Vestibulodynia / Vulvodynia

Vulvodynia is the term used to describe pain the vulva. Vulva is the outer part of female genitalia composed of the two lips (labia majora and labia minora) and the clitoris.

It may be generalized or localized to a portion of the vulva. Generalized vulvodynia is generally perceived as a burning sensation present in the region constantly. Localized vulvodynia may be in the region of the clitoris or vestibule (vestibulodynia) – part of the vulva in between the two labia minora. Localized vulvodynia is usually provoked by touching in the area or attempted penetration of penis, tampon into the vagina.

The exact cause is unknown. It is believed that Vulvodynia is caused due to abnormal sensations carried by the nerves which supply the vulva or female external genitalia. Normally the nerves which transmit sensations such as touch, pressure, heat and stretch, begin to transmit pain and hence they feel a burning sensation in the external genital region.

Some women describe it as a burning, stabbing, stinging sensation or feeling of rawness in the region. Some describe the feeling as a chronic dull aching pain. Few women with vulvodynia avoid intercourse due to pain and few have little effect on intercourse. Some women describe the pain as constant , whereas for some women it lasts for a few hours, days or weeks only.

Women with vulvodynia have a normal appearing external genital region. It is important to remember that there is a large variation in the appearance of vulva in different women. Some women may rarely notice redness at the entrance of vagina in case of vestibulodynia – pain in the entrance of vagina.

There are no laboratory test or ultrasound scan findings to diagnose vulvodynia. A detailed history and ruling out other conditions of pain in the external genitalia such as infections and skin conditions, helps in the diagnosis of vulvodynia. It is necessary to consult a doctor with experience in treating these conditions. A cotton swab test is used to localize the site of pain which helps in the management.

Avoid the use of soaps, scented products and detergents which irritate the vulva. Non perfumed water based lubricants can be used. Avoid the use of Thongs, synthetic and tight fitting undergarments. Use appropriate fitting cotton undergarments. Vaginal cups or tampons can be used as an alternative to sanitary pads.

A diagnosis of vulvodynia provides relief for these women. A specialist who deals with such women can help overcome this pain. It is a chronic condition characterized by abnormal nerve transmission of sensations. Neuromodulators, a class of drugs which modulate nerve conduction, provides relief for vulvodynia. These medications include antidepressants, anti seizure medications and muscle relaxants. Some drugs like gabapentin, pregabalin or duloxetine provide relief. Recent research has concenterated on vaginal application of these drugs providing relief.

Botox injections into the muscles of pelvic floor have provided relief to women. Nerve blocks in the area with anaesthetics may be of help. Physical therapy by appropriately trained person is beneficial.

Vestibulectomy, a surgery to remove the vestibuea and approximate the area with surrounding skin and mucosa has provided relief in cases of localized pain in the vestibule.

Sexual counseling may be required for couples if there is associated problems with sexual desire, arousal or orgasm.

It is important to have patience during treatment as it may take months for the condition to improve. However, majority of women experience relief with the right treatment.