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What is vulvodynia?

Vulvodynia is a chronic pain disorder characterized by vulvar discomfort or pain. Patients often complain of burning, stinging, irritation, or rawness in the vulvar area. The characteristics of the pain are often different for different women. There are essentially two types of vulvodynia – organic vulvodynia (vulvodynia with a known cause) and essential vulvodynia (pain with no known cause). Examples of organic vulvodynia include contact dermatitis (irritation from common chemicals such as soaps, douches, and menstrual pads), infection (such as yeast or herpes), or vulvar trauma.

Essential vulvodynia is vulvar pain with no known cause. This type of vulvar pain often affects older patients. Basically, this is vulvar pain where no etiology can be identified. Even with no identifiable pathology, the pain associated with essential vulvodynia can often be controlled.

Vulvodynia can have a profound effect on a woman’s quality of life. It may affect a woman’s ability to have intercourse, engage in physical activity, her work, and her social life. Sometimes these things can affect her self-image and can lead to depression.

How is vulvodynia diagnosed?

Essential vulvodynia is usually a diagnosis of exclusion. Your physician will place you through a detailed history and physical exam. Other types of vulvar pathology are eliminated, and if none can be found you will be given the diagnosis of vulvodynia. Although no specific cause is known for essential vulvodynia, several hypotheses have been made. Some people think that a heightened reaction to candida (which causes yeast infections) may be linked to vulvodynia. Others think that an allergic response to irritants that are unable to be identified is responsible for vulvodynia. Still others feel that high levels of oxalate in the urine may explain vulvodynia. Finally, some people feel that the muscles of the pelvic floor are abnormal and that this abnormality leads to vulvodynia.

How is vulvodynia treated?

There are several treatment options when dealing with vulvodynia. First, if chronic irritation from yeast infections is a concern, your physician may suggest a trial of long-term yeast medications. Additionally, your physician may suggest trying topical analgesia for pain relief with such medicines as topical lidocaine.

Perhaps the most common and successful treatment for vulvodynia is the tricyclic antidepressant medications that are commonly used to treat depression. Over time, these agents have been shown to be helpful for multiple chronic pain disorders where the etiology is unknown. The most common medication used is amitriptyline and is given either two or three times a day

Due to the fact that some people feel oxalates in the urine may be associated with vulvodynia, a low oxalate diet has been advocated as being beneficial in preventing vulvodynia. When starting a low oxalate diet, foods to avoid include tea, cocoa, beans, beets, celery, greens, peppers, squash, berries, grapes, tangerines, peanut butter, tofu, nuts, and candies with chocolate. Foods that are low in oxalate include lemonade, avocado, cauliflower, mushrooms, onions, peas, white potatoes, apples, bananas, cherries, grapefruit, melons, peaches, plums, bread, pasta, rice, milk, yogurt, beef, pork, fish, poultry, eggs, butter, and hard candies. Improvement has been shown when the low oxalate diet is used in conjunction with calcium citrate.

Finally, some people advocate the use of biofeedback or physical therapy for improving the symptoms of vulvodynia. Biofeedback is a learned technique of self-relaxation. Patients are taught to voluntarily control their nerve and muscle responses to certain stimuli. Physical therapy that involves retraining your pelvic muscles may help control vulvodynia if there is a muscular component.

Vulvodynia can be a difficult problem to treat and often involves a long treatment plan.

What is vulvar vestibulitis?

Vulvar vestibulitis is a specific subset of vulvodynia. Vulvar vestibulitis involves severe pain at the opening of the vagina, pain when this area undergoes localized pressure, and redness (erythema) of this area. Like vulvodynia, symptoms of burning, stinging, and rawness are often present. The cause of this disorder is unknown as well. Treatment is similar to that for essential vulvodynia. If the above treatments fail, however, surgical excision of the affected area can be performed. Surgery has been shown to relieve pain in approximately 50% of patients, but has been shown to have no improvement or potentially even worsen pain in 10%.

Indu S. Anand, MD

Dr. Anand is a former Assistant Professor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center, in Memphis, Tennessee. She now is in private practice in Atlanta, GA.

*The recommendations and information provided by this Web site are for educational purposes only. This Web site does not contain comprehensive coverage of the topics addressed, and is not a substitute for direct consultation with your health care provider. Always consult a health care provider regarding your specific condition. Trademarks referred to are the property of their respective owners.

Category: Gynecology

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