Most vaginal pain or discomfort can be traced back to an identifiable medical cause, such as a yeast infection, sexually transmitted infection (STI), contact with an irritating chemical or physical trauma to the area. There are other cases, however, in which the pain does not correspond to any of these reasons and it is then referred to as vulvodynia.
Vulvodynia is defined as any chronic pain, burning, stinging, irritation, throbbing or rawness in the area of the vulva (a woman’s external genitals) that is not caused by any obvious infection or disease. Vulvodynia is often difficult to diagnose since the symptoms can vary drastically from case to case. Some women may experience frequent and severe pain, while others may only experience occasional, but longer bouts of discomfort.
The pain caused by vulvodynia can make sexual intercourse difficult or even impossible for the women who suffer from it. Even putting in a tampon can be extremely uncomfortable. In extreme cases, everyday activities, including sitting, may cause discomfort. Many women with vulvodynia begin to isolate themselves by cutting themselves off from physical affection and any activity that may worsen the pain. This can lead to severe self-esteem issues and depression, especially if the condition goes undiagnosed.
Types
There are several varieties of vulvodynia. Generalized (or dysesthetic) Vulvodynia is a condition in which the pain is inconsistent in location, severity and frequency. Vulvar Vestibulitis Syndrome occurs only in the vestibule, a U-shaped area surrounding the vaginal and urethral openings, and only after touch or pressure is applied to the area. Cyclic Vulvovaginitis is connected either to a certain point of a woman’s menstrual cycle or to chronic yeast infections. Vulvar Dermatoses describes skin conditions of the vulva.
The Causes
The causes of vulvodynia are still shrouded in mystery since not enough research has been done to determine the root of this wildly varying condition. Experts suspect that it may be influenced by any of the following factors:
- nerve damage connected to the vulva
- infection or injury causing abnormal cell reactions in the vulva
- susceptibility to the condition due to existing genetic factors
- extreme sensitivity to Candida or yeast
- spasms in the muscles that support the pelvic organs
- chronic bacterial infections or changes in the pH of the area
- irritation from strong chemicals, such as detergents, soaps, spermicides or lubricants
Diagnosis
The process of being diagnosed with vulvodynia can be a long and frustrating one. The divergent symptom patterns of various patients and the general lack of knowledge on the subject means that a woman may have to see a series of doctors and specialists before all other possibilities are ruled out and a diagnosis of vulvodynia is made. A variety of questions and tests may have to be performed to arrive at the diagnosis including taking a thorough medical and sexual history, careful examination of the area for other potential causes, fungal and bacterial cultures, biopsies of suspicious areas, swab tests or a colposcopy.
Treatment
There is no definitive cure for vulvodynia, but with treatment, the pain can be managed or even eliminated. Since every woman’s symptoms are different, some treatments may work for one woman and have no effect for another. Doctors suggest avoiding the use of any topical medications, soaps or other products that may worsen symptoms and washing with only water, including washing and patting dry the area after urination.
Vulvodynia sufferers should wear only cotton underwear and use cotton menstrual products. Plenty of lubricant during sexual activity is highly recommended. Application of A and D ointment or witch hazel pads may soothe skin. Taking calcium citrate tablets and drinking cranberry juice may help. A bath with 4 to 5 tablespoons of baking soda may reduce burning and itching.
Sometimes local anesthetics, such as lidocaine, are necessary. Some women have found that tricyclic antidepressants or topical estrogen creams make a difference. For many, diet adjustments, physical therapy or biofeedback may be beneficial. In severe cases, injections of interferons, nerve blockades or even surgery (for vulvar vestibulitis only) may be performed.
