Vulvodynia

Vulvodynia is a puzzling syndrome in which women feel chronic pain in the vulva, which consists of the external genitals (including the clitoris, the pubic mound, and the labia). Women with the condition describe the pain as a burning, itching, rawness, or stinging, particularly during urination. This vulvar discomfort ranges from annoying to unbearable, and can be continuous or set off by touch. Some women with severe forms of the ailment hurt even while walking or sitting. Because the pain is so excruciating, they may be unable to have intercourse or even wear tight pants or stockings.

Experts say that vulvodynia, which literally means “vulvar pain,” is more common than people think. A survey of nearly 1,000 women reported in the Journal of Lower Genital Tract Disease found that 28 percent of those questioned suffered from the disorder in the past 6 months. Vulvodynia is a chronic condition that affects girls and women of all ages. It may last months or years but can disappear suddenly for no apparent reason.

Are there related conditions?

Yes. One of the best-known is vestibulitis, which may affect more than one in 10 women receiving primary care, reports the National Institutes of Health. This condition usually shows up as a reddened patch of skin at the opening to the vagina and can cause the inner labia, the folds around the vaginal opening, to become red, inflamed, and extremely sensitive to even the slightest touch. As one sufferer put it, “All the torment was radiating from an area the size of a quarter.” A woman with vestibulitis feels pain whenever something touches her vaginal opening or is inserted into her vagina (as when she tries to have sex or put in a tampon). Sometimes there’s a stabbing pain that extends from the clitoris to the skin around the rectum and anus.

Some women who suffer from vulvodynia — particularly those who are postmenopausal — have no visible signs of it, such as inflammation, swelling, or irritated patchy skin. But the typical symptoms include burning, redness, rawness, or itching of the vulva. Sometimes these are accompanied by spasms in the pelvis and pain in the groin, thighs, or lower back. Pain during sexual intercourse or during the insertion of a tampon is also common. And because some women experience chronic, intense pain that forces them to put their sex lives on hold and to cut out many other activities, vulvodynia can understandably lead to depression.

No one really knows. It’s not a sexually transmitted disease. Researchers think it may result from irritations caused by laundry detergent, soap, scented toilet paper, douching, feminine hygiene spray, or scented tampons or sanitary napkins. Some medications, such as antifungal preparations used for yeast infections, have allegedly caused vulvar pain as well. Still other cases appear to have been caused by skin-tight jeans worn daily for long stretches of time.

These sorts of causes, researchers say, may be especially common in cases of vestibulitis. The tissue at the vagina’s opening is especially well-furnished with nerves, and for reasons that aren’t understood, a short-term irritation — from soap, scented tampons, or childbirth — can make these nerves hypersensitive, according to the Center for Vulvovaginal Disorders in Washington, DC. The nerves may then overreact, sounding an alarm whenever the tissue is so much as touched.

Infections or allergies may be culprits, too. Many women with vulvodynia have also been plagued by recurrent yeast or herpes simplex infections, or have had genital warts or the painful bladder condition known as interstitial cystitis. Much research is in progress looking at vulvodynia as an immunological problem similar to lupus and rheumatoid arthritis. Other research focuses on the possibility of a viral-induced neuropathy, i.e., irritation of nerve roots by various undiagnosed viruses.

Some studies point to another cause: damage to the nerves, perhaps stemming from childbirth and surgery, connected to the vulva. Still others indicate a link between vulvodynia and foods high in oxalate acid (the list includes tea, chocolate, and most fruits and vegetables), but those findings aren’t conclusive.

There are no specific tests for vulvodynia. If you have any of the chronic symptoms described above, see a doctor who’s familiar with the condition. After ruling out other, more serious infections and thoroughly investigating your medical history, the doctor will examine you for redness, swelling, pain, and other problems associated with vulvodynia. He or she may also try the Q-tip test: if the patch of skin at the entrance to your vagina hurts when lightly touched with a cotton swab, you may have vestibulitis. Your doctor may also order vaginal cultures to rule out other infections or skin disorders, and may also recommend a colposcopy, a test in which the vulva is examined more closely.

How can I reduce the pain?

If you can tolerate underwear, wear all-cotton underpants and put them through an extra rinse to minimize a detergent residue. Use nothing but mild, unscented soap, and if that causes discomfort, wash with water alone. While you’re in the bathroom, you may want to spray your vulva with water occasionally to relieve the burning. Avoid douches, feminine hygiene sprays, and tampons, and use only cotton sanitary napkins. Buy white, unbleached toilet paper. And drink a lot of water; some studies suggest that relieves burning during urination.

Because the causes of vulvodynia are unclear, a doctor who’s familiar with the disorder may try a combination of remedies. The Vulvar Pain Foundation says that according to its members, the most effective treatments are estrogen creams and a diet low in oxalic acid.

Other treatments have been tried, with varying degrees of success. Since vulvodynia can cause chronic, debilitating pain, some doctors prescribe antidepressants for it, as they do for comparable pain disorders. If the nerves are irritated, antidepressants can lessen the intensity of the pain. Xylocaine, a mild numbing spray, has reportedly eased the condition’s symptoms in some women, but it can cause skin problems if used frequently. Some doctors recommend a local nerve block for the specific area of pain. This may significantly reduce the discomfort, and depending on the anesthetic agent used, may offer relatively long pain-free intervals.

Physical therapy and biofeedback have come up with promising results. Howard Glazer, a psychologist at Cornell University Medical College, believes that the vaginal muscles of some women with vestibulitis are in continuous spasm, which can result in inflammation caused by the release of histamine. To teach the muscles in the pelvic area to relax, he has his patients do modified Kegel exercises twice a day. Each woman contracts and releases their vaginal muscles while a sensor tells her the strength of the contraction. After nine months to a year of this biofeedback therapy, about 80 percent of Glazer’s patients have been able to resume their sex lives.

Massage can help relieve pain. Ultrasound combined with trigger-point pressure can release painful knots in muscles that are causing pain in the vulva. Topically applied estrogen creams have provided relief to some women.After recovery, some women may want to see a psychologist or sex counselor in order to feel comfortable with sex again.

“Vulvodynia,” MayoClinic,

Glazer HI. Dysesthetic vulvodynia. Long-term follow-up after treatment with surface electromyography-assisted pelvic floor muscle rehabilitation. J Reprod Med 2000 Oct;45(10):798-802

Sadownik LA. Clinical profile of vulvodynia patients. A prospective study of 300 patients. J Reprod Med 2000 Aug;45(8):679-84

Chronic Vulvar Pain May Be a Highly Prevalent Disorder. National Vulvodynia Association.

Reed, BD et al. Pain at the Vulvar Vestibule: A Web-Based Survey. Journal of Lower Genital Tract Disease. 8(1)