Overview

Vulvodynia (“vul-vo-din-ee-a”) is chronicpain or discomfort of the female genitals (the space close the surface of the vagina) that lasts for 3 months or longer with none proof of different skin or gynecological causes. Vulvodynia is sometimes characterised by burning, stinging, irritation or rawness of the world. The most common complaint is a burning sensation.

Vulva Anatomy

Labia—the folds just outside the vaginal opening

Vestibule—the portion of skin at the duct gap that contains the gap of the duct, channel and lubricating glands

Perineum—the area between the vaginal opening and the anus

Some women experience discomfort of the entire vulva area (generalized pain). Others have localized pain, that affects a selected a part of the female genitals, such as the vestibule or clitoris. Symptoms may be constant or come and go. The pain may be provoked by sexual and/or nonsexual contact (e.g., inserting a tampon, during a pelvic exam, wearing tight-fitting pants), unprovoked (spontaneous), or mixed (provoked and unprovoked).

The two types of vulvodynia are:

Generalized vulvodynia—refers to generalized, unprovoked vulvar pain.

Vulvar vestibulitis—is characterized by pain experienced when pressure is applied to the area surrounding the vaginal opening. In this case, the repeated fanny pain is also triggered by sexuality, tampon insertion or gynecological exams, or when wearing tight-fitting pants or even when sitting

It is estimated that up to 16 percent of women—roughly 13 million—will suffer with chronic vulvar pain at some point in their lives. Still, vulvodynia remains poorly understood and is usually misdiagnosed.

Many women suffer with unexplained fanny pain for months—even years—before an accurate diagnosing is formed associated an acceptable treatment set up is set. A Harvard study funded by the National Institutes of Health found that sixty % of girls that suffer from the condition consult a minimum of 3 health care professionals in seeking a diagnosis, and 40 percent of those still remained undiagnosed. The study emphasizes however vital it’s for ladies to be persistent in seeking associate correct diagnosing so that they will receive acceptable treatment.

While vulvodynia affects ladies of all age teams, the onset of symptoms is most common among women between the ages of 18 and 25. This risk drops considerably in those thirty five years and older. Although vulvodynia was once thought to have an effect on principally Caucasian ladies, recent studies have shown that Hispanic and African yankee ladies ar equally possible to develop the condition.

Causes and Risk Factors

There is no straightforward answer to the question, “What causes vulvodynia?” We do know that it is not caused by infection, the human papillomavirus (HPV) or other sexually transmitted diseases, cancer or neurologic disorders. It can only be diagnosed after other causes of vulvar pain, such as yeast infections, have been ruled out.

Early difficulty or pain when using tampons appears to predict those at high risk for future vulvodynia.

Research shows the following may contribute to vulvodynia:

pelvic nerve damage or irritation

spasms or weakness of the muscles that support the pelvic organs

abnormal response of cells in the vulva to environmental factors, such as infection or injury

allergies to certain detergents or soaps

altered hormone receptor expression in the vulvar tissue

receptor expression in the vulvar tissue genetic factors, including susceptibility to inflammation

recurrent yeast infections

previous laser treatments or surgery external to the vagina

Impact on Quality of Life

Vulvodynia will cause important physical, sexual and psychological distress. Women who are suffering with vulvodynia report difficulties exercise, being intimate and taking part in other daily activities. Even sitting for long periods of your time will trigger female genitalia pain episodes in some ladies.

According to an NIH-funded study done at Robert Wood Johnson Medical School and reported by the National Vulvodynia Association:

Seventy-five percent of women with vulvodynia feel “out of control” of their bodies.

Sixty percent say the condition interferes with their enjoyment of life.

Almost two out of three (60 percent) cannot have sexual intercourse because of the pain. The sheer anticipation of female genitalia pain will heighten anxiety and lead many ladies to avoid sexual issues. Refraining from sex not only affects a woman’s self-image, but it may also result in spasms of the muscles around the vagina (vaginismus), making it even more difficult to be intimate with her partner.

