Vulvodynia

Vulvodynia is chronic pain or discomfort of the vulva, the outside area of the female genitals often in the absence of any recognizable cause. The vulva includes the pad of fatty tissue at the base of the abdomen, the labia, the clitoris and the opening of the vagina. The pain may be constant or it may come and go. It may occur after contact with the vulvar area, during exercise or when simply sitting or resting. The pain can last for months or even years, beginning and ending suddenly. Vulvodynia can take a toll on a woman's daily life and her relationships. Some women with chronic vulva pain may become afraid to have sex, which can lead to vaginismus, an involuntary spasm of the muscles around the vagina. It can be difficult to find the cause of the vulva pain; however treatments are available to help provide relief.

The cause of vulvodynia is not yet known. In some cases vulvar pain can be a symptom of another condition. When the cause of the pain can't be determined it is called vulvodynia. What is known is that vulvodynia is not sexually transmitted nor or is it a sign of cancer. Factors that may contribute to vulvodynia include:

• Infections
• Genetics
• Spasms of the muscles that support the pelvic organs
• Allergies
• Hormonal changes, including those that occur with a menstrual cycle or birth control use
• Damage or irritation of the nerves of the vulva
• History of sexual abuse
• Overuse of topical medications

Symptoms may include:

• Burning
• Stinging
• Rawness
• Itching
• Aching
• Soreness
• Throbbing
• Swelling
• Painful intercourse

The vulva typically appears normal.

The pain may be ongoing or intermittent. It may be generalized, meaning it is felt in the entire vulvar region, or localized, meaning it is felt only in one area. Localized pain confined to the opening of the vagina (the vestibule) is a form of vulvodynia known as vestibulodynia.

Diagnosis typically includes the following:

• Thorough medical history and discussion of symptoms
• Physical exam
• Pelvic exam - including careful examination of the vulva and vagina
• Testing for vaginal infections - such as a yeast infection or bacterial vaginosis, through a vaginal discharge sample
• Cotton swab test - using a moistened cotton swab to touch different areas of the vulva to determine the location and intensity of the pain
• Biopsy or colposcopy, if any skin changes are found during the pelvic exam

Treatment for vulvodynia is aimed at relieving the pain and other symptoms. It may take time, sometimes weeks to months, both to find the treatment that works best for each woman, and for a particular treatment to begin providing relief. In some cases a combination of treatments may work best. The key is to be patient, work closely with your physician, and pay close attention to triggers that may worsen your symptoms. Treatment strategies include:

Lifestyle changes:

• Wear 100 percent cotton underwear (no underwear at night)
• Avoid tight-fitting undergarments and pantyhose
• Use mild soaps for bathing and clean the vulva with water only; avoid douching, vaginal wipes and deodorants, bubble bath, and pads or tampons with deodorants
• Use lubrication for intercourse
• Avoid exercises that put pressure directly on the vulva, like bicycling
• Apply cool gel packs to the vulva area to reduce pain and itching

Medications. To lessen pain and reduce itching, including local anesthetics, steroids, and some antidepressants and anticonvulsants.

Physical therapy and biofeedback. To help control muscle spasms that can cause pain.

Therapy or sexual counseling. To help cope with the stress of living with chronic vulva pain and the impact it has on a woman's daily activities and relationships.

Surgery. In cases of severe pain that can be specifically pinpointed (localized vulvodynia), surgery to remove the affected skin and tissue, a procedure known as a vestibulectomy, relieves pain in some women.