Vulvodynia

Chronic pain of vulva is called Vulvodynia. Pain is accompanied by irritation or burning sensation in the area around vaginal opening.

The cause of pain is unknown. It can cause marked discomfort making it impossible to continue sitting for long periods or participate in sex.

Women with Vulvodynia may not have visible signs and feel embarrassed to report the condition. Seek help if you experience such symptoms as there are treatments that can ease your pain and discomfort.

Pain in your genital area is the main symptom of vulvodynia, which can be characterized by:

• Burning 
• Soreness 
• Stinging 
• Rawness 
• Throbbing 
• Itching 
• Painful intercourse (dyspareunia) 

Nature of the pain is unpredictable, it may occur constantly or randomly. Also it may persist for months to years or may just go away. Pain is vulvodynia can affect the entire vulva or may be limited to the vestibule. There is a similar condition called vestibulodynia in which pain is felt only after pressure. 

When to see a doctor? 

Vulvodynia is a common yet underreported condition. Discuss your problems with your doctor or see a gynecologist. Vulvodynia signs are similar to those caused by yeast or bacterial infections, other skin conditions, and medical problems such as diabetes. So, proper medical consultation is required to exclude these causes. Don’t overuse over-the-counter treatments for fungal infections without seeing your doctor. 

The exact cause of vulvodynia is still a mystery. Some possible causes include: 

• Nerve injury to or irritation in the vulvar region 
• History of vaginal infections 
• Allergies or skin sensitivity 
• Hormonal changes 

Vulvodynia isn't an STI (sexually transmitted infection) and does not indicate cancer.

You can see your family doctor or primary care provider to receive a diagnosis of vulvodynia. You may also be referred to S/he may refer you to a gynecologist (a specialist in female reproductive problems). 

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor. Some typical questions can be: 

• What could be most probable cause of my symptoms? 
• What are the tests that I need? 
• What are my treatment options? 
• How long will this condition last? 
• When will my pain and discomfort ease? 
• Do I need to take precautions while taking the medicine? 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

• When did you start noticing the symptoms? 
• What’s the severity and duration of your pain? 
• Can you describe how does your pain feel — sharp or dull, continuous or intermittent? 
• Are there any triggers for your pain such as intercourse or exercise? 
• Do you experience painful urination or a painful bowel movement? 
• What effects does menstrual have on your pain? 
• Is there anything that improves or worsens your pain? 
• Have you undergone a pelvic surgery? 
• Have you been a mother or are you now? 
• Have you ever received treatments for urinary tract or vaginal infections? 

Your doctor can also ask you other additional questions to obtain further insights on your condition. S/he can also perform the following tests: 

• Pelvic exam: In involves visual examination of external genitals and vagina to detect if any underlying cause is present. Your doctor can also test a sample of cells from vagina to identify a vaginal infection, such as a yeast infection or bacterial vaginosis, if any.
• Cotton swab test: A moistened cotton swab is gently inserted into the vagina to look for specific, localized areas of pain. 

Treatments for vulvodynia aim to relieve symptoms. Work on to find which treatment works for you. Be patient as treatment takes weeks or months to show noticeable effects. Treatment options may include: 

• Medications: Steroids, tricyclic antidepressants or anticonvulsants may be used to reduce chronic pain. 
• Antihistamines for itching. 
• Biofeedback therapy: With this therapy, you can learn and practice various pelvic muscles relaxation techniques. 
• Local anesthetics: Numbing agents like lidocaine ointment, can be used to relieve the symptoms such as pain, irritation and discomfort. Lidocaine ointment 30 minutes before sexual intercourse is recommended. 
• Nerve blocks: Nerve blocks are administered to women with chronic unresponsive pain. 
• Pelvic floor therapy: It includes exercises of muscles of pelvic floor. 
• Surgery: Surgery to remove affected skin and tissue (vestibulectomy) may be performed in women who have localized Vulvodynia or Vestibulodynia.

Here are some lifestyle tips that may help you manage the symptoms of Vulvodynia: 

• Try cold compresses on the affected area. Cold can ease pain and itching. 
• Soak in a sitz bath: Ten minutes of bath in lukewarm water two to three times a day, may be helpful.
• Avoid tightfitting pantyhose and nylon innerwear: Tight clothing can limit airflow and increase irritation. 
• Wear cotton underwear. 
• You may not wear underwear while sleeping, if it’s comfortable to you.
• Limit or avoid stay in hot water 
• Avoid activities such as biking or horseback riding to reduce pressure on vulva.
• Wash gently: Don’t scrub the affected area. Gently clean the vulva with plain water and pat dry. You may apply preservative-free emollient, such as plain petroleum jelly after bath.
• Use lubricants: Lubrication before sexually activity can reduce the symptoms during or after sex. 
• Try an anti-allergic medication: You may take this drug before sleeping to reduce itching and facilitate sleep.

Talking to another woman with similar condition can help you broaden your knowledge and feel better. If you are comfortable, you can join a support group, or ask your doctor to find a counselor.

There are several complications associated with vulvodynia.

Pain, discomfort and inability to participate in sex can cause various physical and psychological problems: 

• Vaginismus, contraction of vagina which can be caused by fear of sex
• Anxiety 
• Depression 
• Sleep problems
• Sexual dysfunction 
• Body image problems 
• Relationship problems 
• Reduced quality of life