What is Vulvodynia?
Vulvodynia refers to a chronic discomfort of the vulva, which is the part of a female’s body that protects the genitals.
It includes the external female genitalia, including the mons pubis, the labia minora and majora, the perineum, and the clitoris.
Vulval pain can occur due to several reasons, but Vulvodynia is particularly linked to a hypersensitivity of the nerve endings in the skin.
The major one amongst Vulvodynia symptoms is a pain in the genital area. It can be characterized by:
- Painful intercourse
The pain can be occasional or constant. The pain might occur only when the sensitive area is touched or provoked. The patient might feel the pain in the entire vulvar area, or it might be localized to a certain area, like the opening of the vagina.
The vulvar tissue might look swollen or inflamed in some cases. In most cases, the vulva appears normal.
Who is at risk?
Risk factors for Vulvodynia may include:
- Irritation or damage of the nerves around the vulva
- A high-density of pain-sensing nerve fibers in the vulval area
- High levels of inflammatory substances in the area
- Genetic susceptibility
- Weak or unstable pelvic floor muscles
- Unusual or long-term reaction to trauma, infection, or another environmental factor
- Changes triggered by hormones
Vulvar pain causes may include infections, neurological problems, inflammatory conditions, and neoplasms, such as squamous cell carcinoma.
Vulvodynia is not related to any underlying condition and the exact Vulvodynia cause is unknown. The condition is not caused by a sexually transmitted infection or any other infection, skin disease, or cancer, even though these conditions can also lead to pain.
Factors that increase the susceptibility of Vulvodynia include:
- Frequent yeast infections
- Sexually transmitted infections (STIs)
- Chemical irritation of the external genitalia, caused by soaps, feminine hygiene products, or detergents in clothing
- Rashes on the genital area
- Previous procedures such as laser treatment or surgery on the external genitals
- Nerve irritation, muscles spasms, or injury in the pelvic area
- Precancerous or cancerous conditions on the cervix
A provoked Vulvodynia could result from:
- Sexual intercourse
- Tampon insertion
- A gynecologic examination
- Prolonged sitting
- Wearing tight pants and underpants
- Activities like cycling or horseback riding
How is Vulvodynia diagnosed?
Vulvodynia diagnosis may include a pelvic examination to assess the pain and look for any skin changes.
Vulvodynia test may include a cotton swab test which is used to delineate the areas of pain and categorize the severity. A physician may press with a cotton swab in different areas while asking the patient to rate the level of pain they are experiencing.
The patient should be prepared to describe the pain, including the type and severity of the pain, when the pain began and if it began gradually or suddenly, which areas does it hurt and how often.
The doctor may use special magnifying glass to carry out a colposcopy test.
Other tests that may be carried out to eliminate other causes and find out the source of pain may include:
- Taking a culture for yeast and bacteria
- Blood tests to check levels of estrogen, progesterone, and testosterone
- A biopsy
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How is Vulvodynia treated?
Vulvodynia treatment aims at alleviating symptoms.
Vulvodynia medicine to block pain may include antidepressants, anticonvulsants, or serotonin-norepinephrine reuptake inhibitors (SNRIs). Other options include lotions, creams, and anesthetic gel to apply to the vulval area.
Interrupting the pain signals can provide short term relief and can be done by using a nerve block.
In case no other method proves effective, surgery may be required to remove the painful tissue. Neurostimulation and spinal infusion pump are two techniques that are currently being investigated.
Neurostimulation can replace the pain with a tingling sensation and involves delivering low-voltage electrical stimulation to a specific nerve.
A spinal infusion pump can dull the pain. It is an implanted device that can deliver low-dose medication to the spinal cord and nerve roots.
However, limited evidence is present regarding the use of these measures for Vulvodynia.
How can Vulvodynia be prevented?
Measures that can help in Vulvodynia prevention or reduction of risk of triggering pain include:
- Wearing cotton underwear and loose-fitting clothes around the genital area
- Avoiding scented toilet papers, perfumed soaps, and creams
- Avoiding sitting for prolonged periods or friction
- Avoiding excessive genital washing
- Avoiding douching or using vaginal wipes
- Using water-soluble lubricants during sexual intercourse
- Patting the area dry after urinating or rinsing
In case a vaginal infection is suspected, it is vital to get it treated.