What is Vulvodynia?
Vulvodynia is a chronic or recurrent pain located at the vaginal entrance or in the vulva area. Generally two major subcategories are identified:
- Provoked Vestibulodynia (aka Vulvar Vestibulitis Syndrome (VVS), where pain is localized at the
vaginal entrance (the vestibule) and is provoked/triggered by touch, friction,
or pressure (e.g., with tampon insertion, intercourse, etc.)
- Generalized Vulvodynia (aka Dysesthetic vulvodynia), where pain occurs in diffuse areas of the vulva. Pain is usually chronic, but pressure or friction can exacerbate the pain.
What are the causes of Vulvodynia?
Women with vulvodynia may have red and inflamed vulva tissue, or their vulvas appear normal. This is problematic for women and many are misdiagnosed. A careful discussion of the history of symptoms (e.g., Where does it hurt? When does it start? How does it feel? What treatments have failed?, etc.) can help in reaching a correct diagnosis and appropriate treatment referral. Provoked vestibulodynia can also be confirmed by palpation of the vulva and vaginal entrance to determine the location of pain in the vestibular area. Active infections or skin disorders (e.g., dermatoses) need to carefully be ruled out.
Vulvodynia is not caused by an active infection and is not a sexually transmitted disease. What causes vulvodynia, however, is still speculation. Researchers have identified several potential causes:
- An injury to or irritation of the nerves that supply sensation to the vulva.
- Past infection or trauma to the pelvic floor (e.g., falling, sexual abuse, chronic allergic reactions) may have caused abnormal changes in different cells in the vulva.
- Pelvic floor problems such as lack of control over contraction and especially relaxation.
How is vulvodynia treated?
Vulvodynia is a pain condition that significantly affects sexuality and quality
of life. A multi-disciplinary approach works usually best for most women.
Treatment may involve consulting with a gynecologist, dermatologist,
neurologist as well as a psychologist/sex therapist for pain management and sex
therapy, and a pelvic floor physical therapist for pelvic floor rehabilitation.
Many experts believe that a combination of pain management, sex therapy, and
pelvic floor physical therapy may be most beneficial. Women with vulvodynia
also benefit from low doses of tricyclic antidepressant medication
and gabapentin (a medication given for neuropathic pain). Provoked vestibulodynia
can also be treated via vestibular surgery. List of
health care professionals treating sexual pain problems.
Some advice for diminishing the pain – do not underestimate the value of conservative treatment (!)
- Wear only 100% cotton, white underwear; avoid panty liners.
- Avoid tight fitting clothing and spandex/lycra clothing.
- Try not wearing underwear when possible (e.g., at night)
- Avoid vulvar contact with bath oils or scented products.
- Avoid using irritating chemicals and cleaners in the vulvar area (try washing with warm water only).
- Try using hypoallergenic detergents (e.g., Ivory) and avoid dryer sheets altogether.
- Never use over-the-counter vulvovaginal products (douches, yeast treatments [ask for oral medications such as Diflucan]).
- Use water soluble lubricants or pure vegetable oil during sexual activity (you may need to try different ones to find a non-irritating lubricant that works for you).
- Cold packs can soothe the pain of vulvodynia.
- Topical anesthetic ointment (i.e., EMLA creme) may help soothe the pain.
- If your vulva is dry and itchy, get a prescription or obtain from your pharmacist Magistrale crème: 10GM Glycerin, 50GM Distilled water, 40GM Aquaphor.