| What is vulvodynia? Vulvodynia, in the simplest of terms, means "pain of the vulva." It is defined as chronic vulvar discomfort or pain, characterized by burning, stinging, irritation or rawness of the female genitalia. The cause of vulvodynia remains unknown. It may be the result of multiple factors. Physicians speculate that it may be caused by the following: an injury or irritation of the nerves that supply and receive input from the vulva; a localized hypersensitivity to yeast; an allergic response to environmental irritants; high levels of oxalate crystals in the urine; and spasm and/or irritation of the pelvic floor muscles. There is no evidence that vulvodynia is caused by infection or that it is a sexually transmitted disease. What are the symptoms of vulvodynia? Burning sensations are most common, however, the type and severity of symptoms experienced are highly individualized. Some women describe their pain as stinging, irritation or rawness. Vulvodynia may be constant or intermittent, localized or diffuse. The two major subsets of the condition, Dysesthetic Vulvodynia and Vulvar Vestibulitis Syndrome (VVS), are quite different. Dysesthetic vulvodynia is characterized by pain that is diffuse throughout the vulvar region. It can be present in the labia majora and/or labia minora. Sometimes it affects the clitoris, perineum, mons pubis and/or inner thighs. The pain may be constant or intermittent and is not necessarily initiated by touch or pressure to the vulva. The vulvar tissue may appear inflamed, but in most cases there are no visible findings. Women with VVS have pain when touch or pressure is applied to the vestibule (area surrounding the opening of the vagina). Women may experience pain with intercourse, tampon insertion, gynecologic exam, bicycle riding, horseback riding, motorcycle riding and wearing tight clothing such as jeans. Most often, the vestibule of women with VVS is inflamed and red. Regardless of the type of vulvodynia a woman has, the disorder imposes serious limitations on a woman's ability to function and engage in normal daily activities. The pain can be so severe and unremitting that it forces women to resign from career positions, abstain from sexual relations, and limit physical activities such as walking. Not surprisingly, these limitations negatively affect a woman's self-image; many women become depressed because of the physical pain itself and the associated psychological and social implications. What is involved in diagnosing vulvodynia? The diagnosis of vulvodynia is made by ruling out other conditions that can cause vulvar pain such as sexually transmitted diseases, infections, skin disorders and human papillomavirus. A patient's medical history needs to be reviewed carefully and a complete vulvar and vaginal examination is necessary. A culture is routinely taken from the vagina to rule out sexually transmitted diseases and infections. A "q-tip" test is often administered during the exam. During this test, different areas of the vulva and vestibule are touched with a q-tip to determine the location and severity of a woman's pain. If the doctor sees areas of skin that look suspicious during the exam, a biopsy of the skin may be required. Additionally, physicians may recommend a colposcopy, a procedure which uses a specialized instrument to examine the vulva more closely. What are the treatments for vulvodynia? Since few cases are cured, treatments are directed toward alleviation of symptoms and may provide partial or complete relief. It is important to keep in mind that the cause of vulvodynia is unknown and that there may be multiple causes. Consequently, no one treatment works all the time. Some women respond very well to a particular treatment while others respond poorly to the same treatment. It takes time to find a treatment or combination of therapies that will alleviate the pain. Current treatments available include: anti-inflammatories antihistamines local anesthetics (e.g., lidocaine) tricyclic antidepressants anticonvulsants interferon injections topical estrogen cream surface electromyography (biofeedback) low oxalate diet plus calcium citrate surgery (for vulvar vestibulitis syndrome only) What should women with vulvodynia tell their husbands/partners? Many physicians welcome the presence of husbands/partners during medical consultations for vulvodynia. Since this condition significantly affects the sexual relationship of the couple, it is important that a woman's partner understand what the condition is and how it affects her, both physically and psychologically. Women should be honest and open with their partners about what they are experiencing. Counseling with a sexual therapist is often helpful for couples dealing with vulvodynia. Sexual therapists can help women and their partners confront difficult issues that arise when sexual dysfunction is present in a relationship due to illness and help the couple explore alternate avenues of expressing their love and affection. |
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