Chronic pain makes some women afraid to have sex. This fear can lead to a spasm of the muscles around the vagina known as vaginismus. The muscles tighten up, making it difficult for penetration, which is frustrating for both partners. Vulvodynia can make it hard to work or stay active, and that affects self-image. Over time, it can lead to depression.
Depression makes it harder to deal with pain and also harder to handle stress.
And stress can make the pain worse. It's a vicious cycle. A thorough history and careful examination are essential to making the diagnosis. Any history of infections or skin problems, and how they were treated, needs to be considered. Testing may include vaginal cultures and colposcopy, and biopsy may also be needed.