Essential facts about vulvodynia women should know

There is a bit of a medical mystery striking anywhere from 9 % to 18% of women between the ages of 18 and 64.  The women who are unfortunate enough to have this malady often do not seek help or go from doctor to doctor seeking a diagnosis and treatment without receiving answers.  This medical anomaly is called vulvodynia.  Considered neither a sexually transmitted disease nor a sexual dysfunction, according to the National Vulvodynia Association, it is a condition marked by “chronic vulvar pain without an identifiable cause.”  Many women may not be especially familiar with the body parts below the belly button, typically referred to as “down there.” The vulva is the external part of the female genital area and is not the same thing as the vagina. Think of it in this way, if you have chapped lips, lip balm is applied to the surface of the lips and not inside the mouth. The same applies to vulvar disorder. To treat the vulvar, you would not insert medicine into the vagina. 

The vulva protects a woman’s vagina, urinary opening and vestibule, and is the center of much of a woman’s sexual response.

Now, imagine your life if sex was so painful you’d do anything to avoid it.  Or having excruciating pain when trying to insert a tampon, undergo a pelvic exam, wear a pair of jeans, ride a bicycle or go jogging?  This is the reality for 6 million American women who have chronic, debilitating pain in their vulvas.  The condition is known as vulvodynia and the pain can be constant and unbearable and not just during intercourse.  Vulvodynia is a condition that can occur out of the blue – one day you are perfectly fine, and the next, you’re experiencing genital pain.

Some women describe it as “acid being poured on my skin” or as a “constant knife-like pain.”  Other symptoms associated with it include burning, stinging, soreness, rawness, throbbing and itching. The pain can be so bad it can affect a woman’s ability to lead a normal life.  The ability to sit, to work, to be intimate, can crush a woman’s self-image leading to feelings of isolation and hopelessness.  Alarmingly, almost 16% of all women in the U.S. will experience vulvodynia at some point in their life.  Of the women who do have it, 90% of them will suffer with constant pain for many years.

Vulvodynia is a medical mystery. It is not the result of an infection or a disease but for decades women suffering from vulvodynia have been told that nothing seems to be wrong with them since a physician examining the area will see nothing discernably there.  Women need to know this is not just “all in their head.”  It is a real, physical condition and is not a psychological problem.  Fortunately, there is treatment and relief if a woman gets the proper diagnosis. 

Causes of vulvodynia

There are 4 major causes of vulvodynia:

1.  Genetics

Like many conditions, vulvodynia can have a genetic component.  This means if a woman’s mother, sister or other relative has had a condition leaving them hypersensitive to any inflammatory process or inflammation this can set them up for bringing about the condition of vulvodynia.

2.  Yeast

The presence of yeast is a big factor in the development of vulvodynia.  The theory is that yeast, when it is chronic, can predispose a woman to vulvodynia Yeasts are normally found on body surfaces in low numbers and usually do not cause any problems.  But when women are exposed to certain risk factors, then yeast can overgrow causing symptomatic infections possibly leading to vulvodynia. 

3.  Pelvic weakness

If the muscles and nerves of the pelvic floor become weak  they will not be able to function well and can trigger an upregulation of the pain receptors leading to vulvodynia.  Pelvic floor muscles are the layer of muscle that support the pelvic organs and span the bottom of the pelvis.  They include the bladder, bowel, and uterus in women.   

4.  Trauma or injury

Trauma or injury of the genital area can be due to the delivery of a baby or sexual trauma.  Any injury or irritation of the nerves that transmit pain from the vulva to the spinal cord can lead to vulvodynia. 

Diagnosing vulvodynia

Any woman experiencing symptoms of vulvodynia, should consult with her physician for an accurate diagnosis.  The physician should take a thorough medical history by asking questions of the woman’s symptoms and then carefully examine the vulva, vagina, and vaginal secretions to rule out an infection or skin disorder.  Cultures for bacteria and yeast infections should be performed as well as blood drawn to assess levels of estrogen, progesterone, and testosterone.  The gold-standard test used is to take a Q-tip to gently apply pressure to various vulvar sites asking the woman to rate the severity of the pain.  Any area that appears suspicious should be examined with a magnifying instrument or have a biopsy taken of the area.

Treating vulvodynia

Because it is not known definitively what causes vulvodynia, treatment is usually directed at alleviating symptoms to provide pain relief.  What works for one woman may not work for another as there is no single treatment appropriate for all women with this malady.  It can take time to find the correct treatment(s) that finally work. 

Current suggested treatments for vulvodynia include the following:

·      Oral pain blocking medications

·      Topical medications

·      Pelvic floor muscle therapy such as Kegel exercises

·      Nerve blocks

·      Neurostimulation and spinal infusion pump

·      Wearing 100% cotton underpants during the day and wearing nothing at night

·      Avoid wearing panty liners or pantyhose

·      Avoid harsh soaps or douche

·      Dab the vulva with cool water after urinating

·      Apply cool ice or gel packs before engaging in a triggering activity

·      Use a soft “donut” pillow to sit for a long time