Vestibulodynia

Vestibulodynia is chronic pain and discomfort that occurs in the area around the opening of the vagina, inside the inner lips of the vulva. This area is known as the vestibule. The pain may occur when the area is touched, when a tampon is used, during sex, during a pelvic exam, when tight clothes are worn, or even when sitting for a long time. In some cases the area may also be red and inflamed. Vestibulodynia is a specific type or localized form of vulvodynia, chronic pain of the vulva. This painful condition was previously referred to as vulvar vestibulitis syndrome (VVS).

The exact cause of vestibulodynia is not yet known; however it appears to be the result of hypersensitive nerve endings or an overgrowth of nerve fibers in the vestibule area of the vulva. Factors that may contribute to or exacerbate vestibulodynia include:

• Chronic yeast infections
• Injury or trauma, including sexual abuse and childbirth
• Sensitivity to irritants in detergents, soaps, douches and panty liners
• Genetics
• Hormones
• Allergies
• Damage or irritation of the nerves of the vulva

Some women have a sudden onset of symptoms following a significant event such as childbirth or an infection that causes physical and emotional stress.

Symptoms of vestibulodynia may include:

• Painful burning that occurs when the vestibule is touched, during sexual intercourse, tampon use or a pelvic exam
• Pain during physical activities such as jogging, cycling or horseback riding
• Pain when wearing tight clothing
• Tender, dry or raw vestibule
• Stinging or irritation of the vestibule
• A sensation of tight skin in the vestibule
• Redness of the vestibule

The pain may be so severe it prevents intercourse. The fear of being hurt during sexual intercourse can lead to involuntary muscle spasms in the vagina, a condition known as vaginismus.

In severe cases, the woman may experience pain even when sitting or walking.

Itching is not usually a symptom of this condition.

In most cases there are no visible symptoms of vestibulodynia; however redness may occur. Diagnosis typically includes:

• Thorough medical history and discussion of symptoms
• Physical exam
• Pelvic exam to carefully examine the vulva and vagina
• Testing for vaginal infections - such as a yeast infection, through a vaginal discharge sample
• Cotton swab "touch test" - to pinpoint areas of extreme sensitivity on the vestibule
• Biopsy or colposcopy, if any skin changes are found during the pelvic exam

Treatment for vestibulodynia is aimed at relieving the pain and discomfort. It may take time both to find the treatment that works best for each woman, and time for a particular treatment to begin providing relief. In some cases a combination of treatments may work best. In other cases, the symptoms may subside on their own; however they may last for months or even years. Treatment strategies include:

Lifestyle changes:

• Avoid tight-fitting clothing and activities that put pressure directly on the vulva.
• Avoid soaps, douches, panty liners, etc. with deodorants that may act as irritants.
• Use lubrication for intercourse.

Local anesthetic creams. To temporarily numb the nerves before intercourse.

Medications. Including steroids and some antidepressants and anticonvulsants.

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

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

Vaginal dilators. To gently stretch the area around the vagina and overcome tightness caused by tense pelvic floor muscles

Surgery. In cases of severe pain, surgery to remove the affected skin and tissue, a procedure known as a vestibulectomy, relieves pain in some women.