Vulvodynia, chronic vulvar pain
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Vulvodynia is a condition characterized by chronic pain or discomfort around the opening of the vagina (vulva) that lasts for at least three months, and there is no identifiable cause for the pain. The symptoms may include a burning or irritating sensation, making activities like sitting for long periods or having sex unbearable. The condition can persist for months to years.
There are two main types of vulvodynia, based on the location of the pain:
- Localized vulvodynia: In this type, the pain is specifically localized to a particular area, such as the vulvar vestibule (the skin between the inner labia and the openings of the urethra and vagina) or the clitoris (the small, bead–like organ at the top of the vulva). It is sometimes referred to as localized vulvar pain syndrome.
- Generalized vulvodynia: Unlike the localized type, the pain in generalized vulvodynia is more widespread, and it may be experienced in different parts of the vulva and vagina at various times.
If you are experiencing vulvodynia, don’t allow the lack of visible signs or any embarrassment to prevent you from seeking help, as there are treatment options to alleviate discomfort. Consulting your doctor is essential, as they might be able to identify the cause of your vulvar pain through an examination.
Vulvodynia treatments primarily aim to alleviate symptoms, but no single treatment is universally effective for every case. Often, a combination of treatments proves to be the most successful approach. Finding the right treatments may require some time and patience, as it may take a while after starting a treatment to experience noticeable relief.
Symptoms
Pain in the vaginal area is the most common symptom of vulvodynia. When the pain begins, stops, or becomes the most intense varies for every person. The pain could be constant or intermittent. The pain may be felt across the vulvar area, or it may be confined to a particular area.
The pain in the vulva might be mild to severe. It could feel like:
- Burning
- Soreness
- Stinging
- Rawness
- Throbbing
- Itching
- Dyspareunia, or excruciating sexual intercourse.
Vulvodynia is a condition characterized by constant or occasional pain in the vulvar area, which can be provoked by touch. The pain may be generalized throughout the entire vulva or localized to a specific area, such as the vaginal opening. Sometimes, the vulvar tissue might appear slightly inflamed or swollen, but often it looks normal. Another similar condition called vestibulodynia causes pain only when pressure is applied to the area surrounding the entrance of the vagina. Although vulvodynia is relatively common, many women tend not to discuss it with their healthcare providers.
If you experience genital pain, it’s essential to discuss it with your doctor or seek a referral to a gynecologist. Your doctor should evaluate your symptoms to rule out other easily treatable causes of vulvar pain, such as yeast or bacterial infections, herpes, precancerous skin conditions, genitourinary syndrome of menopause, or medical problems like diabetes. Avoid using over–the–counter treatments for yeast infections without proper medical assessment. Once your doctor has examined your symptoms, they can suggest appropriate treatments or strategies to manage the pain effectively.
Causes
Vulvodynia has no known cause. However, there are several potential causes, such as:
- History of vaginal infections
- Allergies or skin sensitivity
- Hormonal imbalance or changes
- Damage or inflammation of the nerves around the vulvar area
- Spasms or weakening in the pelvic floor muscles that support the uterus, bladder, and intestines
- Genetic factors
- Irritation caused by harsh products that come into contact with the skin
People with vulvodynia are frequently diagnosed with other common pain conditions, such as fibromyalgia, bladder pain syndrome, irritable bowel syndrome, temporomandibular disorder (TMD).
Risk factors
Vulvodynia can occur at any age. However, majority of the diagnosis are among women between the ages of 20 and 60.
Diagnosis
The diagnosis of vulvodynia often begins by ruling out other possible causes of the discomfort. This involves asking one’s medical, sexual, and surgical history, and inquiring about the symptoms including the location, type, and intensity of the symptoms.
To confirm the diagnosis, test and procedure may be performed:
- Physical examination: To assess the vagina and cervix, the healthcare provider will inspect the vulva and do a pelvic exam with a speculum. Pelvic floor muscles are inspected to identify affected areas. This procedure also involves visually inspecting the external genitals and vagina to identify signs of infection or other potential causes for the symptoms.
- Cotton swab test: This exam is particularly useful for identifying localized pain in the vulvar vestibule. The healthcare provider will use a wet cotton swab to gently inspect the vulvar area for localized areas of pain. He or she will ask when or where the contact is unpleasant.
- Swab test for infection: Even if there is no visible infection, the healthcare provider may take a sample of vaginal cells to test for an infection. Sexually transmitted infections (STIs), bacterial vaginosis, and yeast infections are all illnesses that can cause vulvar pain.
Treatment
Treatment for vulvodynia focuses on symptom relief. However, treatment for vulvodynia requires time. Finding the right treatment or combination of treatments to relieve the pain requires trial and error and may not function right away. Good hygiene practices that keep the vulva and vagina healthy may also help with vulvar pain.
Several treatments are available to manage vulvodynia, such as:
- Medications: Antihistamines may help with itching. Oral medications such as antidepressants and anticonvulsants can help relieve nerve discomfort.
- Biofeedback therapy: By teaching a person how to relax the pelvic muscles and control how the body responds to the symptoms, this therapy can help reduce pain.
- Local anesthetics: Topical treatments include lotions and ointments that numb the vulva or stabilize the nerves. Healthcare provider may prescribe topical creams containing estrogen or a combination of estrogen and progesterone. To alleviate the discomfort, the healthcare provider may advise to apply lidocaine 30 minutes before sexual intercourse. Temporary numbness may be felt my one’s partner after contact.
- Nerve blocks: Local nerve block injections may be beneficial for women who have chronic pain that has not responded to other therapies. The medication blocks the pain signals from the nerves to reaching the brain.
- Pelvic floor therapy: Vulvodynia is associated with muscle spasms. Physical therapy can help relax the muscles, ligaments, and connective tissue in the pelvic floor. Stretching, extending, and strengthening weak pelvic floor muscles may be used in treatment. Tension in the muscles is common in many women who have vulvodynia.
- Surgery: Vestibulectomy can help relieve pain among women with localized vulvodynia whose pain has not improved with more conservative therapy. During the procedure, tissue from the painful area of the vulva is removed.
