Vulvodynia is a condition causing chronic pain of the vulva without an known or identifiable cause with varying symptoms among women. The condition is broken into two subtypes which may be experienced alone or in combination of each other; Vulvar Vestibulitis Syndrome also referred to as Provoked Vestibulodynia and Generalized Vulvodynia. The American College of Obstetricians and Gynecologists (ACOG) refers to these sub-types as generalized or localized vulvodynia and are described as pain felt on the entire vulva versus one specific location on the vulva respectively.
Vulvar Vestibulitis Syndrome (VVS), a form of localized vulvodynia, is described as pain limited to the area surrounding the vaginal opening referred to as the vestibule. The pain associated with this condition generally occurs during or after the presence of vestibular pressure such as with sexual intercourse, insertion of tampons, gynecologic exams, etc. It may also occur in more benign situations as with sitting for long periods of time or wearing pants which are fitted. When the pain is experienced during the first attempt at vaginal penetration, it is referred to as Primary VVS whereas with Secondary VVS, the pain develops after a period of pain-free sexual intercourse.
While there is no one cause of vulvodynia, it is thought that some of the contributing factors to the development of the condition include:
- Nerve irritation and/or injury
- Increased nerve fiber density
- Vulvar tissue with elevated levels of inflammatory substances
- Atypical response of the cells of the vulva when environmental factors such as infection or trauma are present
- Abnormal hormone receptor expression
- Hypersensitivity to organisms such as Candida aka yeast or others
- Pelvic floor abnormalities such as muscle weakness or spasms
A diagnosis of vulvodynia will be made after your medical provider discusses your medical history and performs an gynecologic examination. They may also obtain cultures to determine if the presence of yeast and/or a bacterial infection may be causing symptoms. Additional testing may include blood samples to test for estrogen, progesterone and testosterone levels and you may also undergo a cotton swab test which includes applying pressure to various areas of the vulva. During this exam, a biopsy may be taken for additional evaluation.
The treatment of vulvodynia may includes a multi-team and multi-treatment approach. Treatment approaches may include discontinuing possible offending irritants, pain medications, antidepressants, anticonvulsants, topical creams including hormone, anesthetics and compounded formulations, pelvic floor muscle therapy/biofeedback therapy, nerve blocks, elimination diet/diet modification, neurostimulation/spinal infusion pump, complementary/alternative medicine approaches, trigger point therapy with or without pain medication injection, psychotherapy and/or surgery (vestibulectomy).
Simple modifications in your daily routine may help relieve your symptoms and include:
- Avoiding products which have dyes, deodorants and/or perfumes which may be irritating to the vulva
- Wear only cotton underwear
- Use cotton menstrual products
- Try using cool gel packs for pain control
- Eliminate foods such as caffeine, highly acidic or sugary foods and processed foods
If you believe that you are experiencing the symptoms of vulvodynia, it is important to contact your healthcare provider for an evaluation.