Vulvovaginal Treatment

Vulvodynia is a broad term used to describe unexplained pain in the genital area that has been present for more than three months. Vulvodynia pain is described by women in many different terms, such as burning, stinging, itching, stabbing, or aching. Some women experience pain only in the opening of their vagina when touched (provoked vulvodynia). Others experience pain without being touched and their pain is throughout the vulva (generalized vulvodynia).

This pain may wax and wane and often symptoms feel worse if anything aggravates the vulva (i.e. recent intercourse, prolonged sitting, or tight clothing). Each woman with vulvodynia has a unique story and pain description.

The exact cause of vulvodynia is uncertain but there are many different theories. It is possible that some women may have a genetic predisposition to chronic pain disorders.

Many women with vulvodynia (or their family members) experience other auto-immune and chronic pain conditions, such as:

• Migraine headaches
• Temporal mandibular joint pain (TMJ) or jaw pain
• Anxiety
• Irritable bowel symptoms
• Interstitial cystitis or frequent bladder symptoms
• Chronic fatigue syndrome
• Fibromyalgia or unexplained joint pain

Other theories suggest that the nerve impulses in the vulvar region are not working properly and stuck in the “on” position. What causes these nerves to flare-up may be different for each woman. It is proposed that chronic irritation or injury could damage the vulvar nerves. For some women, it could be a history of recurrent infections like yeast.

Other women with vulvodynia report a specific precipitating incident, such as childbirth or surgery. Still, others find vulvar pain begins randomly without any warning. Researchers are currently working on trying to understand the cause or causes of vulvodynia in order to provide better treatment options.

In order to diagnose and treat vulvar pain, your provider must first rule out all other possible explanations. First, a very thorough medical history will be obtained. Check to see if your provider offers a specific questionnaire on this topic.

After your history is reviewed, a vulvar and vaginal exam will be performed. Great care is taken to be a gentle as possible due to your history of vulvar pain and for some women, a full exam will not be completed if it is not tolerable. The goal is to rule out any vulvar skin disorders or vaginal infections and to determine exactly where your pain is.

Typical treatments include oral and topical vulvar medications and/or physical therapy. Some of the oral medications used fall into the antidepressant family (amitriptyline or Cymbalta) or the anticonvulsant family. These medications are known to calm down nerve excitability.

Topical medications may be used to provide the vagina with more estrogen and build up the lining of the vaginal wall. Others calm down or numb the nerve pain.

Additionally, physical therapy is often recommended to help retrain and relax the pelvic muscles.