Vulvodynia

For women suffering from Vulvodynia, life can be very challenging and difficult. As a chronic pain condition, Vulvodynia can have a profound impact on a woman’s quality of life. It typically affects her ability to engage in sexual activity and may interfere with daily functioning: sitting at a desk, engaging in physical exercise, and participating in social activities. These limitations can negatively affect self-image and lead to depression.

Vulvodynia is described by the National Vulvodynia Association as:

Chronic vulvar discomfort or pain, characterized by burning, stinging, irritation or rawness of the female genitalia in cases in which there is no infection or skin disease of the vulva or vagina causing these symptoms.

People who have an illness like Interstitial Cystitis, such as myself, may be misdiagnosed with Vulvodynia because the symptoms are similar. I believe I have Vulvodynia along with my IC Disease but I have never been officially diagnosed with Vulvodynia.

 

Cause(s)

The cause or causes of Vulvodynia is currently unknown. There has not been enough research done on this chronic pain condition to properly determine what is causing it. What the medical community knows are not causes are STDs and active infections.

The theory is that some causes for Vulvodynia may include:

  • An injury to the nerves of the vulva
  • Infection or trauma
  • Genetic factors
  • A hypersensitivity to yeast (candida)
  • Muscle spasms in the pelvic region

For most Vulvodynia patients, a burning sensation is normally the major symptom but the severity and type of symptoms may vary among each person.

Vulvodynia is classified into two types: Generalized Vulvodynia (dysesthetic) and Vulvar Vestibulitis Syndrome (VVS).

 

Generalized Vulvodynia

Women who have this type of Vulvodynia may experience symptoms that are diffuse or in different areas at different times. Pain may be present in the labia majora, labia minora, and/or the vestibule. See above diagram for reference. Some women experience pain in the clitoris, mons pubis, perineum and/or the inner thighs. The pain may be constant or intermittent. Symptoms are not necessarily caused by touch or pressure to the vulva, i.e., with intercourse or bicycle riding, but these activities often exacerbate the symptoms.

 

Vulvar Vestibulitis Syndrome

For women who have this form of Vulvodynia, they only feel pain on the vestibule. See above diagram for reference. They will only feel pain on this area during or after touch or pressure is applied. Burning sensations are the most common symptom and may be experienced with some or all of the following: sexual intercourse, tampon insertion, gynecologic examination, bicycle riding, and wearing tight pants.

 

Diagnosis

To diagnose Vulvodynia, a doctor will review your medical history, as a series of questions regarding sex life, diet, lifestyle in general, medical conditions and medications, etc. The doctor will need to examine the vulva, vagina and any vaginal secretions for other causes of your pain such as infections and skin disorders. A fungal vaginal culture will probably be taken to rule out an infection that might be causing excessive burning and/or irritation. A Q-tip test may be done to determine the location and severity of pain.

Treatment

While there is currently no cure for Vulvodynia, there are treatments available to help alleviate symptoms. For some people they find relief while others don’t. It may require a combination of treatments in order to get relief for some women.

Here is what the NVA lists as treatment options:

  • Discontinuation of all topical medications, soaps, douches, etc., that can worsen irritation
  • Local anesthetics (i.e. lidocaine)
  • Tricyclic antidepressant medications (e.g., amitriptyline, nortriptyline, desipramine)
  • Anticonvulsants (e.g., Tegretol, Neurontin)
  • Interferon injections
  • Nerve blockades
  • Topical estrogen cream
  • Pelvic floor therapy (for patients who have pelvic floor muscle abnormalities as measured by surface electromyography)
  • Physical therapy
  • Diet modification
  • Surgery (for vulvar vestibulitis syndrome only)

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