Vulvodynia

Vulvodynia is chronic pain and discomfort of the vulva that is not caused by an infection, skin disease or cancer. It is likely that many factors, including those related to the body’s nerves, hormones or immune system, are involved.

Two types of vulvodynia are recognized: generalized vulvodynia and localized vulvodynia. In generalized vulvodynia, the pain is felt over the entire vulvar area. In localized vulvodynia, the pain is felt on a specific area of the vulva. Vulvar vestibulitis syndrome (VVS) is a specific form of localized vulvodynia. In VVS, the pain is felt only in the vestibule (the area around the opening of the vagina), usually in response to touch or pressure.

Symptoms

Pain is described as burning, stinging and rawness. Additional descriptors include itching, aching, soreness, throbbing and swelling.

Symptoms can start and stop without warning or they may occur only when the area is touched, such as while inserting a tampon, having sex or wearing snug underwear. Some women report symptoms when doing certain activities, such as during exercise, after urinating, or while sitting or resting. The pain also may have no relationship to touch or pressure and may be constant.

Causes

Vulvodynia is a complex pain disorder. Many factors acting together are believed to be involved. Some of these factors include the following:

  • Damage or irritation of the nerves of the vulva
  • Increased number of nerve endings in the vestibule
  • Increased production of chemicals by cells in the vulva that lead to inflammation
  • Long-term reactions to certain infections
  • Changes in responses to hormones
  • Weakening of the muscles of the pelvic floor

Diagnosis

We will try to rule out other known causes of pain first. We most likely will perform a physical exam and may order specific tests. You may be asked questions about your symptoms and medical history, such as when symptoms occur, what treatments you have tried, and whether you have any chronic infections or skin problems.

We will examine the vulva and vagina carefully. If any skin changes are found, tests may be done. A swab test may be done to find out whether the pain is generalized or localized. In this test, the health care provider uses a cotton swab to touch areas of the vulva and vestibule. The goal is to find where the pain is and whether it is mild, moderate or severe.

Treatment

The first step in vulvodynia treatment usually involves avoiding products, clothing and other items that come in contact with the vulva and that may be irritating, such as soaps and products containing deodorants, perfumes and dyes. Wear cotton underwear and switch to cotton menstrual products. Pay close attention to what makes your symptoms worse, and avoid the things that provoke your pain. While you are experiencing pain, applying cool gel packs may bring relief.

For some women, certain foods make symptoms worse while other foods help relieve symptoms. An elimination diet may help you identify these foods. In this kind of diet, you cut out one type of food at a time and note whether this makes your symptoms better or worse. Foods commonly associated with triggering symptoms include caffeine, sugar, acidic foods and processed foods.

The following medications have been found to be helpful in treating vulvodynia:

  • Local anesthetics
  • Antidepressants and anti-seizure drugs
  • Hormone creams

Physical therapy can relax tissues in the pelvic floor and release tension in muscles and joints. Biofeedback is a form of physical therapy that trains you to strengthen the pelvic floor muscles. Strengthening these muscles may help to lessen your pain.

A nerve block — an anesthetic drug injected into the nerves that carry pain signals from the vulva to the spinal cord — interrupts pain signals and can provide short-term and sometimes long-term pain relief.

Vestibulectomy, the removal of the painful tissue from the vestibule, can be used for women who have VVS for whom other treatments have not worked. The procedure may help relieve pain and make sex more comfortable. It is not recommended for women with generalized vulvodynia.

Source: American College of Obstetricians and Gynecologists.