Vulvodynia
Vulvodynia
Vulvodynia is a lasting inexplicable pain of the vulva, or female genital area including the skin and the entrance to the vagina. The appearance of this area, however, is normal.
This pain can occur at any age. It is a long-term problem which affects quality of life.
Symptoms include:
Permanent pain restricted to the vulva and surrounding entrance to the vagina
Burning, stinging pulsating pain
Pain caused by contact (sexual intercourse, inserting a tampon)
Pain worsened by sitting
These pains can also spread to the entire genitalia and rectum
Some women observe further problems such as vaginismus , interstitial cystitis, painful menstruation or irritated bowels.
Permanent pain can have a negative influence on relationships, including on your sex life, also affecting your overall mood and even lead to depression.
Pain in this area is often so stressful that it is difficult to talk about it, and women can sometimes suffer from a sense of isolation or loneliness.
How the problem is diagnosed
If you have permanent pain in the area of your genitalia, then please overcome any shyness you might feel and visit an expert, a sexologist or urogynecologist, because it is very unlikely that vulvodynia will get better by itself, with some medicines being prescription only.
Diagnosis is based upon a detailed interview about your problems, and a physical examination during which the locality and intensity of the pain is ascertained using a cotton bud.
At the same time, it is necessary to rule out other forms of pain in the area of the genitals, including infection.
How the problem is treated
Some changes to lifestyle, which are within your capabilities, can help reduce your problems. A combination of changes is usually called for in order for you to achieve the desired effect:
· Wear cotton underwear and a free hanging skirt or trousers
· Cease using perfumed hygienic products (tissues, bubble bath, soap, etc.)
· When problems occur apply a cooling gel to the skin in this area
· Use some form of vaseline before swimming in a swimming pool to protect the skin of the genitals from chlorine
· Try not to completely avoid sex or touching the genital area because this may lead to hypersensitivity. Try to find some sexual positions which are acceptable for you, or choose some other form of sexual activity if vaginal sex is painful.
· Before sexual intercourse (approx. 20 mins) it is possible to apply an anaesthetic cream (such as lidocaine). This gel can then dry before intercourse so that it does not come into contact with your partner. A latex condom can be damaged by this gel.
· A further possibility is the use of vaginal lubricant or cream.
· If stress increases the pain, try to find ways to reduce it.
· f the pain is increased while sitting, try to use a cushion in the shape of an inflatable ring.
Further treatments are mostly on prescription or the recommendation of the doctor:
· Antidepressants (type: amitryptiline) can help. A side effect can be sleepiness, dryness in the mouth or an increase in weight.
· Antiepileptic drugs (gabapentine, pregabaline) can be effective. The effects can be seen in a few months. The side effects are similar.
· If the pain is very localised, a local anaesthetic or corticoid can be applied to the area of the nerve which denervates the area.
· Stretching and loosening of the muscles of the pelvic floor (physiotherapy) can relieve problems, particularly in the region surrounding the vagina.
- Another technique is to relax the muscles around the vagina and reduce their excessive sensitivity by using special vaginal cones that gradually increase in size and length. These cones are inserted into the vagina first under the supervision of a sexologist, and later on you can do everything in the privacy of your own home.
· Sometimes it is possible to use electronic nerve stimulation via the skin, called TENS ·(transcutaneous electrical nerve stimulation).
· Cognitive behavioral therapy, under the direction of a sexologist or psychologist, attempts to help the problems with a change in a patient’s thinking and activity from a practical point of view cognetive behavioural therapy
· Cooperation with a sexologist and psychologist (psychosexual consultation) may also be appropriate when pain infuences your intimate relations with your partner.
· Surgical solutions (removal of certain parts of the vulva) are only perfomed very rarely. Very often the pain reoccurs.