Chronic Vulvovaginal Pain
“External and sometimes vaginal itching, burning, rawness and irritation that can be worsened by wiping, wearing tight clothing, sexual intercourse, cycling, or inserting a tampon.”
For some it may come and go but for others it may be constant and relentless. These are some of the ways women describe their chronic vulvovaginal pain. Historically, the causes of vulvovaginal pain have not been well understood. With the recent emphasis on studying women’s health problems, the National Institute of Health has begun allocating funds for research on this topic. As women’s healthcare providers, we are finally benefiting from the new information coming out of these studies and are integrating it into our practice to provide better diagnosis and treatment for our patients with chronic vulvovaginal pain.
The key to treating chronic vulvovaginal pain is to get an accurate diagnosis and to develop an individualized treatment plan using all of the tools that we have available. There are many causes of vulvovaginal pain and it is important to take a systematic approach to ruling out the many different causes of vulvovaginal pain and to focus in on the specific cause of each woman’s symptoms.
Causes of vulvovaginal pain can include:
To better understand vulvodynia and vestibulodynia, we looked at other areas of medicine and chronic pain and found that the excessive pain and burning to light touch that women with vulvodynia and vestibulodynia have, with no abnormal findings of exam, were similar to people with phantom limb pain. Patients with amputation of a limb often have hyperalgia or excessive pain when the normal healed skin of the amputation is touched and allodynia or pain with touch that is normally pleasurable. The similarities between these and other forms of chronic pain led to the theories that vulvodynia and vestibulodynia are pain disorders that come from abnormal pain circuits that develop in the central nervous system, through a process called central sensitization. Vulvodynia is most likely from a nerve injury and vestibulodynia is most likely from nerve irritation.
Treatments for these conditions can include avoiding vulvar irritants and possibly some dietary changes. Physical therapy with biofeedback and pelvic floor rehabilitation is an important part of treatment. Medications, both topical and oral forms of tricyclic and other antidepressants, and seizure medications are often used for their pain relieving effects on those abnormal pain circuits. Topical estrogens and local numbing medications are also used as out nerve blocks and injected steroids. In women with vestibulaodynia only, if there is no improvement in symptoms after all medical treatments have been tried, then surgical treatment with vestibulectomy or perineoplasty can be effective.
If you would like more information about this topic, please refer to The V Book: A Doctors Guide to Vulvovaginal Health, written by Dr. Elizabeth Stewart. It was written for women having vulvodynia or vestibulodynia, and Dr. Stewart makes this very complex subject understandable. This is also beneficial information for spouses and significant others of women experiencing these problems.
The National Vulvodynia Association is a very active support group for women with chronic vulvovaginal pain. The organization publishes an associated newsletter with helpful information on the topic.
National Vulvodynia Association
PO Box 4491
If you are having symptoms of chronic vulvovaginal pain and would like to be evaluated, please call 502.891.8700 to schedule an appointment.