What is Vulvodynia?
The International Society for the Study of Vulvovaginal Disease (ISSVD) defines vulvodynia as a pain in the vulva (the external part of the female genitals) that lasts at least three months. It has no identifiable reason and there could be other related factors. Vulvodynia is diagnosed by ruling out other causes and is a type of pain disorder that we don’t know the cause of.
What Causes Vulvodynia?
We don’t really understand why vulvodynia, a type of pain in the female genital area, happens yet. However, scientists are working hard to find out what leads to this condition. Several potential causes could be to blame such as nerve damage that messes up how pain signals travel from the vulva to the spinal cord, an increased count or sensitivity of nerve fibers in the vulva, or abnormal responses to things in the environment.
Other possibilities include higher than normal amounts of inflammatory substances like cytokines in the vulva, genes that make a person more likely to get vulvodynia, or issues with the pelvic floor muscles like weakness, spasms, or instability. So, although we are still trying to pinpoint the exact cause, there are many different angles being investigated.
Risk Factors and Frequency for Vulvodynia
Vulvodynia, a condition that can affect women, showed an annual frequency of 3.1% in 2012, and it rose to 4.2% in 2014 per 100 women-years. These numbers can vary based on factors like age, ethnicity, and marital status. Various reputable studies funded by the National Institutes of Health (NIH) reported that between 3% and 7% of women of childbearing age suffer from this condition.
- Three of these studies confirmed the condition clinically.
- According to one researcher, Harlow, up to 7% of American women may have symptoms of vulvodynia by the time they turn 40.
- Surprisingly, only about 1.4% of women who sought medical care for symptoms were correctly diagnosed with vulvodynia.
Signs and Symptoms of Vulvodynia
A thorough examination of the reproductive organs is necessary for patients. This involves checking for any potential cause of patient discomfort, ranging from infections and inflammation, to hormonal imbalances, growths, and problems with the nervous system. Once these factors have been explored and addressed, a detailed inspection of the external female genitalia and entrance to the vagina follows.
Here’s a simplified breakdown of some key examination techniques:
- Cotton swab evaluation: Ask the patient to point out where the pain is and whether it hurts even before touching the area. Then carefully use a cotton swab to mark the painful locations, starting from the inner thigh and moving in towards the vaginal opening, involving areas like the larger outer folds of the vulva, smaller inner folds, clitoris, and the area between the vagina and anus. The patient should then rate their pain on a scale of 1 to 10.
- Neurosensory evaluation: This involves contrasting the sensation between a cotton swab and a pinprick in the same areas, looking for normal sensitivity or lack thereof, along with sharp, burning, or shooting pain.
- Pelvic muscle examination: This involves examining the muscles of the pelvic area, beginning with the puborectalis muscle (a loop-like band of muscle that’s part of the pelvic floor).
It’s also important to evaluate if the patient has any other conditions causing pain, such as a bladder condition called interstitial cystitis, a disorder causing pelvic pain and infertility called endometriosis, jaw joint disorders, or chronic headaches. Understanding the impact of pain on the patient’s emotional wellbeing, sleep patterns, relationships, physical and sexual functioning is also crucial.
Testing for Vulvodynia
No blood tests are required in this case. All that is necessary is a comprehensive health history check and physical examination, along with a review of your current medications and any known drug allergies.
Treatment Options for Vulvodynia
Treatment for this condition requires professionals from different areas of medicine to work together. The most important thing is that the woman’s pain is taken seriously. Often, women have suffered for a long time and seen several practitioners without getting adequate help. When a woman finds the right healthcare team, it may include practitioners like a gynecologist who focuses specifically on health issues related to women’s genital area, a dermatologist, a neurologist, a pain management specialist, a urologist, or a physical therapist specialized in women’s health.
Methods of treatment include:
* Self-care: This involves avoiding irritants that might worsen the condition.
* Medication: These are drugs that help to alleviate pain. The drug categories include certain types of antidepressants which are often used for nerve pain, and anticonvulsants. The doses are usually lower than those prescribed for treating depression. Because these medications may have side effects, they are often started at very low doses and then gradually increased.
* Topical Medication: These are treatments applied directly to the painful area, provided they do not contain any substances that could cause an allergic reaction. They usually need to be specially made, in a process called compounding.
Non-drug therapies have also been found effective in treating this type of pain. Women’s health physical therapy, for instance, can be helpful in treating weakness and spasms in the pelvic floor muscles. This therapy includes a mix of exercises, massages and work on the soft tissue and joints. Techniques like nerve block, psychotherapy, mindfulness, yoga, and neurostimulation can also help in managing pain.
Surgery is an option, but it is usually reserved for very specific cases. It involves removing the painful areas in the vagina. Recovery may include physical therapy and the use of vaginal dilators.
What else can Vulvodynia be?
Conditions that can be mistaken for each other because they present with similar symptoms include:
- Atypical candidiasis
- Bacterial vaginosis
- Herpes simplex
- Lichen planus
- Lichen sclerosis
- Trichomoniasis
- Vulvar burning or irritation
It is crucial to carry out proper tests to identify the real condition causing the symptoms.