In addition, some women with vulvodynia may be burdened by other health problems, including interstitial cystitis, fibromyalgia, irritable bowel syndrome, chronic fatiguesyndrome, temporomandibular joint and muscle disorders and endometriosis.

Lack of awareness about this condition, coupled with the stigma frequently associated with genital disorders, makes diagnosis and treatment more challenging. As a result, many ladies area unit left not knowing why they need such severe, typically enfeebling female genitalia pain, which might strain a couple’s relationship. Some women report being told the pain is “all in your head” by health care providers, who are often unaware that vulvodynia is a common medical problem in women with long-term vulvar pain.

If untreated, chronic pain can lead to:

low self-esteem

anxiety

depression

reduced quality of life

And the severity of the pain can worsen when women with this condition are stressed, depressed or anxious.

Diagnosis

Vulvodynia is poorly understood and, as with many pain conditions, it can be difficult to diagnose. Vulvodynia is diagnosed once alternative causes of female genitals pain, such as infections, skin problems or neurologic disorders, are evaluated and ruled out.

Women with vulvodynia typically report having one or a lot of of the subsequent symptoms within the female genitals area:

burning (most common symptom)

stinging

rawness

aching

throbbing

stabbing

soreness

To make a diagnosing, your health care professional will begin by reviewing your medical history. He or she’s going to raise you specific questions about your symptoms, treatments you may have already tried, your menstrual cycle, feminine hygiene, sexual history, previous medical problems or surgeries, as well as any medications you use (including over-the-counter medicines). You should also discuss any difficulties you have using tampons or having sexual intercourse. Your health care supplier can then do a girdle examination and thoroughly examine your female genitalia. He or she may order blood tests and/or take a sample of discharge from your vagina to check for yeast or other infections that could be causing your symptoms.

A cotton swab check is usually wont to map female genitals pain. For this analysis, your doctor will use a moist, cotton-tipped swab to place pressure on various parts of the vulva to identify the location and intensity of your pain. You will be asked to rate the extent of the pain at each site; for example, how would you describe the pain on a scale of 0 to 10 (no pain to extreme pain)? Your health care skilled might use a diagram to visually note wherever you’re feeling discomfort, as well as the degree and nature of the pain, such as burning, throbbing or stabbing.

Your doctor may use a large magnifying instrument (called a colposcope) to take a closer look at the vulvar skin. While there may be redness and inflammation, vulvar skin usually appears normal despite the occurrence of pain.

Describing Your Pain

Describing Your Pain

Be sure to clearly describe your pain, including its:

onset (When did the pain begin, and did it start gradually or all of a sudden?)

location (Where do you feel pain? Is it isolated to a certain part of the vulva?)

frequency/duration (When do you feel pain? Is it constant or will it come back and go? How long have you had vulvar pain?)

nature/type (Is it aching, burning, stabbing?)

severity (On a scale of 0 to 10, 10 being the worst pain you can imagine, how bad has your pain been?)

Explain however chronic female genitals pain impacts your standard of living. Are there certain activities you avoid, such as exercise, use of tampons or sex? You may want to keep a pain diary with detailed information about your pain—when it occurs and for how long, things that make it better or worse and any other symptoms. This can provide important clues and will help your health care professional make a diagnosis.

Treatment

There are treatments available to provide symptom relief. These might embody a mixture of recommendation on female genitals skin care, oral and/or topical medications, physical therapy and biofeedback training, dietary modifications, counseling and, in some cases, surgery. Adjunct therapies, such as acupuncture, massage therapy and cognitive behavioral therapy, are also being explored.

