Vulvodynia

The vulva is the external part of the female genitalia. The outer and inner lips of the vulva are called the labia majora and labia minora. The vestibule surrounds the opening of the vagina and the urethra. The openings to the Skene’s and Bartholin’s glands are located within the vestibule. The perineum is the area between the bottom of the vulva and the anus.

Vulvodynia is defined as chronic vulvar discomfort or pain for which no cause can be identified. The symptoms include vulval burning, stinging, irritation or rawness. Burning sensations are the most common, but the type and severity of symptoms are highly individualized. Pain may be constant or intermittent, localized or diffuse.

Vulvodynia has been classified into the following subtypes:

Generalized (or dysesthetic) Vulvodynia
Generalized Vulvodynia symptoms may be diffuse or in different areas at different times. Pain may be present in the labia majora, labia minora, and/or the vestibule. Some women experience pain in the clitoris, mons pubis, perineum and/or the inner thighs. The pain may be constant or intermittent. Symptoms are not necessarily caused by touch or pressure to the vulva, i.e., with intercourse, insertion of tampons or bicycle riding. However, these activities often exacerbate the symptoms. Women may complain that symptoms are even triggered by clothing rubbing, even gently, against the skin of the vulva.

Vulvar Vestibulitis Syndrome
Women with VVS have pain only in the vestibule, and only during or after touch or pressure is applied. Burning sensations are the most common symptom and may be experienced with some or all of the following: sexual intercourse, tampon insertion, gynaecologic examination, bicycle riding, and wearing tight pants.

There are many dermatologic conditions that may cause pain in the vulva. The most common include: allergic or contact dermatitis, lichen sclerosus, lichen simplex chronicus and lichen planus. These conditions may cause symptoms of itching and burning. Scratching the vulva and overusing topical medications may inflame the tissue, causing swelling and additional pain. Vulvodynia, as with most chronic pain conditions, can have a profound impact on a woman’s quality of life. It typically affects her ability to engage in sexual activity and may interfere with daily functioning, e.g., sitting at a desk, engaging in physical exercise, and participating in social activities. These limitations can negatively affect self-image and lead to depression.

Many women may suffer from vulvodynia for years before an accurate diagnosis is made. Very often it is presumed that thrush is the cause of symptoms.

To diagnose Vulvodynia, your doctor will carefully review your medical history. You will be asked questions about your symptoms, sexual activity, diet, feminine hygiene, previous medical problems and medication use. Your doctor will also carefully examine the vulva, vagina and any vaginal secretions for other causes of your pain such as infections and skin disorders. Occasionally doctors will  perform routine vaginal cultures to ensure that an infection is not causing or worsening any irritation or burning.

A "q-tip test" may be used during your exam. During this test, different areas of the vulva and vestibule are touched with a Q-tip to determine the location and severity of your pain. With vulvodynia even the slightest touch of a soft “q-tip” can trigger extreme pain and tenderness. If your doctor sees areas of skin that look suspicious during your exam, a biopsy of the skin may be required. Additionally, he/she may look more closely through a magnifying glass at any abnormal lesions in the vulva or may recommend a colposcopy, a test in which an instrument is used to look at the vulva more closely.

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 each woman’s symptoms are unique; no single treatment works all the time or is appropriate for every patient. Some women respond very well to a particular treatment, while others respond poorly or experience unacceptable side effects. It takes time to find a treatment or combination of treatments that will decrease or alleviate your pain.

Advice offered to women with vulvodynia include discontinuing all topical medications, soaps, douches etc that may contribute to irritation..

Some of the current treatments include:

For further information: www.nva.org