Vulvodynia: what is it, causes, symptoms, treatment in women

What is vulvodynia?

Vulvar pain (or vulvodynia) Is a clinical condition characterized by the presence of chronic pain (lasting at least 3 months), located in the vulva (female external genitalia), without any visible causes.

Vulvodynia is a clinical condition (symptom) of great importance for various reasons:

• This is a problem that affects many women, although many do not usually talk about the condition with their doctor.
• in addition to pain, patients also experience other symptoms (itching, burning, swelling, vulvar discomfort) that can be particularly unpleasant and disrupt normal daily activities;
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• although this is not a dangerous condition, it can be associated with complications, especially psychological ones, which can disrupt daily life, but above all, relationships between couples and intimacy with partner;
• Although vulvodynia is widespread, it is a largely underdiagnosed illness that often traces solely to stress or psychological conditions (anxiety, depression);
• There are many medications available to treat vulvodynia that are not universally effective (some women benefit from taking medications that are not effective for other women), so treatment should be individualized and often very long-term; note, however, that many women can successfully overcome this problem;
• dialogue is at the core of treatment success: overcoming the embarrassment of talking to a doctor or gynecologist is the first therapeutic step.

It is very difficult to estimate the number of women actually affected by vulvodynia, as many usually do not report the symptoms to the doctor; It is possible to roughly estimate the prevalence in Russia of 200,000 / 6,000,000 people of any age (from adolescence to postmenopausal period).

Classification

The vulva is the outer part of the female genital organs, which includes:

• large labia;
• small labia,
• vestibule of the vagina;
• clitoris.

Based on the location of the vulvodynia, it is possible to determine:

• generalized: pain is perceived indiscriminately in any area of ​​the vulva, affecting several areas at the same time, or it can migrate, occur spontaneously and be aggravated by pressure in one of the painful areas;
• localized: Only part of the vulva is affected, and more often the pain is caused by pressure on the affected area.

Causes of vulvodynia

To talk about vulvodynia, the pain must be chronic (lasting more than 3 months) and idiopathic in nature (for no specific reason).

When one or more reasons can be recognized, it is better to talk about secondary pain in the vulva, which is easy to recognize by the presence of the vulva and treatable damage when eliminating the cause that provoked it.

Reasons considered include:

• genital infections (herpes in an intimate place, bacterial vaginosis, candidal infections, vaginal trichomonas…),
• neoplasms of the vulva;
• scleroatrophic lichen;
• furuncle;
• abscess bartholin gland;
• vulvar warts;
• atrophic vaginitis;
• local injuries in the vaginal area;
• exposure to harmful agents or chemicals.

Primary vulvodynia free of visible damage, but at its base may be functional or anatomical microscopic changes. In fact, there is a chronic inflammatory process at the level of the vulva, characterized by a predominance of mast cells, which release factors that can increase nerve endings and increase sensitivity to stimuli (hyperesthesia) or abnormal perception: in other words, usually painless stimuli are perceived by a woman as painful (the process is called allodynia).

This major change may be related to:

• predisposing genetic diseases;
• previous, chronic, or recurrent infections of the vulva;
• hormonal changes;
• allergies or skin hypersensitivity;
• damage to the nerves of the vulva;
• frequent use of antibiotics;
• previous operations;
• special psychological condition: shy, introverted women with dysthymic changes (bad mood) or cyclothymic mood (frequent changes in mood), which often find it difficult to express their emotions orally or who are prone to their retention;
• there were cases of sexual violence.

In response to pain, an increase in the tone of the pelvic floor muscles is established, which can lead to muscle spasm, which can also make intercourse difficult (vaginismus).

Signs and symptoms of vulvodynia

The main symptom of vulvodynia is pain, usually with a sudden onset, lasting months or years, which can manifest in various forms:

Symptoms can be so severe that they can make it difficult to perform daily tasks, work, and sometimes even trivial activities.

Complications of vulvodynia

Although not a dangerous clinical condition, vulvodynia can have dangerous psychological consequences if left untreated, which leads to a serious deterioration in the quality of life in the absence of treatment.

Relationship problems with a partner

• Dyspareunia (pain during intercourse)
• decreased libido (decreased libido),
• Difficulty getting pleasure during a relationship.

These are problems that can make a woman feel inferior, unable to satisfy her partner and prevent her from living in a calm and fulfilling relationship.

These factors can ruin the relationship of a couple, especially when there is no good, sincere dialogue about the problem with partner, which can provoke the psychological closeness of the woman, aggravating the situation, so that vicious circle.

Psychological disorders

• Anxiety,
• depression,
• difficulties in communicating with people,
• difficulties in solving everyday problems of a different nature.

Are the consequences of the discomfort caused by vulvodynia that can prevent you from leading a fulfilling life.

Sleep disturbances

Often, a woman who suffers from this chronic condition also goes into insomnia: pain and reduced sleep hours can be the basis for:

• irritability,
• difficulty concentrating
• poor performance at work or school.

Change in the perception of one's own body

In extreme cases, this disorder can lead to more serious problems, especially in adolescents, such as anorexia and bulimia.

