Vulvodynia

Overview

Vulvodynia is a type of long-term pain or discomfort around the outer part of the female genitals, called the vulva. It lasts at least three months and has no clear cause. The pain, burning, or irritation linked with vulvodynia can make daily activities uncomfortable and may impact a person's mental health, relationships, and overall quality of life. Symptoms include pain, burning, irritation, stinging, rawness, soreness, sharp or knife-like pain, aching, throbbing, and swelling. Experts don't know the exact cause of vulvodynia, but factors such as nerve injury or irritation, past infections, inflammation, genetic conditions, allergies, hormonal changes, and muscle spasms might play a role.

Understanding the disease

Symptoms

Symptoms of vulvodynia include pain or discomfort in the outer part of the female genitals, called the vulva, lasting at least three months with no clear cause. The pain can be described as burning, irritation, stinging, rawness, soreness, sharp or knife-like pain, aching, throbbing, and swelling. Symptoms can vary in frequency and location, and may be constant or come and go. Vulvodynia may not cause visible changes to the tissue of the vulva.

Development

Vulvodynia is a condition characterized by long-term pain or discomfort around the outer part of the female genitals. The exact cause of vulvodynia is not known, but several factors may contribute to its development. These factors include injury to or irritation of the nerves of the vulva, past infections of the vagina, painful swelling called inflammation that affects the vulva, genetic conditions, allergies, hormonal changes, and muscle spasm or weakness in the pelvic floor. Each person's experience with vulvodynia can vary in terms of frequency and location of symptoms. If you have symptoms of vulvodynia, it's important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

Assessment and Diagnosis

Triage

You should see a doctor if vulvodynia is suspected. If you have pain in your vulva, it is important to talk with your gynecologist or another healthcare professional to determine the cause of your pain, as there may be treatable causes such as an active infection, a sexually transmitted disease, an inflammatory skin condition, vulvar growths, or genitourinary syndrome of menopause. A healthcare professional can provide an exam and recommend the right treatment for you.

Diagnosis

To diagnose vulvodynia, your healthcare professional will likely take a combination of approaches. They may ask questions about your medical and sexual history, perform a pelvic exam, conduct a cotton swab test, and possibly do a biopsy or blood test. The goal is to identify any potential infections, assess the condition of your pelvic floor muscles, and determine if there are any abnormalities in the skin of your vulva. Additionally, they may also consider potential psychological factors, such as relationship conflicts or past trauma, that could be contributing to the pain.

Management and Treatment

Complications

The potential complications of vulvodynia can include:

1. Mental health issues: Vulvodynia is linked with anxiety and depression, which can negatively impact a person's overall well-being.
2. Relationship problems: The pain and discomfort associated with vulvodynia can cause difficulties in maintaining intimate relationships, leading to emotional distress and strain on the partnership.
3. Sexual dysfunction: People with vulvodynia may experience decreased sexual desire, arousal, and enjoyment due to the discomfort and pain during sexual activities.
4. Fear of intimacy: Fear of experiencing pain during intercourse can lead to the development of vaginismus, a condition characterized by involuntary muscle spasms that make penetration difficult or impossible.
5. Shame and low self-esteem: The ongoing pain and discomfort, as well as the impact on sexual function, can contribute to feelings of shame, low self-esteem, and a negative body image. It is important to seek medical advice if you are experiencing symptoms of vulvodynia, as proper diagnosis and treatment can help alleviate these potential complications.

Treatment

The main vulvodynia symptom is pain in the vulva, which includes the opening of the vagina. The pain often is described as burning, irritation, stinging, rawness, soreness, sharp or knife-like pain. Additionally, you may feel aching, throbbing, and swelling. The tissue of the vulva might look slightly inflamed or swollen, but more often, your vulva doesn't look different than usual. If you have pain in your vulva, it's key to talk with your gynecologist or another member of your healthcare team to find out if your pain has a treatable cause that's different from vulvodynia. Despite the cause of vulvodynia being unknown, various treatments can help to ease discomfort. These treatments include:

1. Pelvic floor physical therapy: This involves exercises to strengthen and relax the muscles in the pelvic area.
2. Medications: Your healthcare provider may recommend over-the-counter pain relievers or prescribe a topical anesthetic or a low-dose antidepressant to help manage pain.
3. Nerve blocks: In some cases, a healthcare professional may inject a numbing medication around the nerves that supply the vulva to provide temporary relief.
4. Hormone therapy: In cases where hormonal imbalances are suspected, hormone therapy may be considered.
5. Vaginal estrogen therapy: This may be helpful for women experiencing vulvodynia due to genitourinary syndrome of menopause.
6. Behavioral therapies: These may include relaxation techniques, cognitive-behavioral therapy, or biofeedback to help manage pain and anxiety.
7. Avoid irritants: Identifying and avoiding potential irritants, such as certain soaps, perfumes, or tight-fitting clothing, can help reduce symptoms. It's essential to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your specific needs.

Preparing for medical consultation

To prepare for an appointment for vulvodynia, you should:

1. Be aware of any pre-appointment restrictions and ask if there's anything you need to do in advance, such as restricting your diet.
2. Write down any symptoms you're experiencing, including those that may not seem related to vulvodynia.
3. Note key personal information, such as major stresses or recent life changes.
4. Make a list of all medications, vitamins, or supplements you're taking.
5. Consider bringing a family member or friend along for support and to help remember important information discussed during the appointment.
6. Prepare a list of questions to ask your care team, such as:
   • What could be causing my symptoms?
   • What tests do you recommend?
   • What treatments are most likely to improve my symptoms?
   • When might I expect to get relief?
   • How can I manage other medical conditions together with vulvodynia?
7. Gather any previous scans, X-rays, or medical records relevant to your situation to bring to the appointment. Remember to be thorough in your preparation to make the most of your appointment and ensure that all your concerns are addressed.