VulvodyniaVulvodynia means painful vulva. The vulva is the external female genitals, including the clitoris and labia. It includes the mound of tissues over the pelvic bone that becomes covered with hair at puberty.
The International Society for the Study of Vulvovaginal Disease (ISSVD) defines vulvodynia as chronic vulvar discomfort or pain, characterized by burning, stinging, irritation or rawness of the female genitalia when there is no infection or skin
diseases of the vulva or vagina that could cause these symptoms. Burning sensations are the most common, but vulvodynia pain is highly individualized. The condition varies in persistence and location. Pain may be constant or intermittent, localized or diffuse. In many cases of vulvodynia, pain occurs spontaneously. Vulvar vestibulitis, one type of vulvodynia, refers to pain experienced primarily when pressure is applied to the vestibule, the area surrounding the entrance to the vagina.
Vulvodynia, as with most chronic pain conditions, has a profound impact on quality of life. It often affects one's ability to engage in sexual activity and can interfere with daily functioning. It can impair one’s ability to work, engage in physical activity, and participate in a social life. These limitations can negatively affect self-image and may sometimes lead to depression.
Vulvodynia is a quite common condition affecting approximately 15% of all women. Sometimes a woman with vulvodynia may have a rash or scaly patches on her vulva with visible areas of redness or irritation. But in other cases, no physical abnormalities of the vagina can be observed. Because the symptoms of vulvodynia may be so variable, the condition is commonly misdiagnosed. Physicians may even mistakenly suggest that the symptoms result from a psychological condition. However, vulvodynia is a pain condition resulting from physical factors. It is common for women experiencing vulvodynia to suffer for many years and to see many doctors before being correctly diagnosed. However, an increasing number of physicians have become more knowledgeable about vulvodynia and can help women with the condition.
The exact causes of vulvodynia are unknown. However, it is thought that neurological injury may be involved in some types of vulvodynia. In other cases, a skin condition or dermatoses may cause the pain. Women experiencing vulvodynia may have a history of recurrent vaginal yeast infections. Also external causes such as previous treatment such as laser surgery or sensitivity to corticosteroid drugs may play a role. In some cases, the entire vulva may be involved and in other cases only a portion of the vulva surrounding the entry to the vagina – the vestibule - may be involved. This type of vulvodynia is known as the vestibulitis.
Vulvodynia is difficult to diagnose. The most important part of the diagnosis is to rule out STDs and infections. Sometimes, vulvodynia may have not visible signs and the pain may come and go. Treatments directed toward symptom relief include drug therapies such as tricyclic antidepressants or anticonvulsants, physical therapy, biofeedback, nerve blocks, and in some cases, diet modification. If the diagnosis is vulvar vestibulitis, interferon or vestibulectomy (vulvar surgery) may be recommended.