Vulvodynia is often characterized by burning discomfort, itching, throbbing, or tenderness of the vulva - sometimes in the labia, sometimes around the opening of the vagina, sometimes affecting the vestibular glands - which may be experienced either as diffused irritation or as specific painful spots.
The group of symptoms is classified by many names, partly because of the ways in which it may present or respond to treatment: vulvar pain syndrome, focal vulvitis, vestibular adenitis, vulvodynia, vulvar vestibulitis, or simply vestibulitis.
A surprising number of women suffer from a condition of chronic, unexplainable pain in the skin of the genitals, which has only recently begun to receive public attention and validation as a legitimate complaint. Efforts to treat the syndrome have been frustrating for women seeking relief as well as for caregivers who attempt to help them.
A woman with chronic vestibulitis may trace the onset of the pain to inflammation due to irritants (shampoo, soap, detergent, feminine hygiene products) or with infection (yeast, herpes, human papillomavirus) or other trauma to the tissue.
However, the symptoms can appear with no known cause or may be associated with several causes or a sequence of contributing factors, including response to medical or surgical treatments. Symptoms may also progress.
The condition ranges from a minor annoyance to severe pain that prevents or seriously impedes daily activities, affecting what one women characterized as “sitting, sex, and sports.”
Another woman reported that some days she was unable to walk without excruciating pain, and would lie in bed every morning, crying, wondering which underpants would be bearable to try to wear.
The painful tissue may look essentially normal under examination, or it may whiten when swabbed with a vinegar solution. Biopsy may show chronic, nonspecific inflammation. Whatever the initial cause, it seems possible that for some people pain pathways are activated that do not deactivate when the source of irritation has been removed or ameliorated.
Initial treatment needs to be as gentle and noninvasive as possible. The first line of response is to remove any possible environmental irritants - deodorant products, laundry soap, bubble bath, scented soaps or toilet tissue, or contact with highly chlorinated water or synthetic fabric.
Preservatives in topical medications may exacerbate the condition. Even pantyhose or the elastic in cotton underwear can be implicated. If urine irritates the tender tissue, spraying or rinsing with water after urinating may help.
Some people discover that they are sensitive to foods and that the pain gradually dissipates after eliminating such substances as caffeine or sugar from their regular diet.
Once irritants have been eliminated, it may take the tissue some time to heal and become pain free. In fact, some people report an initial worsening of symptoms as over-stimulated nerves seem to retain their sensitivity. This can be very discouraging and can confuse certainty as to whether the treatment is helping or not.
Symptomatic treatment includes sitz-baths, anesthetic gels (lidocaine), topical steroid creams (for 14 days or less to prevent skin atrophy), pain medications, or low doses of antidepressant (sometimes given with an antispasmodic) to deactivate the pain pathways.
More aggressive medical and surgical treatments may include laser surgery to burn off the painful tissue, or plastic surgery in an attempt to remove the source of the pain. Unfortunately, the invasive techniques can themselves complicate matters by ultimately creating more or different kinds of pain. They have proved to be controversial in terms of outcome.
Do any tests need to be done to diagnose the condition?
What treatment do you recommend?
Will any topical or oral medications be prescribed? What are the side effects?
When will this resolve?