Vulvodynia

What Is Vulvodynia? What Causes Vulvodynia?

Vulvodynia, also known as vestibulodynia, is a condition from which 15% of women suffer. Usually found in women who are younger to middle-aged, the condition is not infective and can be suppressed with proper treatment.

Vulvodynia is a chronic discomfort inside the vulva, the entrance to the vagina and to the urethra. It occurs as a result of problems with the nerve fibers in that area, and it does not manifest itself visually. It is characterized by the nerve endings in those areas being super-sensitive and painful to the touch. The pain may be constant or come and go in cycles.

The pain is usually described as a burning, stinging, itching, irritating or a raw feeling. Sexual intercourse, walking, sitting or exercising can make the pain worse.

According to Medilexicon's medical dictionary:

Vulvodynia is chronic vulvar discomfort with complaints of burning and superficial irritation.

It can be present in the labia majora and/or labia minora. Sometimes it affects the clitoris, perineum, mons pubis and/or inner thighs. The pain may be constant or intermittent, and it is not necessarily initiated by touch or pressure to the vulva. The vulvar tissue may appear inflamed, but in most cases there are no visible findings.

Vulvodynia usually starts suddenly and may last for months to years. Although it isn't life-threatening, the pain may make one cut back on some normal activities. It can also make one upset or depressed. It might even cause problems in one's relationship with spouse or partner, because it can make sexual intercourse painful.

What are the symptoms of Vulvodynia?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Pain is the most notable symptom of vulvodynia, and can be characterized as a burning, stinging, irritation or sharp pain that occurs in the vulva, including the labia and entrance to the vagina. It may be constant, intermittent or happening only when the vulva is touched, but vulvodynia is usually defined as lasting for at least three months.

The pain is usually found around the urethra and at the top of the legs and inner thighs, and it can be either intermittent or constant.

Symptoms may occur in one place or the entire vulvar area. It can occur during or after sexual activity, when tampons are inserted, or when prolonged pressure is applied to the vulva, such as during sitting, bike riding, or horseback riding.

What are the causes of Vulvodynia?

The exact cause of vulvodynia isn't known.

Some factors that may be involved include frequent yeast infections or sexually transmitted infections, chemical irritation of the external genitals (from soaps, feminine hygiene products or detergents in clothing), rashes on the genital area, previous laser treatments or surgery on the external genitals, nerve irritation, injury or muscle spasms in the pelvic area, diabetes and precancerous or cancerous conditions on the cervix.
Vulvodynia can be confused with other vulvo-vaginal problems such as chronic tension or spasm of the muscles of the vulvar area called vaginismus. This is particularly difficult to distinguish as muscular spasms can cause pain and pain can cause muscular spasms.

Diagnosing Vulvodynia

One may need to have a pelvic exam and tests to check for bacteria and yeast. If any test results don't seem normal, a doctor may want you to have a colposcopy or a biopsy. Colposcopy is an exam of the genital area that uses a special magnifying glass. If one has a biopsy, the genital area is first numbed with a painkiller, and a small piece of tissue is taken to be looked at with a microscope.

A cotton swab test is used to delineate the areas of pain and categorize their severity. Patients often will describe the touch of a cotton ball as extremely painful, like the scraping of a knife.

What are the treatment options for Vulvodynia?

Any treatment of vulvodynia takes many days or months to reach full effectiveness, and there is never a guarantee of a complete loss of the symptoms.

However, the drug amitriptyline, an antidepressant, has proven the most effective solution in lessening the effects of vulvodynia.

In addition, other antidepressants and anticonvulsants can be used to good effect. The use of certain creams and lotions, as well as anaesthetic gel in the vulval area can help treat the symptoms as well. Specific exercises and biofeedback may prove useful. Finally, since stress is one of the suspected causes of vulvodynia, management of stress may very well help ease symptoms.

Preventing Vulvodynia

Several options exist to prevent vulvodynia from occurring. First, wearing cotton underwear and loose-fitting clothes in that area can help to prevent vulvodynia, as can avoiding scented toilet paper and perfumed creams and soaps. In general, avoiding friction to that area is a good preventative measure, as is avoiding sitting for prolonged periods.

Women should avoid excessive genital washing and douching. If a vaginal infection is suspected, it is important to have it diagnosed and treated promptly, and to let a physician know if any treatments are making the condition worse.