The main goals of treatment are to manage your pain, improve your quality of life (e.g., restore a healthy sex life and reduce anxiety), and prevent the recurrence of symptoms. The chronic nature and quality of vulvodynia typically need multiple treatment methods. Finding the right treatment or combination of therapies may take some time, especially because each woman’s symptoms and response to treatment are different. Your health care provider will recommend a treatment approach based on your condition(s), level of pain and preferences.

Available Treatment Options

The following section provides a snapshot of available treatments that have been beneficial in reducing pain symptoms (listed in no particular order):

Medications. Oral and/or topical medications, including topical anesthetics (lidocaine ointment), opioid pain killers (for temporary relief), estrogen, anticonvulsants, certain types of antidepressants and nerve blocks, may be prescribed for chronic pain.

Topical anesthetic ointments provide quick pain relief and comfort and may be used overnight or applied 15 to 30 minutes before sexual activity. Low doses of antidepressant drug antidepressants is also suggested to treat vulvodynia thanks to their pain-blocking properties, particularly amitriptyline (Elavil), desipramine (Norpramin) and nortriptyline (Pamelor). For many women, the tricyclic antidepressants are the initial treatment prescribed. Gabapentin and pregabalin are often considered as additional agents. A newer category of antidepressants, known as SSNRIs (Effexor, Cymbalta), have also demonstrated benefit with fewer side effects for some women than the tricyclic antidepressants. Like the older tricyclic class of antidepressants, these medications can also help relieve symptoms of depression.

Ask your health care skilled regarding varied medications and their common facet effects. When using certain medications, keep in mind it can take up to six to eight weeks for symptoms to improve, and that you will not necessarily achieve complete relief.

Basic vulvar care. Some common suggestions for vulvar care include:

wearing cotton-only underwear

avoiding tight-fitting pants and pantyhose

using unscented cotton pads and tampons

keeping harsh soaps and shampoos away from the vulva area and not using douches

applying plain petroleum (Vaseline) after cleansing to hold moisture in the skin

using plenty of water-soluble lubrication during sexual intercourse

patting the area dry after rinsing and urination

Diet Modifications. Talk with your provider about the pros and cons of eliminating certain types of foods from your diet, such as those high in oxalates or sugar. To test for food sensitivity and to determine which foods, if any, are affecting you, eliminate one food or food group at a time. Use a food diary to record your results—you might begin to notice an association between your symptoms and certain foods you wouldn’t have otherwise suspected.

Biofeedback trainingBiofeedback, which helps you enter a relaxed state to reduce pain, can help decrease vulvar pain by teaching you how to control specific body responses. To help cope with vulvodynia, you can use biofeedback to relax your pelvic muscles, which may contract in anticipation of pain, thus causing chronic pain. Try to notice a training program specialist with expertise treating vulvodynia

Physical therapy Some women may have associated spasms or weakness of the pelvic floor muscles. To determine what may be causing your vulvar pain, a physical therapist may evaluate your pelvic floor muscles, joints and nerves in the pelvic area. Treatments may include exercises, education, biofeedback and manual therapies, such as massage. Ultrasound, hot/cold and electrical stimulation may also provide some relief. Finding a physical therapist with experience treating vulvar pain will be helpful.

Relaxation and breathing techniques. Learning to acknowledge once you ar tensing your girdle floor muscles because of stress then learning specific relaxation techniques to scale back stress and anxiety will facilitate alleviate pain.

Counseling. Vulvodynia will limit daily activities and diminish quality of life. It is not uncommon for women who suffer with chronic vulvar pain to experience depression and feelings of low self-worth. Some women find that psychological counseling helps them develop coping strategies and deal with sexual intimacy issues; for many, it is a valuable part of their overall treatment plans.

Neurostimulation and Spinal Infusion Pump. If alternative treatment forms haven’t helped and your pain is severe, your health care professional may have you consult with a professional skilled in neurostimulation or in the use of a spinal infusion pump. With neurostimulation, an electronic device delivers low-voltage electrical stimulation to a targeted nerve or the spinal cord in an attempt to substitute a tingling sensation for pain. A spinal infusion pump is an implanted device that constantly administers a small dose of medication to the spinal cord and nerve roots to help dull pain.

