Vulvodynia is a condition that causes burning, aching, or stabbing pain in the vulvar area (on the lips outside the vagina). The pain can be confined to just the vaginal opening (vestibule). This is called vestibulodynia. It can also affect the smaller and/or larger lips on the outside of the vagina (labia majora and minora). This is called vulvodynia. Some women experience pain all of the time, other women have pain only when the area is touched or provoked. The vulvar tissues look normal or are slightly reddened. Because the area looks normal many women are told by their health care provider that there is nothing wrong. Some women are presumed to have vaginal infections and receive multiple treatments with antibiotics and antifungals even though their tests are normal.
It is not clear what causes vulvodynia. The condition used to be called vestibulitis because it was thought that it was caused by inflammation of the tissues. Now it is thought that a number of disease processes could be involved including; abnormalities in embryologic development, genetic and or immunologic factors, hormonal factors, central and peripheral neuropathic processes, tightening of the muscles of the pelvic floor and nerve entrapment. Other theories such as infection with human papilloma virus or candida have been called into question. Although many women with vulvodynia have a history of sexual abuse or trauma, vulvodynia is not a result of psychological or sexual dysfunction. It is not clear what the relationship is between past sexual trauma and vulvodynia but many trauma therapists believe that we hold past trauma experiences in our body. In addition, trauma may have caused injury to the muscles or nerves in the area contributing to the pain syndrome.
To identify vulvodynia a special physical examination is performed. Any identifiable disease such as vaginitis or lesions on the vulva should be treated. A q-tip test should be conducted by simply touching the area outside the vagina with a small q-tip to note any change in sensation and its location. If the woman is able to tolerate a speculum exam the vagina should be examined for any abnormalities. Then a special examination assessing the pelvic floor muscles and fascia should be performed. A single finger or two fingers if it is tolerated is inserted in to the vagina and the muscles are palpated. Many women with vulvodynia will find this painful because the pelvic floor muscles are tight and this is one of the sources of their pain.
Living with vulvodynia can affect many aspects of a woman's life: her ability to wear certain types of clothing, sit for long periods of time or to participate in daily activities such as exercise or sexual relations. The findings from the history and physical exam and the woman's preferences will guide the type of treatment chosen. It is important to care for women with vulvodynia in a holistic manner.
Here are some common treatments:
Application of topical anesthetics. In studies, about 76% of women will find pain relief with the application of topical anesthetics such as lidocaine. It is usually applied nightly for at least 3 months. Initially, many women experience burning but the discomfort usually only lasts a few minutes until the medicine numbs the area.
Pelvic floor muscle rehabilitation. Many women with vulvodynia have tense painful muscles inside the vagina. These muscles respond to stretching and manipulation by a physical therapist. Biofeedback can also be very helpful. Women can learn to relax the pelvic floor muscles by watching a monitor that displays muscle tightness. In addition, women learn to exercise, stretch and relax the muscles in the pelvic floor. Physical therapy has been found to help 60-80% of women.
Medications are prescribed. Certain types of antidepressants and anticonvulsants have been found to help with nerve pain. Other pain medication such as ibuprofen or sometimes narcotics are prescribed.
Therapy for support. Living with pain is very challenging and can cause depression and anxiety. Therapy can help women learn ways to cope with pain and to talk with their partner about sexual issues that may have come up as a result of living with vulvodynia.
If you have this condition or know someone who does, do not let them suffer in silence! With a proper diagnosis and a holistic approach to treatment women with vulvodynia can experience enormous pain relief and improve their quality of life.
