Mitzi Perdue

Vulvodynia: We Don’t Have A Cure, but We Can Manage It

VULVODYNIA IS OFTEN UNDIAGNOSED OR MISDIAGNOSED

Vulvodynia is chronic vulvar nerve pain affecting the external female genital organs including the labia, clitoris, and vaginal opening. Women describe it as a burning or stinging sensation, or a feeling of rawness, or it can be a stabbing pain. Because it doesn’t have externally visible symptoms, and the physical exam can appear completely normal, vulvodynia is frequently either undiagnosed or misdiagnosed. In fact it’s only recently that we recognize it as a real pain syndrome. Too often women who experience this kind of pain in the vulvar area have been told that it was all in their heads, or they were instructed to take medications that didn’t help, such as medications for a yeast infection that they didn’t have.

WE DON’T UNDERSTAND THE ETIOLOGY OF VULVODYNIA YET

The risk factors for this condition are broad. They can include: allergens; early age of menarche; frequent use of vaginal medications (more than four treatments per year); coitus; physical, emotional, or sexual abuse; and adverse life effects such as divorce. Stress also plays an important role in vulvodynia. It is quite similar to the way headaches or GI tract problems can be made worse when there’s financial, work, or relationship stress.

WE CAN MANAGE IT, AND WE CAN IMPROVE FUNCTION

Because the causes of vulvodynia are multifactorial, there are a variety of approaches to managing it. Often we can reduce discomfort by as much as 50% by providing a nurturing environment for the skin. This means avoiding contact in the area with any product that isn’t hypoallergenic, including all products with fragrance. It also means avoiding washes and wipes. Hypoallergenic lotions or moisturizers, particularly vegetable oil-based ones, can help. Additional steps include oral neuropathic pain medications, which alter the perception of pain. Yoga or meditation may help with stress reduction. A woman with vulvodynia may have pelvic floor muscle problems because the muscles have inappropriately tightened in response to pain. A physical therapist with expertise in pelvic floor problems can help.

QUICK FIXES USUALLY DON’T WORK LONG TERM

Some practitioners recommend topical medicines, but I stay away from them. We clinicians want to be helpful and we want to recommend something for right now, but multiple studies have shown that while some quick fix medications work for the short term, over time the medication itself can become a contact irritant and offers little symptom resolution. When treating patients, I rarely do the same thing in the same order. I tell my patients, “We’re going on a journey together, and we’ll work on the most bothersome symptoms and then when these improve, we’ll move on to the secondary symptoms.”

IF THERE’S A BLADDER COMPONENT TO HER VULVODYNIA, DIET CHANGES CAN HELP

Foods can aggravate Vulvodynia when bladder problems involved. Have her avoid foods with a high acid content such as tomatoes, strawberries, or citrus. She might also try avoiding alcohol and the water-soluble vitamins such as the Bs and Cs. All of these can make the urine more acidic which can aggravate the vulva. In addition, some women have a bladder condition called interstitial cystitis (IC). Both IC and vulvodynia need to be treated for best outcomes.

INCLUDE THEIR PARTNERS

A woman may experience tremendous relationship problems when her vulvodynia causes her to avoid intercourse. I encourage my women to bring their partner in with them so everyone can understand what’s going on. It can be devastating when a woman not only has to deal with chronic pain, but she also has to deal with a situation that harms her intimate relationship.

IF THINGS AREN’T GETTING BETTER, THERE ARE OTHER APPROACHES TO TRY

The National Vulvodynia Association (https://www.nva.org) can suggest resources. The International Society for the Study of Vulvovaginal Disease (ISSVD.org) is also a useful resource.