What is vulvodynia?

Vulvodynia is a condition characterized by a multitude of vaginal and vulvar complaints that can include burning, itchiness, and painful intercourse. Although there are many working diagnoses of the etiologic causes of this type of vulvar pain, none is proven to be the definitive answer. Vulvodynia is associated with sexual pain and discomfort, and many women

Vulvodynia is a condition characterized by a multitude of vaginal and vulvar complaints that can include burning, itchiness, and painful intercourse.

with this condition have stopped having intercourse. Many women suffer from this condition for many years until the definitive diagnosis is made, and many go unrecognized or untreated for many years.

If you have vulvar complaints, seek medical care from a specialist. Along with a complete history and physical examination, some of the following tests may be done to form a diagnosis: cotton swab test, vulvoscopy, measurement of vaginal pH secretions, and genital cultures to exclude sexually transmitted diseases like gonorrhea and Chlamydia infection[1]. A wet mount or slide preparation of the vaginal discharge will sometimes be made to see if there are other infectious processes going on as well. Vulvodynia may be associated with interstitial cystitis, so it is also important to have a complete genitourinary assessment.

Some doctors also advocate a comprehensive hormonal panel as well as a biopsy[2]. The National Vulvodynia Association (nva.org) is the best resource for those suffering from vulvodynia. Some of the treatments have included strict vulvar care with avoidance of allergens, and application of cold compressors and topical numbing medication 20 minutes before coitus[3]. Hormones such as estradiol alone or combined with testosterone in methylcellulose/petrolatum applied to the vestibule may also be helpful. Topical estrogen creams have also been used with moderate success; they are safe and effective treatments for this condition. Biofeedback and physical therapy have also been used with some success. Acupuncture, the traditional Chinese medicine technique of needle insertion to promote increased chi and bodily energy, has also been tried to help with chronic pain and discomfort. Other medications taken orally or applied topically that have also been used include tricyclic antidepressants, gabapentin, and intralesion interferon. Some more experimental methods include low-oxalate diet with calcium citrate supplementation, topical capsaicin, suppressive antifungal therapy, and topical lidocaine every 6 hours. Some researchers advocate keeping a food diary; some women have linked their symptoms to specific foods such as blueberries, strawberries, and spicy foods. Surgery to remove the skin that is causing the burning or other symptoms should be reserved for refractory cases, and many are not completely helped by such vestibulectomies.

According to the National Vulvodynia Association, many women have very sensitive vulvar areas that can be easily irritated and lead to painful irritative symptoms including painful intercourse. Following is a list of some practical suggestions to help maintain vulvar health. The list is from the NVA.org handbook:

• Wear all-white cotton underwear.

• Do not wear pantyhose (wear thigh-high or knee-high hose instead).

• Wear loose-fitting pants or skirts.

• Remove wet bathing suits and exercise clothing promptly.

• Use dermatologically approved detergent such as Purex or Clear.

• Limit fabric softener.

• Double-rinse underwear and any other clothing that comes into contact with the vulva.

• Use soft, white, unscented toilet paper.

• Use lukewarm or cool sits baths to relieve burning and irritation.

• Avoid getting shampoo on the vulvar area. Do not use bubble bath, feminine hygiene products, or any perfumed creams or soaps.

• Rinse the vulva with water after urination.

• Urinate before the bladder is full.

• Use 100% cotton menstrual pads and tampons.

• Be careful of contraceptive creams or spermicides. Read labels. Often many products contain irritants or allergens that can affect an already sensitive vulvar area.

  • [1] A sexually transmitted disease caused by the infection with the bacterium
  • [2] A surgical procedure that involves obtaining a tissue specimen from the body for laboratory testing to determine a more precise diagnosis
  • [3] Latin word for the penetration of the vagina with a penis.
 
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