Vestibulodynia is defined as pain at the vestibule, which is the area around the opening of the vagina. Being diagnosed with vestibulodynia can leave patients feeling frustrated because it doesn’t explain WHY they have pain at the vestibule. There are several types of vestibulodynia including infection, inflammation, neoplastic, neurologic, trauma and hormonal deficiencies.
The most common type of vestibulodynia iis caused by hormonal deficiencies known as Hormonally-Mediated Vestibulodynia. This type is caused by hormonal changes including taking birth control, breast feeding, postpartum, estrogen blockers, peri and post menopause.
The most common cause of Hormonally-Medicated vestibulodynia in younger women (under the age of 25) is systemic birth control (i.e. oral contraceptive pills (OCPs), depo-shot, nuvaring). Side effects of birth control (BC) such as break through bleeding, nausea, headaches, increased risk of stroke, and abdominal cramping are more commonly discussed among doctors and patients.
However, what is NOT often discussed with patients prior to starting birth control, especially OCPs, is that systemic BC use cause vestibulodynia, decrease vaginal lubrication, decrease thickness of labia minora, and decreased vaginal introitus (opening to the vagina) size, all leading to dyspareunia (painful sex). These changes can occur as early as 90 days after starting OCPs or with long term use.
Unfortunately, if the onset of birth control was before the age of 17, there’s even a higher risk of developing hormonally associated vestibulodynia.
- Goldstein, A, Burrows L, and Goldstein I. Can oral contraceptives cause vestibulodynia? J Sex Med 2010; 7: 1585-1587
So, WHY and HOW, does this happen?
Systemic birth control gets processed through the liver which INCREASES a protein called the Sex Hormone Binding Globulin (SHBG). SHBG binds to the free testosterone in the blood, so even if your body is making testosterone, high levels of SHBG (from the BC) DECREASE the testosterone in your body. This inhibits testosterone from getting to the tissue that needs it to be healthy—–the vestibule. The vestibule is rich with androgen receptors! If those receptors aren’t getting the testosterone (and estrogen) they need because of the increased SHBG then the vestibular tissue can become painful (vestibulodynia)!
Most commonly patients will complain about pain at the opening upon entry, dryness, friction, feeling of tearing, and actual tissue tearing resulting in bleeding, or inability to tolerate penetration at all.
Vestibulodynia can also lead to pelvic floor muscle overactivity which contributes to even more pain!
But don’t worry, we can treat it!! Click on the Client Portal to schedule a pelvic floor assessment in person or sexual counseling telehealth appointment!