Vulvodynia

Irene Jackson RN, MN
Do you suffer from pain in the vulva that sometimes stops you having intercourse or inserting a tampon? If you do, you may have a type of vulvodynia.
The word vulvodynia means vulval pain. The vulva is the external parts of the female genitalia. The areas most often affected are the inner labia, the clitoris, and glands beside the urethra and on either side of the vagina.
Vulvodynia is defined as symptoms of chronic soreness of the vulva that is described as pain, burning, rawness or stinging. The sensations throb and can last for hours or days. There are at least four types of vulval pain (see chart), but the condition is often misdiagnosed or undiagnosed. Because there are often no visible changes to the vulva, some women are made to feel that they are imagining the problem.
Four kinds of Vulvodynia

Symptoms
Physical findings
History
Treatment
Cyclic vulvovaginitis
Itching, burning, redness and swelling that is worse after intercourse.
May recur at the same time of the menstrual cycle.
Vulva is hot, red and tender, and the skin may split. Often there is no vaginal discharge.
Occurs in premenopausal women, or women on hormone therapy. There is often a history of yeast infections or frequent antibiotic use.
Anti-candida cream or pills. Topical cream or oral therapy may be needed for 6 months or more.
Dysesthetic vulvodynia
Constant burning pain that is worse at night. The pain may be sharp or a deep ache. It is not related to touch.
The inner labia and area back to the anus and down the inner thighs may be affected. Detailed examination shows no abnormality.
More common in older women and women with interstitial cystitis or fibromyalgia.
Low-dose, tricyclic antidepressant, such as Amitriptyline, for several months. Prescription antihistamines.
Anticonvulsant drugs containing
Carbemazepine, (e.g.,Tegretol) may help if antidepressants aren’t effective.
Vulvar dermatoses
Chronic burning, skin disorders on the membranes of the vulva.
Inflammation, irritation and hypersensitivity. Skin eruptions including: lichen simplex, lichen sclerosis, lichen planus.
Can occur at any age.
Testosterone propionate ointment.
Topical steroids.
Biopsies to identify lesion.
Vulvar vestibulitis
Raw, burning, dry or tight skin. Symptoms caused by intercourse, touch, and insertion of tampon, tight clothes, bike-riding. Pain may be constant or only after intercourse
Inflammation of the vaginal opening (vestibule) may be present.
With severe continuous pain, vaginismus (spasm of the pelvic floor muscles) may develop.
Extremely tender to very light touch.
Can occur at any age in women who are usually sexually active until pain occurs.
Topical steroids, followed by estrogen creams if steroids aren’t effective. Surgical treatment is used in less than 20% of sufferers.
What you can do
Your family doctor may diagnose your vulval pain, but often a referral to a gynaecologist is necessary. While you are waiting for the specialist appointment or for treatment to begin working, the following tips may stop flare-ups and provide relief. Talk about your self-help plans with your doctor.
Diet
In some women, a low-oxalate diet and calcium citrate supplements help to reduce the pain. Oxalates are present in a variety of foods, from spinach to chocolate. Oxalate crystals are acid and may irritate the genital tissues. Calcium citrate reduces the acid in the urine and reduces the passage of oxalates. The low-oxalate diet cookbook A Taste of the Good Life by Bev Laumann is available in the Women’s Health Resources Library.
Clothing and toiletries
Choose cotton underwear and avoid tight clothing. Wash new panties in baking soda before wearing, and stop using fabric softeners. Switching from pantyhose to stockings or socks decreases irritation. Stop using perfumed toiletries or ones containing chemicals. Some women have found that a vaginal douche made with baking soda provides temporary relief. Use unbleached or white toilet paper. If your vulva burns after passing urine, rinse the area with clear water.
Intercourse
Use vegetable oil (such as Canola oil) or lubricants containing glycerine for lubrication. Since contraceptive creams and devices can cause irritation, reconsider your method of contraception. Talk to your doctor about the benefits of using a local anaesthetic ointment. Applying the ointment around the vaginal opening about 15 minutes before sex will increase your level of comfort, as it deadens the surface nerve endings.
General
Because increased pressure on the vulva causes pain, avoid constipation or a full bladder. Change out of wet bathing suits or clothing as soon as possible. A compress made from powdered oatmeal bath treatment can ease symptoms. Mix two tablespoons of powdered oatmeal in a litre of water and refrigerate. Soak a cotton cloth or cotton sanitary pad in the mixture, and apply over the vulva three or four times a day.
For more information and support contact The National Vulvodynia Association at PO Box 4491, Silver Spring, MD 20914-4491 or look on the Web at
www.nva.org