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Vulvodynia

The term vulvodynia is used to describe pain in the vulva, often severe, of unknown cause. Vestibulodynia (formerly vulvar or vulval vestibulitis) is a related term. more...

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Vulvodynia

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A wide variety of possible causes and treatments for vulvodynia are currently being explored. Some possible causes include: allergy or other sensitivity to chemicals or organisms normally found in the environment, autoimmune disorder similar to lupus erythematosus, chronic tension or spasm of the muscles of the vulvar (or vulval) area.

The guidelines in Vulvovaginal health may be of some help.

Vulvodynia is the term used to describe women who experience the sensation of vulval burning and soreness in the absence of any obvious skin condition or infection. The sensation of burning and soreness of the vulva can be continuous (unprovoked vulvodynia) or on light touch eg. sexual intercourse or tampon use (provoked vulvodynia). Women who have unprovoked vulvodynia were formally know as having dysaesthetic vulvodynia where pain was felt without touch. Vestibulodynia is the term replacing vestibulitis where pain is felt on light touch. A recent change in the terminology of these conditions means that the description of women with vulvodynia can be more uniform amongst health professionals and patients. Many women have symptoms which overlap between both conditions.

Dysaesthetic vulvodynia and vestibulitis are now obsolete terms that you'll hear less and less frequently as they are phased out.

This condition is a cause of vulval burning and soreness usually as a consequence of irritation or hypersensitivity of the nerve fibres in the vulval skin. The abnormal nerve fibre signals from the skin are felt as a sensation of pain by the woman. This type of pain can occur even when the area is not touched. Another example of nerve-type (neuropathic pain) like vulvodynia is the pain some people experience with an attack of shingles. Once the rash of shingles has disappeared the area of skin where the rash was can be intensely painful and sore despite the skin appearing normal. The condition is called post-hepatic neuralgia.

The pain described by women with unprovoked vulvodynia is often of a burning, aching nature. The intensity of pain can vary from mild discomfort to a severe constant pain which can even prevent you from sitting down comfortably. The pain is usually continuous and can interfere with sleep. As with long-term pain of any cause you can have good days and bad days. Itching is not usually a feature of the condition. The pain in unprovoked vulvodynia is not always restricted to the vulval area (area of skin on the outside of the vagina) and some women get pain elsewhere. This can be around the inside of the thighs, upper legs and even around the anus (back passage) and urethra (where you pass urine). Some women also have pain when they empty their bowels. Unprovoked vulvodynia can have an affect on sexual activity and is associated with pain during foreplay and penetration. In some women with unprovoked vulvodynia the burning sensation can be generalised over the whole genital area. Alternatively it can be localised to just the clitoris (clitorodynia) or just one side of the vulva (hemi-vulvodynia).

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Refractory Vulvodynia: Look for Interstitial Cystitis
From OB/GYN News, 7/15/00 by Sherry Boschert

SAN FRANCISCO -- Inpatients with refractory vulvodynia, screening for and treating concomitant interstitial cystitis is often the key to improving both conditions, Dr. Jennifer Gunter said at the annual meeting of the American College of Obstetricians and Gynecologists.

Among 56 women who were referred to a tertiary care clinic for refractory vulvodynia, 50 had at least two signs or symptoms of interstitial cystitis, including urinary frequency, nocturia at least twice per night, dysuria, a history of multiple culture-negative urinary tract infections, and periurethral pain. Of these patients, three declined evaluation for interstitial cystitis, consisting of cystoscopy and bladder hydrodistention.

Evaluations confirmed a diagnosis of interstitial cystitis in 33 patients who met National Institutes of Health criteria for the presence of glomerulations or Hunner's ulcer seen on cystoscopy. Three other patients had been diagnosed with interstitial cystitis prior to referral, for a total of 36 of 47 patients (77%) with interstitial cystitis. Three other patients (6%) had equivocal findings on cystoscopy, and eight patients (17%) had no sign of interstitial cystitis on cystoscopy.

"There was a very strong association between the two conditions," said Dr. Gunter of the University of Kansas Medical Center, Kansas City.

The 39 patients with a diagnosis of interstitial cystitis or equivocal findings were offered treatment for both conditions. Six-month follow-up data on 35 of these patients showed that treatment cut daily pain scores in half, on average.

Prior to combination therapy, patients reported an average daily pain score of 7.1 based on an 11-point Likert scale, with a score of 11 indicating the worst pain. After 6 months of combination therapy, the average daily pain score was 3.6.

Investigators also gave their clinical impressions of the patients' pain; they rated 12 of 35 patients (34%) as significantly improved, meaning these patients had no pain and felt that they needed no further therapy. Moderate improvement was seen in 14 patients (40%), meaning the patient was happy with therapy but had some residual pain on exam. Seven patients (20%) had minimal improvement (still had severe pain on exam), and two patients (6%) did not improve with treatment.

The patients' mean age was 35 years. Some had reported vulvodynia for as long as 20 years, with a mean duration of pain of 4 years. All had failed multiple treatments for vulvodynia, including either tricyclic antidepressants or gabapentin. Dr. Gunter said that about half of patients referred for vulvodynia respond to initial treatment with tricyclic antidepressants.

After evaluation for interstitial cystitis, all patients continued treatment for vulvodynia with standard therapies, including tricyclic antidepressants, gabapentin, carbamazepine, biofeedback, and topical therapies. Patients diagnosed with interstitial cystitis added therapy such as dietary modifications, antihistamines, pentosan polysulfate, biofeedback, antidepressants, or therapeutic hydrodistention.

Check for signs and symptoms of interstitial cystitis as part of the workup for refractory vulvodynia and treat both conditions in patients diagnosed with interstitial cystitis, Dr. Gunter advised.

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