After seeing different doctors in a desperate attempt to find out what is wrong, some women may be thinking that everything is in their heads but this is not the case.
For centuries, undiagnosed pain in the area of the vulva was considered by doctors as a psycho-sexual problem, and women were sent to sex therapists. Modern research tells us that pain is real. It is important to find a doctor who is aware of the conditions of the vulva.
What causes vulvodynia?
The exact cause of vulvodynia is unknown. Research has found that one of any of the following causes could contribute to vulvodynia :
- Chronic yeast infections
- Spasm of the pelvic floor muscles.
- Irritation of the nerves of the skin.
- Genetic predisposition
Types of Vulvodynia
There are several different types of pain conditions that affect the vulva. Two of the most common are the vulvar burning syndrome (dysesthetic vulvodynia) and vulvar vestibulodynia.
Vulvar burning syndrome or dysesthesic vulvodynia
It is more common in perimenopausal or postmenopausal women. Women suffer from constant discomfort, usually a burning sensation, which is felt all over the vulva area and may be accompanied by the urethra or rectal pain.
Vestibulodynia Vulvar (Formerly known as vulvar vestibulitis syndrome)
This causes a pain in the vestibule, the opening of the vagina that can only be seen when the lips part. This pain is usually associated with pressure that makes it uncomfortable to wear tight clothes, sit or ride a bike. It can be painful or impossible to have sex, and even the insertion of tampons can cause severe pain. Women may also experience a burning sensation, stinging, flushing, or a frequent or urgent need to urinate, which can further irritate the vulva.
How is it diagnosed?
The diagnosis of vulvodynia involves the elimination of all other possible causes of pain. Unfortunately, not all doctors are familiar with this condition and you may need to see more than one doctor before getting an accurate diagnosis.
The doctor will take the medical history and focus on your pain complaint. He will ask you to describe the pain, where it is, and if it radiates. He will ask you if something makes the pain improve or worsen. It may be helpful to keep a pain journal in the days leading up to your appointment so that you can answer these questions accurately.
A pelvic exam will be performed during which your doctor will examine your vulva and vagina, locating the visible signs of infection or skin disease. Then, he will touch different areas of the vulva with a cotton swab to try to determine which areas are painful. If there are obvious changes in the appearance of the skin of the vulva, the doctor may recommend taking a sample of tissue for a skin biopsy. If you have a biopsy, you will be given anesthesia to numb the skin. The doctor will cut a small piece of affected skin (4-5 mm). The whole process should be only slightly uncomfortable.
Treatments for vulvodynia
Topical medications such as xylocaine or estrogen cream can be rubbed over the area that is causing the pain. Oral medications such as antidepressants or anticonvulsants are useful for the reduction of chronic pain. Pelvic floor physiotherapy and biofeedback involve exercises that can help control and relieve pain. Physical therapy reduces the increase in tension in the pelvic floor muscles, and relieves muscle spasms associated with any pain.
Surgery may be useful for women with vestibulodynia (this is a type of vulvodynia), which removes the skin at the entrance of the vagina. Dealing with chronic pain can be difficult. Women often feel embarrassed, frustrated and depressed. Depression can make the pain feel worse and often lose interest in sex having difficulty becoming aroused. It is important for women to be open and honest with their partners about the pain they are experiencing. Sex should be a pleasant activity, not painful.