VULVAR PAIN
Pain in the vulva is referred to as vulvodynia. The International Society for the Study of Vulvovaginal Disease defines vulvodynia as a chronic vulvar discomfort or pain, characterized by burning, stinging, irritation, or rawness of the external genitalia with no infections or skin diseases causing the symptoms. The most common symptom is burning but the type and severity of the symptoms are very individualized. The pain can be localized to a single spot or spread over the entire vulva and can be constant or occasionally occurring. The symptoms can be worsened by intercourse, walking, sitting or exercise. It has been reported that the condition occurs in one in six women at some point in life. Studies have shown that less than half of the women with the problem ever seek help.
How is vulvodynia classified?
It has been associated with the following subtypes:
- Generalized vulvodynia usually diffusely found in multiple areas often at different times. It can be associated with pain in the clitoris, mons pubis, perineum or inner thighs. The pain can be constant or occur intermittently. It may be/but not always be associated with touch or pressure to the vulva.
- Vulvar vestibular syndrome usually pain only in the vestibule of the vulva and only when touch or pressure is applied. A burning sensation is the most common sensation and usually occurs with intercourse, tampon insertion, gynecologic exam, bicycle riding, and wearing tight pants.
- Cyclic vulvovaginitis recurrent burning and itching symptoms at the same stage of the menstrual cycle. It is often associated with cyclic bouts of yeast infections.
- Vulvar dermatoses many dermatologic conditions can be associated with pain such as allergic reactions, and lichen sclerosis. These conditions can cause burning and itching. Scratching of the vulva and overuse of topical agents may inflame the tissue, and produce more pain and swelling.
What events are associated with vulvodynia?
The cause of vulvodynia has never been identified but certain factors have been noted to be associated with it. These factors include:
- Frequent use of antibiotic medications
- Frequent yeast infections
- Rashes of the genital area
- Reactions to chemicals in soaps or detergents
- Nerve or muscle irritations or injury to the nerves
- Past or present genital warts
- Changes in estrogen levels around the approach of menopause
What can be done to help control the problem?
The following is a partial list that has been comprised to try to control symptoms and give some relief:
- Try to avoid using soap in the genital region and just wash with warm water.
- Avoid using creams, petroleum jelly, bubble bath, bath oils, or feminine deodorant sprays.
- Wear only cotton underwear and loose clothing. Pantyhose and nylon panties do not allow ventilation and retain moisture that can cause irritation. Sleeping without underwear at night may improve the condition.
- Dont sit around in a wet swimsuit for long period of time.
- Regular exercise can help ease chronic pain but stay away from exercise that puts pressure directly on the vulva.
- Occasionally, certain types of vulvodynia may be worsened by sitting in a hot tub.
- Accept small steps of progress, not expecting instant cure.
Whenever the disorder has been diagnosed, your physician may prescribe medications such as antidepressants or anticonvulsants that can lessen chronic pain, antihistamines that may reduce itching, physical therapy, local anesthetic ointments, topical estrogen or biofeedback therapy. Work with your doctor to gradually bring about improvement in the symptoms.
More about Dr. Aulds
Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.
Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.
Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.
