Vulvodynia is the most frequent reason for consultation in consultations specializing in vulvar pathology. This corresponds to chronic vulvar pain, which has persisted for more than 3 months, without visible lesions and without clinically identifiable neurological disease.

The pain, although present, can have important repercussions on the daily quality of life of women who suffer from it, and more particularly during sexual intercourse. Vulvodynia is not, however, an “incurable” disease. The pain can go away spontaneously, or through the implementation of appropriate medical support.

The term vulvodynia is literally defined as “pain in the vulva”. Indeed, vulvodynia corresponds to a chronic pain, which persists for more than 3 months, without visible lesion and without clinically identifiable neurological disease. The pain is daily, with “ups and downs”, and can exist for many months or years before it is taken care of. Remissions, when they occur, do not exceed a few weeks.

During this persistent painful condition, tension or abnormalities in the control of the muscles surrounding the vulva are often present. 

Women with vulvodynia suffer from other pain more often than other women with no identifiable cause: 

• frequent urges to urinate;
• lower abdomen pain;
• fibromyalgia (diffuse joint and muscle pain);
• irritable bowel syndrome;
• etc.

Vulvodynia results from a dysfunction of the pain modulation system. In normal times, pain is a warning signal to warn of the occurrence of tissue damage. In the case of vulvodynia, the brain receives the “pain” information in the absence of any tissue damage and the pain blocking mechanisms are then failing.

The pain may affect the entire vulva, including the labia majora, or only part of it, such as the vestibule which is the entrance to the vagina. In this case, we speak of vestibulodynia.

Most often, the pain experienced is characterized by an intense, particularly debilitating burning, sometimes associated with vulvar discomfort in the form of discomfort, irritation, a feeling of tingling, tightness, pinching or dryness. The urge to scratch is usually absent.

The pain of vulvodynia can be spontaneous, that is to say, occur in the absence of any local contact or caused by contact (sexual intercourse, tight clothing, tampon, sitting position, hygiene products, topical medications, gynecological examinations, cycling, horse riding, etc.). Pain can also lead to avoidance of sex and loss of sexual desire.

Support involves:

• recognition by the attending physician of patient complaints related to vulvodynia. Indeed, a clear explanation of the pathology and an empathy allow reassurance, which is essential;
• taking into account the different components and repercussions of this condition.

The first step is to eliminate any allergic factor, and to ensure that the mucous membrane is properly hydrated, especially after menopause, which can be ensured through the use of lubricants (Sensilube®, Saugella gel®, KY jelly®) at the time of sexual intercourse, local estrogen, or even moisturizers. Sitz baths in water as well as topical emollients (petroleum jelly, cold cream, cerate, sweet almond oils, etc.) or “healing” (Jonctum®, Cicalfate®) can have a soothing effect. A local anesthetic, such as lidocaine gel or nebulizer, especially during intercourse, or oral pain relievers may be useful.

Depending on the importance of the psychological impact of the pain, antidepressant treatment can be initiated, either with amitriptyline or with nortriptyline.

Perineal rehabilitation sessions by a physiotherapist, knowing this pathology, may be indicated. These consist of massages of the perineal muscles and biofeedback exercises to reduce the tension of the perineal muscles, a factor in the maintenance of pain.

The emotional part of the pain must also be taken into account, for example by a psycho-body approach via the use of hypnosis, relaxation, or even meditation. It can also be taken into account by cognitive-behavioral psychotherapy taking into account the interactions between thoughts, emotions and behaviors. The primary objective of psychotherapy is not to make vulvar pain disappear but to alleviate the psychological suffering which constitutes a factor of maintenance, and sometimes even the cause of vulvodynia.

Finally, consultations with a sex therapist can complete the care. Vulvodynias are sometimes part of a context of marital difficulties independent of the vulvar problem and its sexual consequences. In this case, couples therapy can be helpful.