Vulvodynia – symptoms and diagnosis. Treatment of vulvodynia

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Vulvodynia is a disease of women, which until recently was considered a phenomenon “in the head”. Currently, doctors are convinced that vulvodynia is a real disease. It is characterized by pain in the genital area that is unrelated to infections or any other disease that may explain the symptoms.

Do you suffer from vulvodynia?

Vulvodynia is a female condition characterized by the pain of the vulva, which makes it difficult to have sexual intercourse as well as to sit or exercise. So if you are experiencing chronic pain in your genital area and it is not due to an infection or other disease that might explain the symptoms, you may have vulvodynia. The severity of its individual symptoms is a very individual matter. There may be a burning sensation, a feeling of pain around the vaginal opening or the perineum itself. The greatest severity of the disease is observed in women between 18 and 25 years of age. Women are very often ashamed of this ailment, so they often do not have the courage to see a doctor. Unfortunately, vulvodynia is not tested in Poland, so it is very rarely diagnosed.

Vulvodynia is usually divided into two types:

1. vulvodynia proper (Generalized / dysesthetic Vulvodynia), pain is caused by contact, e.g. by penetration during sex, when inserting a tampon or during a gynecological examination,
2. vestibulodynia (also called Vulvar Vestibulitis Syndrome, Polish sometimes translated as vestibular inflammation syndrome). Pain occurs by itself.

Some women suffer from both vulvodynia and vestibulodynia.

Vulvodynia – causes of formation

The causes of vulvodynia remain unclear. The results of the latest research prove that they can be among them genetic factors, damage or too high density of nerve endings within the genital tractwhich leads to skin hypersensitivity. The only thing that is certain is that it is not a sexually transmitted disease. It does not lead to death, but it significantly worsens the quality of life – in terms of satisfaction derived from sex life.

Important! Not so long ago, it was believed that the ailments of vulvodynia had a psychological background. However, a number of scientific studies prove that this disease is a real problem.

If you experience pain during intercourse and it is located in the lower abdomen, it is most likely not vulvodynia. The pain may then have other causes, such as an infection of the reproductive organs or the urinary tract.

Vulvodynia – diagnostics

A doctor can diagnose vulvodynia only after excluding other causes of pain – infectious, hormonal, systemic diseases, cancer and precancerous conditions. The doctor collects detailed information on the history of the disease, its symptoms, patient hygiene, sexual activity and medications taken. The next step is to examine the vulva and vaginal discharge to rule out other infections. It is also important to exclude vaginal damage due to sexual abuse. Diagnosis (vulvodynia proper and vestibulodynia) is very often made difficult by the fact that patients suffering from it often also suffer from secondary infections of the vagina (fungal and / or bacterial) and / or urinary tract.

When diagnosing vulvodynia, specialists use the “Friedrich criteria”. Based on these criteria, the disease is diagnosed when:

1. a woman feels very strong pain when touching the vestibule or inserting something inside the vagina,
2. the patient is hypersensitive during the «Q-tip test», which consists in gently touching the sore vaginal vestibule with a cotton swab,
3. in a woman in the vestibule of the vagina, redness of varying intensity is observed without any other visible lesions.

In order for the diagnosis to be confirmed, the symptoms mentioned above should last for at least six months, and their intensity of pain and sensitivity of the vaginal vestibule is moderate to very severe. The most important thing in diagnosis is the pain experienced by a woman.

Diagnosing vulvodynia proper

It is very important to ask the patient if her pain is related to an event (disease, surgery in the back, abdomen, vagina), childbirth, sports injury, arthritis, scoliosis, disc prolapse or hip dislocation. The profession that a woman performs, e.g. that requires long-term sitting, is also important. In turn, the above-mentioned test allows to determine whether a woman suffers from vestibulodynia at the same time.

Women often wait a long time until the correct diagnosis is made. They are treated during this time for fungal or bacterial infections that don’t really exist. According to some vulvodynia specialists, topical treatment can irritate sore tissues and worsen symptoms.

It should be emphasized that in women suffering from vulvodynia, unbearable pain often causes changes in the pelvic floor muscles that are tense all the time. In addition, there are situations in which women have less control over whether they tighten or relax their muscles. In such cases, cooperation with an experienced physiotherapist is of great importance.

Vulvodynia is still a rarely noticed problem, which makes treatment more difficult and increases the feeling of isolation and suffering of affected women. According to a study conducted some time ago under the supervision of Dr. Bernard Harlow from Harvard University, it shows that up to 13 million women in the United States may suffer from vulvodynia in their lifetime. Other studies show that vulvodynia affects between 3 and 16 percent in the United States. women (such studies have not yet been carried out in Poland).

Vulvodynia – pre-medical aid

Skin hygiene above all! You should refrain from using fragrant soaps, shower gels and any perfumed cosmetics. No more bath tubs! You should also not wash your hair in the shower, as the foam flowing down the body may irritate sore intimate places. Intimate hygiene gel should only be purchased at a pharmacy.

In slightly less serious cases, they may be helpful creams, gels and ointments for local anesthesia. In order to get rid of the discomfort, they can be used either immediately before or immediately after intercourse.

Wearing should be avoided tight underwear (cotton underwear is the best) or tight-fitting pants.

It is very important not to get involved in activities that make your pain worse. So if you experience ailments, for example, while riding a bike, try another sport. If pain occurs during intercourse, temporarily give up intercourse – until the discomfort has lessened or has completely disappeared.

Vulvodynia – treatment

Given the fact that the causes of vulvodynia are not fully understood, there is no completely effective cure. In the treatment of this disease, patience is most important, as it often takes a long time to make a diagnosis. Often times, doctors prescribe various medications to women in the hope that they will help alleviate symptoms and at least eliminate them to some extent. Also, the effectiveness of treatment is a very individual matter.

Before treatment is started, all factors that irritate the vulva must be eliminated. This includes, but is not limited to, perfumed cosmetics, creams and soaps, and other chemicals (see above).

The treatments for vulvodynia that are currently used around the world include:

1. physiotherapy and biofeedback – used to restore the proper functioning of the pelvic floor muscles,
2. local anesthetics,
3. topical creams,
4. nerve blocks
5. antiepileptic preparations, e.g. neurontin,
6. antidepressants (tricyclic) – they work well in the treatment of chronic pain,
7. Interferon injections
8. an appropriate diet consisting mainly of limiting the consumption of oxalate (the so-called low oxalate diet),
9. psychological help – a woman receives support, thanks to which she can cope better with both emotional and sexual problems resulting from the disease,
10. surgical treatment – performed only in women with vestibulodynia (shallow excision of the vaginal vestibule mucosa).

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