WHAT IS VULVODYNIA?

Overview of Disease
Vulvodynia is a very generalized term meaning pain of the external area of the female genitalia, known as the vulva. Vulvodynia is pain of an unidentifiable cause that has lasted three months or longer. Some women only experience pain in a specific area of the vulva, while other experience pain in multiple areas and may also experience radiating pain. Descriptions and timing of the pain vary as well, depending on the patient. There are four types of vulvodynia: vulvodynia, localized vulvodynia, unprovoked vestibulodynia, and provoked vestibulodynia.

LIVING WITH Vulvodynia

Connect with fellow pain warrior, Emily Sauer.
SYMPTOMS

Vulvodynia symptoms vary on the cause, patient, and type they are diagnosed with. Vulvodynia has no identifiable cause; no infection, skin disorder, or other medical condition. The most common description is a burning pain in the vulvar area; however, some individuals describe the pain as sharp, knife-life pain, stinging, irritation, or rawness.

The four subtypes of vulvodynia include:

  • Vulvodynia: pain/discomfort felt in the entire vulvar area and occurs spontaneously. The pain felt is generally constant; however, periods of symptom relief can be experienced.
  • Localized vulvodynia: pain felt in one specific place on the vulva
  • Unprovoked vestibulodynia: pain is triggered to the vestibule or surrounding area due to pressure to the vestibule, such as:

-sexual intercourse
-tampon insertion
-a gynecologic exam
-prolonged sitting
-wearing tight/fitted pants

  • Provoked vestibulodynia: is pain that occurs in the vestibular region of the vagina i.e. the entry of the vagina.
DIAGNOSIS

The diagnosis of vulvodynia is often one of exclusion. Your gynecologist should try to rule out any infection, skin disorder, organic condition or allergies as well as going over your medical and sexual history before making a diagnosis. The vagina and vulvar area will be thoroughly examined as well as the pelvic floor muscles palpated to determine if there is underlining musculoskeletal dysfunction. Often a gynecologist will use a cotton swab to apply pressure to determine the discomfort or severity of pain experienced in distinct areas. A biopsy and/or a sample of discharge may be taken to insure the correct diagnosis. In some cases, a blood test is performed to see the levels of estrogen, progesterone, and testosterone.

CAUSES AND RISK FACTORS

Researchers believe several factors contribute to vulvodynia. The factors include:

  • Damage or irritation to the nerves or the muscles of the vulva and pelvic floor
  • Inflammation or elevated levels of inflammatory substances in the vulva
  • Genetic factors such as susceptibility to chronic vestibular inflammation, susceptibility to chronic widespread pain, or the inability to fight vulvovaginal infections
  • Pelvic floor instability, weakness, or spasms
  • Abnormal response to environmental factors including infection or trauma
  • Conditions that affect nearby muscles or bones
  • Hormonal imbalances or altered hormone receptor expression in the vulvar tissue
TREATMENT OPTIONS

A multidisciplinary approach is often used when treating vulvodynia, and treatments may include medicinal, surgical, physical therapy, and complementary therapies as well as lifestyle changes. When being treated for vulvodynia, an individual may seek treatment from a gynecologist, neurologist, pain management specialist, and physical therapist.

Medicinal treatments include:

  • Anticonvulsant medicine
  • Tricyclic antidepressants (both oral or topical)
  • Hormone therapy (topical or oral)
  • Opioid therapy (last resort)
  • Lidocaine and other topical creams and suppositories
  • Trigger point therapy
  • Nerve blocks

Surgical treatments include:

  • Vestibulectomy to remove the vestibular tissue that causes pain, which differs in each patient (this surgery is especially common in provoked vulvodynia)
  • Neurostimulation

Physical therapy is used to lengthen and balance the pelvic floor and surrounding areas, and release tension in the muscles and joints. Includes

  • Manual therapy techniques such as, soft-tissue mobilization, myofascial trigger point release, visceral and connective tissue mobilization both external and internal and both vaginally and rectally, and joint mobilization
  • Biofeedback
  • Ultrasound
  • Cold laser
COMPLEMENTARY THERAPIES

There are various types of complementary therapies that are recommended for vulvodynia, including:

  • Yoga
  • Tai chi
  • Qi gong
  • Acupuncture

Other steps that may be helpful in reducing symptoms include:

  • Avoiding exercise that puts pressure on the vulva, such as cycling
  • Exercises that increase pain or symptoms
  • Cooling packs to help vulvar pain
  • Wearing 100% cotton panties with no elastic
  • Avoid tight clothing
  • Clean the vulva with water only
  • Avoid douching
  • Do not use feminine products or lubricants with deodorants or scents/flavors
  • Apply a thin layer of coconut oil to the vulva daily to hold in moisture and protect the skin
DIET AND NUTRITION

There is no specific diet that doctors tell vulvodynia patients to follow; however, since inflammation of the vulvar area is believed to contribute to vulvodynia, a low inflammation diet is recommended. Researchers also recommend following a diet that is low in oxalates because they may produce urine that is irritating, which may contribute to vulvar pain. If you are lactose or gluten intolerant than stick to these diets as well. If you experience bladder or bowel issues, then work on bladder or bowel retraining techniques.

Straining aggravates the pelvic floor and thus the vaginal area so avoid straining and drink plenty of water to flush out toxins.

VULVODYNIA EXPERT

Learn a little more with vulvodynia expert, Amy Stein.
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Disclaimer: The educational information provided is not a substitute for medical advice.  Always consult your primary care physician for diagnosis, treatment, and individual guidelines.