Chronic Vulvar Pain: Vulvodynia

Chronic Vulvar Pain: Vulvodynia

Vulvodynia: Causes, Symptoms, and Treatments

According to a study published in the International Journal of Women’s Health, it’s estimated that up to 16% of woman suffer from some form of Vulvodynia. Considering that a cause has yet to be determined, it can be quite frustrating for women to find treatment that provides true relief.

 

It’s difficult to determine precisely how many women are affected as it’s chronically underreported. Many women are embarrassed to talk about vulvar pain with their doctor.

 

Women of all ages and cultures suffer with vulvodynia. Some women start experiencing symptoms in their teen years.

 

Vulvodynia Defined

 

All women experience occasional irritation of the vulva at some point in their life. Most commonly, it’s from an external irritant such as sand or a reaction to a particularly irritating soap product. Those are not cases of Vulvodynia. Vulvodynia refers to vulva pain, irritation, or discomfort that goes beyond occasional. Diagnosis requires the issue be chronic, have been on-going for a minimum of three months, and have no apparent cause that can be identified.

 

The condition is usually categorized into one of two subtypes:

 

Localized Vulvodynia

 

This is characterized by pain in one, localized part of the vulva and can be further classified as either vestibulodynia or clitorodynia.

 

Vestibulodynia describes pain affecting the tissue that surrounds the opening of the vagina. This used to be referred to as vulvar vestibulitis syndrome (VVS). Less common is when the pain is localized in the clitoris, called Clitorodynia.

 

Most women with Vestibulodynia have Provoked Vestibulodynia (PVD). This means that their pain is provoked by an outside force, such as pressure. Common catalysts to the pain include:

 

  • Tight fitting pants
  • Sitting for a long time
  • Undergoing a gynecologic exam
  • Sexual intercourse
  • Inserting a tampon

 

If the woman had sexual intercourse without pain before developing Vulvodynia, she is said to have secondary PVD. If pain has been present since the first-time vaginal penetration was attempted, she is said to have primary PVD.

 

Generalized Vulvodynia

 

Generalized Vulvodynia (GV) is different from localized in that it occurs in more than one area of the vulva. It doesn’t always occur in the same location and may be constant or intermittent. The same activities that provoke PVD are painful to those with GV. The difference is that, unlike PVD, the activities exacerbate the pain rather than provoke it.

 

Common Symptoms

 

Although everyone is different, common symptoms of Vulvodynia are:

 

  • Itching
  • Aching
  • Soreness
  • Burning
  • Stinging
  • Throbbing
  • Rawness

 

In some cases, the area may appear inflamed, but usually it is not. The lack of physical evidence is another reason women may not be comfortable talking to their doctor. They can be afraid that the doctor won’t believe them.  Some people feel pain that radiates as far as the inner thighs.

 

Possible Causes

 

No one knows what causes Vulvodynia. Research is being conducted in the hope of finding out what causes it, so treatment and a cure can be developed. Thus far, evidence has not been found to link it to any infections or sexually transmitted diseases.

 

Possible causes that are being researched:

 

  • Above normal levels of inflammatory substances located in the vulva
  • Abnormal vulvar cell response to trauma, infection, or other environmental factors
  • Genetic predisposition to chronic vestibular inflammation
  • Weakness of pelvic floor muscles
  • Instability of pelvic floor muscles
  • Spasm of pelvic floor muscles
  • Elevated number and/or sensitivity of the nerve fibers in the vulva that sense pain
  • Chemical allergies or irritation
  • Changes in hormones

 

Diagnostic Process

 

Because there are other things that can cause genital discomfort, the doctor will conduct a thorough examination to rule out other possible causes. There isn’t a definitive test to diagnose it so the diagnosis is done primarily through process of elimination. A visit to the doctor will likely include the following:

 

Pelvic Exam. The doctor will examine the external genital area to look for any obvious cause of the symptoms. Samples of cells will be taken from the vagina to test for a variety of possible infections. The doctor may want to test for:

 

  • Yeast infection
  • Bacterial infection
  • Herpes
  • Genitourinary syndrome of menopause
  • Precancerous skin conditions
  • Diabetes

 

Cotton Swab Test. A moist cotton swab will be used to check if there are specific, or localized, areas of pain. The doctor will press gently in different areas and ask you if it causes any pain or discomfort. If an area does cause pain, you will be asked to rate the pain on a pre-determined scale.

 

Discussion. The doctor will ask questions about the location and extent of the pain to gain a better understanding of the symptoms. He or she will ask about history of surgeries, medical history, and sexual history. Some of the questions may be embarrassing but it’s important to answer candidly and completely. All of this information is important to get an accurate diagnosis and to suggest possible treatment.

 

Medical Treatment Options

 

Because the cause is unknown, treatment is focused on relieving and controlling the symptoms. Unlike specific antibiotics being prescribed for specific types of infections, with Vulvodynia, there isn’t one treatment approach that works for all women. Each woman’s experience of Vulvodynia pain is unique.

 

When a treatment is started, the doctor will give you an idea of how long it may take before the effects might be noticed. It’s important to move forward with the prescribed treatment or combination of treatments even if you don’t notice immediate relief. Stay in communication with your doctor as adjustments and changes will be made until relief is found.

 

Some treatment options doctors may use:

 

  • Biofeedback Therapy. Pain can be reduced by learning how to relax the pelvic muscles and take control of the body’s response when symptoms are present.

 

  • Nerve Blocks. If other treatments are unsuccessful, local nerve block injections might be beneficial.

