VULVODYNIA is a chronic pain, burning or discomfort involving the vulva which the sufferer can feel although there may be no visible symptoms.
The condition can be generalised and affect the whole vulvar area or localised to a specific area.
Provoked vestibulodynia, which used to be known as vulvar vestibulitis syndrome is a specific form of localised 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.
The precise cause of vulvodynia is not known, but researchers believe factors might include:
• damage or irritation of the nerves of the vulva 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; or,
• A history of sexual abuse
Dr Angamuthu Arun from the Waikiki Specialist Centre says vulvodynia is not hereditary and affects women of all ethnic groups.
It’s likely to affect up to 8 per cent of all women and is constant across all decades up to the age of 70.
“Vulval vestibulitis syndrome (VVS) is the most common presentation,” says Dr Arun
“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.“
There are various treatments for vulvodynia, while avoidance is one of the best measures.
That can be done by avoiding soaps, bubble baths, shower gels, shampoos, special wipes and deodorants around the vulvar area, says Dr Arun.
Washing with a soap substitute will keep skin soft and provide a barrier against irritation. He says greasy ointments are a good soap substitute, and can be bought over the counter from chemists and at supermarkets.
“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.
Oral medication may be needed in extreme cases. Three types are commonly used:
• Amitriptyline, an anti-depressant now used for many pain problems. It is available as cream or in tablet form;
• Gabapentin or Pregabalin, an anti-epileptic drug, which is also used for pain; or,
• Vaginal diazepam pessary can be obtained from a compounding pharmacy.
Patients with vulvodynia who have sex-related pain frequently have pelvic floor muscle dysfunction and can benefit from pelvic physiotherapy.
Trigger point therapy, a form of massage therapy, can also be helpful. A trigger point is a small area of tightly contracted muscle. 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.
Vulvodynia 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.