Accompanying illnesses

Often vulvodynia is associated with other pathologies associated with hypertension of the pelvic muscles:

• Vaginismus (an involuntary contraction of the pelvic floor muscles that makes intercourse painful or impossible)
• constipation (dysfunction of bowel movements or anism) due to impaired relaxation of the pelvic muscles necessary for bowel movements;

Pathologies that share pathogenesis:

• Irritable bowel syndromedue to changes in the intestinal nerves and the presence of inflammatory cells in the intestinal walls, painless irritants (such as mild enlargement of intestinal loops) are perceived as noticeable painful;
• functional dyspepsia (stomach pain, feeling of postprandial suppression, decreased rate of gastric emptying), may have the same pathogenesis;
• fibromyalgia (widespread pain throughout the body caused by pressure from certain points called "triggers").

Diagnostics

Often, just a glance from a doctor or gynecologist for symptoms and signs is enough to make a diagnosis. however, additional tests are needed to rule out the presence of other diseases responsible for the secondary vulvodynia.

• Medical history: It is very important to collect data on symptoms and to identify causal factors (history of recurrent infections, predisposing psychological conditions, if any, history of sexual abuse).
• Objective examination: it is necessary to examine the vulva area to exclude the presence of concomitant diseases (infections, neoplasms, lichen).
• Analysis with cotton swabs: Using a cotton swab, the doctor stimulates different areas to detect painful areas.

Care and remedies

Although pathology is often based on psychological problems, there are numerous remedies for vulvodynia that can be combined with targeted psychological support.

Vulvodynia is in most cases a curable disease, although treatment most often takes a long time (months, sometimes even years).

The biggest difficulty is that there is no universal treatment that is certainly effective, but it is likely that the patient should try a large number of drugs before finding one that works for her, as drugs that work for one patient may not work for another.

Lifestyle changes that DON'T

1. Avoid harsh detergents or those that are not suitable for intimate cleaning.
2. Avoid perfumed products, creams, and ointments.
3. Avoid tampons.
4. Avoid using spermicidal creams as a contraceptive.
5. Avoid synthetic underwear.
6. Avoid too tight pants, tights, leggings, bodysuits.
7. Avoid foods that can irritate your bladder (beans, chocolate, chili peppers, dried fruit).
8. Avoid sitting for hours.
9. Avoid excessive physical activity.
10. Avoid sports such as cycling to avoid putting pressure on the vulva area.
11. Avoid spending hours in the pool.

Lifestyle changes that you NEED

1. Good intimate hygiene, washing the external genitals after urination with warm water.
2. It is preferable to use quality intimate products with a neutral pH.
3. External absorbents must be used.
4. Use soft toilet paper.
5. Use cotton underwear.
6. Wear comfortable, wide clothing.
7. Change wet clothes (for example, after exercise).
8. Dry your intimate area thoroughly after showering.
9. Use soft chair cushions, sit on a soft one.

Treatment of vulvar pain

In order of invasiveness, the gynecologist may advise to relieve pain:

1. A bath with warm water.
2. Apply a heat source to the affected area (iron heated cloth, hot water bottle, special products capable of generating warmth ...), while other women benefit from the use of ice (only not in direct contact with the mucous membrane, but wrapped in the cloth).
3. Preparations:
   • Oral antihistamines to treat pruritus.
   • Lidocaine (local anesthetic), for intermittent pain, or before intercourse.
   • Cortisone ointments.
   • Estrogen-based ointments.
   • Antidepressants (tricyclic drugs, SSRIs) by mouth.
   • Opioids (pain relievers).
   • Anticonvulsants for treatment neuropathic pain (Carbamazepine).

Rehabilitation treatment

• Exercises to strengthen the pelvic muscles (Kegel exercises): These are simple exercises that can be done almost anywhere, even several times a day; they involve the contraction and subsequent release of the pelvic muscles to relieve muscle spasm associated with pain.
• Biofeedback: This is a technique that involves doing muscle contraction and relaxation exercises; at least initially, it is necessary to provide support to a competent medical staff who, with the help of sensors, help the patient to increase the awareness of the stress associated with muscles of the pelvis.

Intensive treatment

In cases where the previous measures are not sufficient, you can resort to more invasive methods of treating vulvodynia:

• Spinal infusion pump: Involves the implantation of a subcutaneous device associated with a catheter into the spinal canal that releases pain relievers. The goal is to improve the effectiveness and speed of action of pain relievers.
• Nerve block: In patients who are immune to all other approaches, it is possible to resort to interrupting the nerves transmitting nerve sensitivity to eliminate the perception of pain. This therapy has a major drawback that compromises sensory ability.
• Surgery: in localized forms, the original pain structure can be removed surgically.

Supportive therapy

Along with pain relievers, supportive psychotherapy is very useful, often this type of therapy is necessary in in the most severe cases, can help a woman suffering from vulvodynia overcome the problem by avoiding frequent use medicines. This approach can be implemented by a psychotherapist.

Even recreational and sporting activities, often underestimated, can be effective. a supportive therapy tool such as yoga or Pilates will improve the ability relax muscles.

Finally, it is very important to find a stable sentimental relationship, as well as an open relationship with your partner, to whom you need to explain the condition and symptoms of your problem. While you may initially be embarrassed to talk about such an intimate matter, dialogue will greatly improve the relationship of the couple.

If you don't have a stable relationship, dialogue with a close friend or person is often just as helpful; Finding out that many women suffer from the same problem can also help to feel less lonely and thereby improve the perception of their appearance.

conclusions

• Vulvodynia is a clinical condition that can be very disabling and can significantly affect the psychological sphere of a woman;
• this is a condition that affects many women;
• the condition is curable;
• it is important to overcome the embarrassment and talk to the doctor who will prescribe the most appropriate therapy for the patient.