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Vulvodynia

Vulvodynia is chronic discomfort or pain of the vulva - often described as burning, stinging, irritation, or rawness - when there is no infection or disease that would cause these symptoms. The discomfort may be constant or intermittent, in a specific spot or in a general area. Women who suffer from this little-known, but fairly common, disorder have historically been told it's "all in their head" or misdiagnosed with chronic yeast infections, but vulvodynia is a very real condition, although doctors still don't fully understand it. Sadly, it can have debilitating effects on its sufferers and there is no guaranteed cure.

Doctors aren't sure what causes vulvodynia, but they suspect it may be a combination of several factors, including an injury or irritation of the nerves that supply and receive input from the vulva, hypersensitivity to yeast, an allergic response, high levels of oxalate crystals in the urine, and spasms and/or irritation of the pelvic floor muscles.

There are two types of vulvodynia:

Generalized (dysesthetic) vulvodynia - Symptoms of generalized vulvodynia may appear in different areas at different times, including in the labia majora, labia minora, and/or the vestibule (vaginal opening), clitoris, mons pubis, perineum, and/or the inner thighs. The discomfort may be constant or intermittent and is not necessarily caused by touch or pressure (such as when riding a bike), but may worsen after such contact. Symptoms often worsen just before each menstrual period as hormone production changes.

Vulvar vestibulitis syndrome (VVS) - Symptoms of VVS are concentrated in the vestibule and flair up during or after touch or pressure, including sexual intercourse, tampon insertion, gynecological examination, bike riding, and wearing tight pants.

Vulvodynia is diagnosed by ruling out any other possible condition that can cause such pain, including STDs, infections, skin disorders, and HPV (LINK to article). Your doctor will perform a vaginal exam, during which he or she may use a q-tip to touch different areas of the vulva and vestibule to determine the location and severity of pain, and may also take a biopsy of skin or perform a colposcopy (examination of the genital area with a special magnifying glass).

Experts previously believed that vulvodynia was rare; however, emerging research is suggesting it is much more common. In a 2003 study, researchers at Brigham and Women's Hospital (BWH) found that approximately 16 percent of respondents to a survey reported experiencing chronic vulvar pain for at least three months or longer. Nearly 7 percent of respondents were experiencing the pain at the time of the survey. One of the difficulties in establishing an accurate affliction rate is that many women don't report their symptoms to their doctor. About 40 percent of women in the BWH survey chose not to seek treatment, even when their symptoms limited their ability to have sexual intercourse. This may be due to the fact that some cases of vulvodynia may cause only minor and intermittent discomfort, many women may mistake the discomfort for symptoms of an STD or believe that some amount of pain in this area is normal. In addition, many doctors are still unfamiliar with vulvodynia and may misdiagnose their patients or dismiss it as psychologically-based. As a result, more than 60 percent of respondents to the BWH survey who sought treatment ended up seeing three or more doctors.

Vulvodynia spontaneously resolves in some women, disappearing as quickly as it appeared. However, for other women, the discomfort can continue for months or years, with potentially debilitating results. The symptoms are so disruptive for some women that they are unable to have sex, exercise or work and become severely depressed. Unfortunately, there is no cure for vulvodynia and no one treatment works for every woman. It is generally a process of trial-and-error to find a treatment that relieves symptoms. Options include:

  • Medications, including antidepressants, which work by inhibiting certain pain fibers in the vulva, anticonvulsants, and antihistamines to reduce itching.

  • Biofeedback, which involves learning to relax the pelvic floor muscles to reduce tension and pain.

  • Physical therapy, including massage, transcutaneous electrical nerve stimulation (TENS), ultrasound and trigger-point pressure.

  • Local anesthetics such as xylocaine or lidocaine.

  • Topical estrogen or cortisone.

  • Trigger point injections of interferon.

  • Surgery (for VVS only).

  • Low oxalate diet. (Oxalates are a type of organic acid found in many plants and plant products. Limiting your intake of high-oxalate foods may decrease symptoms.)

To help minimize symptoms, limit irritation to the vulvar region by avoiding perfumed sanitary pads, powders, feminine hygiene deodorants, creams and soaps, as well as excessive washing and douching. Wash the genital area with just water and gently pat dry or dry with a hair dryer on the cold setting. Wear white, all-cotton underwear and loose clothing and avoid wearing pantyhose or sitting in a wet bathing suit for extended periods of time. Avoid hot tubs. Cold compresses applied to the external genital area may temporarily reduce pain and itching.

Because vulvodynia can make sexual intercourse painful and sometimes impossible, it is important to discuss the condition with your partner, or better yet, bring him to your doctor's appointment so he can ask his own questions and understand how this affects you physically and psychologically. And because this condition can significantly affect your sexual relationship you may also want to both talk with a sexual therapist to explore other ways to express your love and affection.

For additional information, newsletters and support, visit the National Vulvodynia Association Website.

 


 

Featured Sites:

Cord Blood Registry
March of Dimes
Susan G. Komen


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