Vulvodynia is chronic pain in the vulva, the area on the outside of a woman’s genitals. Vulvodynia is defined as pain that lasts more than three months and doesn’t have a clear identifiable cause, such as an infection or a skin disorder. This pain may cause sexual dysfunction and it can negatively impact a woman’s quality of life.
Vulvodynia affects the vulva, your external female genital organs. This includes the labia, clitoris, and vaginal opening. There are two main types –
• Generalized vulvodynia is pain in different areas of the vulva at different times. Vulvar pain may be constant or happen every once in a while. Touch or pressure may or may not cause iit. But it may make the pain worse.
• Localized vulvodynia is pain in one area of the vulva. Often a burning sensation, this type of vulvar pain usually results from touch or pressure, like sex or prolonged sitting.
The main vulvodynia symptom is pain in your genital area, which can be characterized as –
• Painful intercourse (dyspareunia)
Your pain might be constant or occasional. It might occur only when the sensitive area is touched (provoked). You might feel the pain in your entire vulvar area (generalized), or the pain might be localized to a certain area, such as the opening of your vagina (vestibule).
Vulvar tissue might look slightly inflamed or swollen. More often, your vulva appears normal.
Doctors don’t know what causes vulvodynia, but possible contributing factors include –
• Injury to or irritation of the nerves surrounding your vulvar region
• Past vaginal infections
• Allergies or sensitive skin
• Hormonal changes
• Muscle spasm or weakness in the pelvic floor, which supports the uterus, bladder and bowel
Risk Factors –
Several risk factors for the development of vulvodynia can include –
• Post-traumatic stress disorder
• History of abuse
Because it can be painful and frustrating and can keep you from wanting sex, vulvodynia can cause emotional problems. For example, fear of having sex can cause spasms in the muscles around your vagina (vaginismus). Other complications might include –
• Sleep disturbances
• Sexual dysfunction
• Altered body image
• Relationship problems
• Decreased quality of life
To diagnose vulvodynia, your doctor may –
• Ask about your medical, sexual and surgical history.This helps them understand exactly where and how much pain (and other symptoms) you’re having.
• Give you a pelvic exam.They’ll check your external genitals and vagina for things that might be causing your symptoms. They might take a sample of cells from your vagina to test for an infection.
• Do a cotton swab test. For this test the doctor uses a cotton swab to check for exact areas of pain in your vulvar region.
• Do a biopsy. The doctor will take a small piece of tissue from a particular area to examine it further. They’ll only do this if they find a sore or something else unusual.
Vulvodynia treatments focus on relieving symptoms. No one treatment works in every case. For many, a combination of treatments works best. It can take time to find the right treatments, and it can take time after starting a treatment before you notice relief.
Treatment options include –
• Medications. Steroids, tricyclic antidepressants or anticonvulsants can help lessen chronic pain. Antihistamines might reduce itching.
• Biofeedback therapy. This therapy can help reduce pain by teaching you how to relax your pelvic muscles and control how your body responds to the symptoms.
• Local anesthetics. Medications, such as lidocaine ointment, can provide temporary symptom relief. Your doctor might recommend applying lidocaine 30 minutes before sexual intercourse to reduce your discomfort. Using lidocaine ointment can cause your partner to have temporary numbness after sexual contact.
• Nerve blocks. Women who have long-standing pain that doesn’t respond to other treatments might benefit from local nerve block injections.
• Pelvic floor therapy. Many women with vulvodynia have tension in the muscles of the pelvic floor, which supports the uterus, bladder and bowel. Exercises to relax those muscles can help relieve vulvodynia pain.
• Surgery. In cases of localized vulvodynia or vestibulodynia, surgery to remove the affected skin and tissue (vestibulectomy) relieves pain in some women.
• Avoid tight clothing and pantyhose.
• Wear all-cotton underwear.
• Use cold compresses or gel packs.
• Avoid exercises that put pressure on the vulva, like cycling or horseback riding.
• Wash the area gently with plain water. Don’t use soap in the genital area, don’t douche, and don’t use other possible irritants like deodorants or bubble bath.
• Use a lubricant during sex, but stay away from the lubricants that are flavored or designed to create a cooling or warming sensation.
• If you have to sit down for prolonged periods, it might help to sit on a foam “donut” or some other type of cushion that reduces pressure on the area of the vulva.
• Reduce your stress levels and get adequate sleep.
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