Vulvodynia (Chronic pain in the female genital area): When it controls your life?
What is Vulvodynia?
Vulvodynia is a chronic pain, burning or discomfort involving the vulva in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder.
What are the types of Vulvodynia?
- Generalized vulvodynia – affecting the whole vulvar area: pain is felt over the entire vulvar area.
- Localized vulvodynia – affecting a specific area of the vulva.
What is Provoked Vestibulodynia?
Provoked Vestibulodynia (Fig.1) (formerly known as Vulvar vestibulitis syndrome) is a specific form of localized vulvodynia. In VVS, the pain is felt only in the vestibule (the area around the opening of the vagina), usually in response to touch or pressure.
What causes Vulvodynia?
The precise cause is not known.
Researchers believe that many factors acting together are involved.
Some of these factors include the following:
- Damage or irritation of the nerves of the vulva which can be after childbirth.
- Increased number of nerve endings in the vestibule
- Increased production of chemicals by cells in the vulva that lead to inflammation
- Long-term reactions to certain infections
- Changes in responses to hormones
- History of sexual abuse
Who gets it?
- Vulvodynia is not hereditary and it affects women of all ethnic groups.
- Lifetime prevalence has been estimated at 8% and is constant across all decades up to the age of 70.
- Provoked vestibulodynia is the most common presentation.
How is vulvodynia diagnosed?
- Your specialist will try to rule out other known causes of pain first. You may be asked questions about your symptoms and medical history, such as when symptoms occur, what treatments you have tried, and whether you have any chronic infections or skin problems.
- Your specialist will examine the vulva and vagina carefully. The specialist uses a cotton swab to touch areas of the vulva and vestibule to find out whether the pain is generalized or localized. The goal is to find where the pain is and whether it is mild, moderate, or severe. Taking swabs to look for infection or a biopsy (removal of a small sample of skin under a local anaesthetic to examine under the microscope) may occasionally be needed to rule out other causes.
How is vulvodynia treated?
Various treatments can be tried. The following are sensible lines of treatment:
- Avoid soap, bubble baths, shower gels, shampoos, special wipes and deodorants in this area. Wash with a soap substitute, as this will keep your skin soft and provide a barrier against irritation.
- Greasy ointments are a good soap substitute, and can be bought over the counter from chemists and at supermarkets without a prescription. Use petroleum jelly to protect the area from chlorine when you are swimming.
- Local anaesthetic ointment can be used to numb the area, reducing discomfort. Lignocaine cream and ointment can be bought without a prescription. These medications are applied to the skin for short-term pain relief, or they can be used for extended periods. Occasionally long term use of this ointment can cause allergy to lignocaine, but this is rare.
If these measures do not give you enough relief, then prescribed oral medication may be needed. Three types are commonly used:
- Amitriptyline. This is an anti- depressant but is now used for many pain problems. It is available as cream or in tablet form.
- Gabapentin or Pregabalin. This is an anti-epileptic drug, which is also used for pain.
- Vaginal diazepam pessary can be obtained from a compounding pharmacy.
Other treatments include:
- Pelvic Physiotherapy: Patients with vulvodynia who have sex- related pain frequently have pelvic floor muscle dysfunction. Physical therapy can relax tissues in the pelvic floor and release tension in muscles and joints. Biofeedback is a form of physical therapy that trains you to strengthen the pelvic floor muscles. Strengthening these muscles may help to lessen your pain.
- Trigger Point therapy: Trigger point therapy is a form of massage therapy. A trigger point is a small area of tightly contracted muscle. Pain from a trigger point travels to nearby areas. Trigger point therapy involves soft tissue massage to break up the trigger point and relax muscles. An anesthetic drug also can be injected into the trigger point to provide relief.
- Self-care (What can I do?) This condition is not life threatening or contagious. Wear cotton underwear and switch to cotton menstrual products if regular ones are irritating. Pay close attention to what makes your symptoms worse, and avoid the things that aggravate your pain. While you are experiencing pain, applying cool gel packs may bring relief.
- If intercourse is painful this may have emotional and psychological effects on sexual relationships. It is important to understand this, and to communicate fully with your partner, discovering techniques and lubricants that are comfortable and suit you both.
- Psychotherapy: A counsellor can help you learn to cope with chronic pain. This may help reduce stress and help you feel more in control of your symptoms. Sexual counselling can provide support and education about this condition for both you and your partner.
Is surgery an option for Vulvodynia?
If you have a type of vulvodynia called provoked vestibulodynia (Fig.1), your specialist may suggest vestibulectomy to remove painful tissue, especially if other treatments have not worked. The procedure may help relieve pain and make sex more comfortable. It is not recommended for women with generalized vulvodynia.
This is an operation where the inflamed skin is removed and the area is covered over by the back wall of the vagina.
Benefits – The benefit of this is that it cures or improves the problem in about 80% women treated. In selected patients that up to 80% gain partial or even complete long term improvement.
Risks – The major risk is failure to resolve the problem. There can be short term discomforts and spasm of the pelvic floor muscles but this usually resolves after two to three weeks.
For Treatment enquiries, please contact
Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG
Waikiki Specialist Centre
221 Wilmott Drive
Tel: 08 95500300
Fax: 08 95929830