Surgery. girls with severe vulvodynia localized within the vestibule UN agency have didn’t notice relief with alternative remedies, may consider vestibulectomy, a surgical procedure that removes the painful tissue of the vulvar vestibule. This surgery is sometimes reserved just for girls with female genitals vestibulitis UN agency haven’t more matured additional conservative therapies and perceive that, despite the surgery, the pain might not resolve subsequently.

Prevention

Because we don’t know what causes vulvar pain, we really don’t know how to prevent it. But there are some things you can do to help minimize your pain. As always, talk with your health care provider about what’s best for you. Check your environment and follow basic vulvar skin care. Check your surroundings and follow basic vulval skin care. If your vulvar pain symptoms come and go, think about what that area is exposed to. Do you use a lubricant during intercourse? Have you switched laundry detergents? Are symptoms worse when you wear a certain kind of underwear or use a certain brand of sanitary pad? Try changing one thing at a time and see if it helps. Don’t miss your annual exam. Routine girdle exams—once a year for ladies age eighteen and older—are vital to make sure early intervention for issues, including chronic pelvic and vulvar pain. Annual gynecologic appointments may include breast exams, Pap tests and other important preventive screenings, such as cholesterol screening and thyroid tests. These visits give you the opportunity to discuss any gynecological concerns or symptoms with your provider. If you experience vulvar pain, don’t wait. Make an appointment to discuss your symptoms with your health care professional. Diet. There is some evidence that vulvar pain, though not necessarily vulvodynia, is associated with oxalates and other highly acidic foods, such as soda, wine, energy drinks, juice, tart candies, citrus fruits and foods containing vinegar, and foods high in sugar, such as candy, cakes, cookies, pies, ice cream and sugary drinks. Avoiding these foods may help improve your symptoms.

Facts to Know

Because we do not grasp what causes female genital organ pain, we actually do not know a way to stop it. however there area unit some belongings you will do to assist minimize your pain. As always, speak along with your health care supplier concerning what is best for you. Women that suffer with vulvodynia report burning, stinging, irritation and rawness within the space. For some, this pain affects the complete female genital organ, for others it’s localized to 1 space. Pain is also constant or episodic, typically once triggered by tampon insertion, gender or exercise, particularly cycling. One study found that roughly 3 out of 5 ladies consulted 3 or additional doctors in seeking Associate in Nursing correct designation. It is calculable that up to sixteen % of women—roughly thirteen million—will suffer with chronic female genital organ pain at some purpose in their lives There is no renowned explanation for vulvodynia. However, we have a tendency to do comprehend it isn’t caused by an energetic infection, as well as sexually transmitted diseases; skin disorders; cancer; or neurological or psychological disorders. Diagnosis typically includes a cotton swab take a look at within which the doctor places pressure on completely different elements of the female genital organ space to find the pain and its relative intensity. As with different chronic pain conditions, the unrelenting nature of vulvodynia, its negative impact on a woman’s quality of life and talent to perform daily activities and therefore the challenges encountered in its designation and treatment, could cause depression, anxiety, fatigue and low self-image, particularly associated with a woman’s gender. The goal of treatment is to manage pain, restore traditional activities, improve quality of life and stop return of symptoms. Treatment could embody a mix of recommendation on female genital organ tissue care, oral and/or topical medications, nerve blocks, physiotherapy, training program, dietary modifications, content and, in some cases, surgery. several therapies suggested to market general health can also be suggested with ancient medical approaches for individuals in chronic pain. These therapies embody stylostixis, massage medical aid, relaxation techniques, training program and psychological feature behavioural medical aid. The aim of current analysis is to see the causes of vulvodynia and to seek out more practical ways in which to spot and treat chronic female genital organ pain.

Key Q&A