Vulvodynia: Causes, Symptoms, Diagnosis, Treatment and Complications

Vulvodynia is the term for persistent pain or discomfort in the area surrounding the vulva, the external portion of the female genitalia. It has no known cause and lasts for three months or longer. Vulvodynia can cause such intense pain, burning, or itching that it is difficult to remain still or engage in sexual activity. The illness may not go better for months or even years.

It's crucial to discuss your vulvodynia symptoms with your gynaecologist or another medical expert. Don't let the lack of symptoms or embarrassment stop you. Your discomfort may go away with treatment. Your healthcare providers might be able to determine what's causing your suffering. That's why getting a medical assessment is crucial.

Causes Of Vulvodynia

The aetiology of vulvodynia is unknown to experts. The following are some of the variables that might matter:

• Damage or irritability to the nerves of the vulva.
• Previous infection of the vagina.
• The vulva is swollen painfully when there is inflammation.
• Specific genetic illnesses.
• Allergy symptoms.
• Hormone changes.
• Uterine, bladder, and colon-supporting pelvic floor muscles become weaker or spasm.

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Symptoms Of Vulvodynia

Pain in the vulva, which affects the vaginal entrance, is the main indicator of vulvodynia. The discomfort is often characterised as follows:

• Burning.
• Intense
• Piercing pain like a knife.
• Soreness
• Edoema.

Every individual has a unique set of symptoms, varying in frequency and location. You can experience persistent pain that doesn't go away. Only if the vulva is touched might it erupt. Your vulva might feel the pain from beginning to end. This is known as generalised vulvodynia. 

Alternatively, the area around the vestibule at the entry of the vagina may experience an abrupt onset of intense discomfort. This is known as localised vulvodynia, and it is more common than generalised vulvodynia.

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Diagnosis Of Vulvodynia

If you have vulvodynia, your gynaecologist or another member of your care team may inquire about your past sexual and medical history. They'll also ask if you have any prior surgical experience.

You might have a:

• Examination of the Pelvis: We examine your external genitalia and vagina to check for signs of infection or other potential causes of your symptoms. To check for bacterial or yeast infections, a sample of your vaginal cells can be required. Your healthcare professional may also insert a gloved finger inside your vagina to feel for any pain in the pelvic floor muscles.
• Examination using a cotton swab: To feel for particular sore places in your vulva, you use a moistened cotton swab. If a sore site is found, you will likely be asked about its level of discomfort and its sensation.
• Biopsy: Your gynaecologist or doctor may remove a small sample of tissue for laboratory analysis if the vulva's skin seems abnormal.
• Analysis of blood: You could have your levels of oestrogen, progesterone, and testosterone measured.

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Treatment Of Vulvodynia

Relief from symptoms is the aim of vulvodynia therapy. Not every treatment works every time. Most of the time, a mix of therapy works well. It could take some time to find the perfect combination. Moreover, recovery may take several months.

Medications

Your healthcare team may recommend drugs such as:

• Antidepressants or convulsants: These might offer persistent pain alleviation. Some antidepressants can be used topically as creams.
• Localised anaesthesia: These strong drugs have a transient analgesic effect. For example, you might use lidocaine lotion on your vulva 30 minutes before sexual activity to make it more comfortable. After having sex, this drug may cause your partner to feel cold for a short while.
• Nerve obstructions: These injections are given in proximity to a nerve or group of nerves that are sensitive to pain. They might be useful if you have persistent pain that doesn't improve with other therapies.
• Hormone creams: If hormonal variations are the cause of your problems, applying oestrogen lotion to your vagina may help ease them. Occasionally, it is given in addition to cream containing testosterone.
• Antihistamines: These drugs, commonly used to treat allergies, may also reduce itching associated with vulvodynia. Antihistamines, however, may be drying if you have passed menopause.

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Therapy

Physical therapy employs a variety of techniques that may lessen your discomfort and improve your quality of life. Some of them are:

• Therapy for the pelvic floor: Those who suffer from vulvodynia frequently have stiff pelvic floor muscles, which support the uterus, bladder, and intestine. Stretches and relaxation techniques for those muscles may help with vulvodynia pain. Furthermore, you could be advised to use a vaginal dilator at home by your physical therapist. This causes the vagina to stretch and get aroused. Additionally, it may reduce the fear of feeling uncomfortable during sexual activity.
• Biofeedback: You can learn to relax your pelvic muscles with this mind-body technique, which can help lessen pain. Additionally, it might teach you how to control how your body responds to the symptoms.
• Talk therapy includes working with a therapist who can teach you coping skills for your discomfort. As illustrations, think about:
• Behavioral and cognitive intervention: This technique helps you recognise negative thoughts and generate positive answers. You will likely be encouraged to document your daily hardships as well. You note in your notebook when you experience vulvodynia symptoms and what seems to improve or exacerbate them.

Sometimes, interpersonal issues or painful past experiences are linked to vulvodynia pain. Individuals can also get through these challenges with the help of therapy

• Couples counselling or sexual therapy: In ways that divert attention from sex, a therapist can assist you and your partner in strengthening your bond and improving your communication. Along with advice on how to overcome your fear of getting wounded during sex, you might learn this.

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Surgery

Surgery may be an effective treatment option if you feel pain in the tissue surrounding your vaginal opening, or vestibule. Usually, surgery is reserved for the last possible circumstances.

It is possible to surgically remove the unpleasant vestibule tissue from the vulva. A vestibulectomy is the name given to the procedure. If you suffer vulvodynia symptoms in other vulva parts, surgery is generally not a good course of treatment for you.

If you are thinking about having the operation, ask your medical team to go over the benefits and drawbacks with you. Sometimes after surgery, there are scars or severe pain.

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Complications Of Vulvodynia

Untreated vulvodynia can have a severe effect on your relationships, mental health, and other aspects of your life.The condition has been associated with depression and anxiety. It also seems to be related to decreased arousal, desire, and satisfaction of sexual relations. 

Fear of uncomfortable sex can cause a problem called vaginismus, which is characterised by spasms in the muscles surrounding the vagina. Due to intimacy difficulties such as these, many people with vulvodynia report feeling inadequate in a sexual partner, low self-esteem, embarrassment, and bad body image.

The discomfort associated with vulvodynia and other symptoms may make it more difficult to continue working productively. Also, you may feel less social. Furthermore, it may be difficult for you to get a good night's sleep.

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