Vulvodynia is a condition of chronic vulvar pain of at least 3 months duration. The vulvar region includes the pad of mons pubis — the fatty tissue at the base of your abdomen, the labia, the clitoris and the vaginal opening. The location, constancy and severity of the pain vary among sufferers. It is described by most patients as burning, stinging, irritation, or rawness.
Vulvodynia can have many descriptors:
- Localized (affecting a specific area of the vulva) or Generalized (throughout the entire vulva) or mixed (Localized and Generalized).
- Provoked (pain occurring with contact or attempted vaginal penetration) or Spontaneous (pain occurring without external stimulus) or Mixed (Provoked and Spontaneous).
- Primary (pain has always been present) or Secondary (at one time the patient was pain free, but now the pain has developed).
- Temporal pattern (intermittent, persistent, constant, immediate, delayed).
The most commonly reported type of vulvodynia is Provoked Vestibulodynia.
Vestibulodynia is a subset of vulvodynia. Vulvodynia refers to any pain in the vulva. Vestibulodynia is characterized by severe pain during attempted vaginal entry (intercourse or tampons insertion), tenderness to pressure localized to the vulvar vestibule (the ring of tissue surrounding the vaginal opening), and often redness of the vulvar vestibule. Vestibulodynia is pain specific to the vulvar vestibule, the small ring of tissue surrounding the vaginal opening.
Vestibulodynia and vulvar vestibulitis are synonymous terms.
Vulvodynia is diagnosed through a careful history and focused genital examination.
Genital exam will include the “Q-tip test”, where the clinician will examine and stroke with a moistened Q-tip several locations on the vulva and vestibule to determine where a patient is feeling pain. An examination of the pelvic floor muscles will also be performed. Cultures may be taken to rule out infections.
There are multiple causes of vulvodynia. Most common include:
- Hormonal changes (menopause, child birth, breast feeding, birth control pill use)
- Pelvic Floor Dysfunction (high pelvic muscle tone)
- Increased production of nerve endings in the vestibule (congenital or acquired)
- Vaginal infections
- Contact or allergic irritants
Vulvodynia treatment varies depending on the underlying cause. This is why correct diagnosis and careful examination is so important when treating vulvodynia. Treatment can include hormonal creams, medication changes, vaginal dilation, pelvic floor physical therapy, valium suppositories, treatment for underlying infections, vulvar hygiene changes, and botulinum toxin injections.
Emotional responses to vulvodynia are similar to those experienced by chronic pain sufferers. There is a great deal of frustration and anxiety that the problem may never resolve and that they will have to live with this pain for the rest of their lives. Women are often fed up with having gone from doctor to doctor and not getting helped and this can express itself as anger at the medical establishment.
If a woman has been suffering with the problem for a long time she can experience a sense of sadness and loss that her life has become more limited and focused on this medical condition.
It is important for patients to understand that one of the reasons that we involve a therapist in every step of the process is to help women address these issues. It is not that we believe that emotional or mental health issues have caused these problems but rather that we think emotional and psychological support is critical when dealing with any long-term pain. Vulvodynia effects the woman, her sense of herself as a human being and often the long term health of her relationships. We want to be there to help with all facets of the problem.