 

  • Pelvic Floor Therapy. Some women find relief through exercises to relax the muscles that support the pelvic floor, uterus, bladder, and bowel.

 

  • Local Anesthetics. Topical numbing agents, like lidocaine, can provide temporary relief of symptoms.

 

  • Tricyclic antidepressants, anticonvulsants, or steroids have been known to provide pain relief. Itching can sometimes be controlled with antihistamines.

 

  • Localized vulvodynia can sometimes be relieved through a surgical procedure to remove the areas of skin and tissue that are affected.

 

Home Remedies

 

Before embarking on a home remedy, it’s important to see a doctor to rule out other medical issues or infections that might be causing the pain. Attempting a home remedy could delay diagnosis and treatment of an existing infection and cause further complications.

 

Some women find they can manage their symptoms by following one or more of these suggestions:

 

  • Sitz bath. Sit in lukewarm or cool water with colloidal oatmeal or Epsom salts for 5 – 10 minutes, 2-3 time per day. Sitz bath tubs that fit over the toilet seat make this more comfortable and convenient.

 

  • Cold compresses. Gel packs or cold compresses placed directly on the external area can relieve itching and pain.

 

  • For women who are sexually active, using a lubricant before having intercourse can help. Steer clear of lubricants that are warming or cooling, contain alcohol, or are flavored.

 

  • Avoid hot water. Hot baths and hot tubs can exacerbate pain and itching.

 

  • No deodorant pads. Don’t use pads or tampons that have a scent. If unscented pads and tampons are still irritating, try ones that are 100-percent cotton.

 

  • Avoid tight clothing. Tight underwear, pantyhose and pants don’t allow for air to flow around your genitals. The moisture and increased temperature can lead to irritation. Stick to white, cotton underwear during the day and sleep without underwear at night. If you need pantyhose, try thigh-highs or a garter belt.

 

  • Gently wash. Don’t scrub. Use plain water to clean the area and gently pat dry. A thin layer of petroleum jelly can provide a barrier to reduce friction and irritation.

 

  • Avoid irritants. Wash underwear without fabric softener and only use hypoallergenic detergent that’s free of perfumes and dyes. Use soft, white, unscented toilet paper, avoid getting any soaps or other products on the vulvar area. If you do, wash gently and thoroughly with plain water.

 

  • Doughnut pillow. If prolonged sitting is uncomfortable but necessary, use a doughnut pillow to relieve the pressure.

 

Other Complications

 

Chronic pain can cause other life issues. The impact of the psychological and emotional issues that can come with vulvodynia need to be addressed, too.

 

Disrupted intimacy

 

Painful sexual intercourse can strain a relationship. The partner with pain may feel guilty, disappointed, or fearful. The partner without pain may feel resentful or rejected. The most important thing is for both people to communicate openly and honestly with each other. A therapist can help facilitate meaningful, constructive exchanges and will also be able to help a couple develop methods of maintaining and increasing physical and emotional intimacy. It’s worth the effort to call around and find a therapist who has specific experience with sexual dysfunction. Your partner needs support, too. Many couples have happy, successful partnerships despite vulvodynia.

 

Depression

 

It’s not uncommon for someone with chronic pain to experience depression. Women with chronic vulvar pain can feel like their life is out of their control and they aren’t able to fully enjoy life. Because women may be reticent to discuss vulvodynia with their friends and family, they can feel isolated and alone in their suffering. Isolation can intensify feelings of depression.

 

Dual Approach

 

The physical and psychological symptoms of vulvodynia can’t be completely separated. Chronic pain is stressful. Stress exacerbates chronic pain. Treating the physical body without addressing the emotional and psychological effects is like putting a bandage on only half of a wound. Some helpful techniques for coping with the pain are:

 

  • Be Mindful of Your Limits. Listen to your body and don’t push it beyond what it is capable of handling.

 

  • Keep Active. Continue to do the things you enjoy. Resist the temptation to withdraw from life because it hurts. Don’t let the pain completely take over. If necessary, modify activities so you can take a break if you need to.

 

  • Move Your Body. Keep exercising. Or, start if you don’t already exercise. Your body is best able to fight pain if it’s healthy. Try minimal impact exercise like yoga that has the added benefit of stress management.

 

  • People who have social connections and support are less likely to experience anxiety and depression. Have coffee with a friend or just chat on the phone if that’s all you’re up to doing.

 

  • Plan Distractions. Plan ahead with distractions for when you have flare-ups of pain. Have a list of movies you want to watch on Netflix or books to read on hand. Plan pleasant experiences that you can engage in that will take your mind off of the pain.

 

Getting Support

 

It’s so important to remember that you’re not alone. Millions of women suffer from vulvar pain. Find other women that you can talk to about it. If you’re too shy to talk about your own pain, lurk on a support group forum and read about other people’s experiences. Eventually, you may find that you’re comfortable opening up. Even if you never open up to others in the group, it’s comforting to see that other people know your journey.

 

 

 

 

It’s worth calling around to find a local therapist who has heard of Vulvodynia and treated women with it before. Your doctor may have suggestions.

 

The Next Step

 

Don’t suffer in silence. The Charlotte Center for Pelvic Health has treatments available and wants to help. You deserve to feel better. It’s worth pushing through the feelings of embarrassment and reaching out for help. Contact us today for a confidential consultation to find out what your options are for relief.

ABOUT AUTHOR

Dr. John Hettiarachchi, FACS FPMRS

Dr. John Hettiarachchi, FACS FPMRS