerosus

This common condition can affect women of any age but the risk is higher in postmenopausal women (most diagnosed in women over 50). It can also affect men, but is 10 times more common in women. Thickened, patchy, or white wrinkled skin is a typical feature of this condition and can present in small areas of the vulva or even involve the perineum (space between the genitals and anus) or the clitoral hood. Itching, soreness, bruising, and ulcers can result from scratching the affected areas. It can also lead to adhesions and scarring. 

There are other forms of vulvovaginal disease. Vulvar atrophy can result from aging and a resulting decrease in hormones, and cancerous causes of vulvovaginal disease can include melanoma and squamous cell carcinoma. 

Diagnosis and treatment

A detailed medical history, including a physical exam and a colposcopy, is necessary to determine the specifics of the problem. The latter is a procedure that uses a microscope to closely examine the vulvar skin. A vaginal biopsy may also be necessary if there’s evidence of vaginal lesions.

Treatments vary depending on the cause of your condition. Bacterial infections can be treated with antibiotics, physical therapy (including exercises to strengthen the pelvic floor) can help treat some conditions, and oral or topical ointments can help alleviate symptoms including pain. Nerve stimulation, lifestyle changes, and sex therapy can also help.

If you think you have any form of vulvovaginal disease or other vaginal conditions, call one of our four convenient locations or make an appointment online today with Dr. Kohli and Boston Urogyn.


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