Vulvodynia (pronounced vuhl-voe-DIN-ee-yuh)
is chronic pain or discomfort of the vulva. Researchers and health care
providers currently know very little about why and how vulvodynia
occurs-the condition and the pain have no known cause or cure. Although
therapies can help relieve symptoms of vulvodynia, the condition can
have potentially serious consequences for women's reproductive health
and day-to-day life. Understanding vulvodynia is an important part of
the NICHD's mission to improve women's quality of life.
Vulvodynia is a term used to describe chronic pain or discomfort of the vulva. The vulva refers to the external female genitalia, including the labia ("lips" or folds of skin at the opening of the vagina), the clitoris, and the vaginal opening. Vulvodynia is usually described as burning, stinging, irritation, or rawness.
Sometimes, vulvodynia is described with more specific terms.
The main symptom of vulvodynia is pain. The type of pain can be different for each woman.
Vulvodynia can cause burning, stinging, irritation, or rawness of the vulva. Some women may also have itching, aching, soreness, throbbing, or swelling. These symptoms may be caused by pressure on the vulvar area, such as during sex or when inserting a tampon. Symptoms may occur during exercise, after urinating, or even while sitting or resting.
Pain may move around or always be in the same place. It can be constant, or it can come and go.
Health care providers do not know what causes vulvodynia. It tends to be diagnosed when other causes of vulvar pain, such as infection or skin diseases, are ruled out. Researchers speculate that one or more of the following may cause or contribute to vulvodynia:
Because vulvodynia is often a diagnosis of exclusion, it can be difficult and time-consuming to arrive at an actual diagnosis. The diagnostic process can be especially problematic for women who lack health insurance because they may not have the resources to continue seeking care to exclude the many possible causes of pain. Moreover, some women may be reluctant to discuss their pain or seek treatment.
Researchers sponsored by the NICHD are investigating how to better evaluate and understand vulvar pain. Some have proposed ways to better map the pain to identify nerves that may be involved. Some researchers believe that vulvodynia and vulvar vestibulitis syndrome involve dysfunction in the pathways that process pain.
Gentle care of the vulva can help provide pain relief:
Vulvar pain can have an emotional or psychological aspect, and some women benefit from psychological counseling, sex therapy, or both. Referral for therapy does not mean that the pain is "all in the head." Sex therapy can provide education and information for individuals or couples. Psychological treatment can provide techniques for relaxation or coping with pain or an opportunity to explore other conditions that may relate to the pain. A randomized, controlled clinical trial found that women who had cognitive behavioral therapy reported a 30% decrease in vulvar pain that occurs with intercourse.
Physical therapy and biofeedback also can be helpful for women with vulvodynia. Physical therapy for vulvodynia may include exercise, education, or manual therapies, such as massage, joint mobilization, or soft-tissue mobilization. Other methods of physical therapy can involve ultrasound, electrical stimulation, or biofeedback techniques.
Other complementary and alternative treatments, such as yoga and acupuncture, may be helpful in managing pain from vulvodynia, but there is little evidence about the effectiveness of these approaches.
Some patients find that following a diet that is low in oxalates, along with taking calcium citrate supplements, is helpful, although the evidence to support this approach is limited. Foods that are high in oxalates include greens, nuts, tea, chocolate, and soy products. Food high in oxalates may produce urine that is irritating, which contributes to the vulvar pain.
Antidepressants, corticosteroids, and topical pain relievers
have all been suggested for treatment of vulvodynia. However, the
results of clinical research studies have not supported the use of
these treatments. For example, NICHD-funded research found that
amitriptyline (a tricyclic antidepressant) with or without topical
triamcinolone (a corticosteroid used to treat skin conditions) was no
more effective than self-management approaches (which included
components of education and cognitive-behavioral, physical, and sex
therapy) in managing vulvar pain, although the number of people in the
study was small. Other NICHD-supported investigators conducted a
randomized, controlled trial and found that oral desipramine (a
tricyclic antidepressants) and topical lidocaine (an anesthetic), alone
or in combination, were no better than placebos in helping women with
vulvodynia. Research sponsored by the NICHD is evaluating the use of
gabapentin, a drug that helps control epileptic seizures, for women
with provoked vestibulodynia (or vulvar vestibulitis syndrome) in a
randomized, controlled trial. The findings may also shed light on
treating other chronic pain syndromes.Medical Treatment
Surgery may be an option for women with severe pain from vulvar vestibulitis who have not found relief through other treatment options. A vestibulectomy (pronounced ve-STIB-yuh-LEK-tuh-mee) removes the painful tissue of the vestibule and may help relieve pain and improve sexual comfort. However, surgery is usually considered a last resort and is not recommended for women with generalized vulvodynia.
-NIH
