• What is Vulodynia?
• Causes of Vulvodynia
  
• Symptoms of Vulvodynia
• How to Address the Symptoms of Vulvodynia
  
• Vulvodynia Self Care
  
• Resources for Vulvodynia

What is Vulvodynia?

At least 200,000 women in the United States have Vulvodynia, but experts believe the condition is greatly underrecognized. Some research suggests the disorder may affect as many as one in six women at some point in their lives. There are several reasons Vulvodynia may be underreported. It may be partly due to the absence of visible signs of the condition. Or it could be the reluctance of many women to talk about their symptoms.

Vulvodynia is the term used to describe women who experience the sensation of vulval burning and soreness in the absence of any obvious skin condition or infection. The sensation of burning and soreness of the vulva can be continuous (unprovoked vulvodynia) or on light touch eg. sexual intercourse or tampon use (provoked vulvodynia).

This condition is a cause of vulval burning and soreness usually as a consequence of irritation or hypersensitivity of the nerve fibres in the vulval skin. The abnormal nerve fibre signals from the skin are felt as a sensation of pain by the woman. This type of pain can occur even when the area is not touched.

Another example of nerve-type (neuropathic pain) like Vulvodynia is the pain some people experience with an attack of shingles. Once the rash of shingles has disappeared the area of skin where the rash was can be intensely painful and sore despite the skin appearing normal. The condition is called post-hepatic neuralgia.

Causes of Vulvodynia

Doctors don't know what causes Vulvodynia, but contributing factors may include:

• Injury to or irritation of the nerves surrounding your vulvar region
• Past vaginal infections
• Allergies or a localized hypersensitivity of the skin
• Muscle spasms

Many women with Vulvodynia have a history of treatment for recurrent vaginal yeast infections. Some women with the condition have a history of sexual abuse. Vulvodynia isn't sexually transmitted or a sign of cancer.

Symptoms of Vulvodynia

The pain described by women with unprovoked vulvodynia is often of a burning, aching nature. The intensity of pain can vary from mild discomfort to a severe constant pain which can even prevent you from sitting down comfortably. The pain is usually continuous and can interfere with sleep. As with long-term pain of any cause you can have good days and bad days. Itching is not usually a feature of the condition. The pain in unprovoked vulvodynia is not always restricted to the vulval area (area of skin on the outside of the vagina) and some women get pain elsewhere. This can be around the inside of the thighs, upper legs and even around the anus (back passage) and urethra (where you pass urine). Some women also have pain when they empty their bowels. Unprovoked vulvodynia can have an affect on sexual activity and is associated with pain during foreplay and penetration.

In some women with unprovoked vulvodynia the burning sensation can be generalised over the whole genital area. Alternatively it can be localised to just the clitoris (clitorodynia) or just one side of the vulva (hemi-vulvodynia).

How to Address the Symptoms of Vulvodynia

Treatments for Vulvodynia focus on relieving symptoms. No one treatment works for every woman, and you may find a combination of treatments works best for you. Available options may include:

Medications. Tricyclic antidepressants such as amitriptyline (Elavil) can help lessen chronic pain. This type of antidepressant may work better than some of the other types of antidepressants, such as Prozac or Zoloft, for this condition. Anticonvulsants such as carbamazepine (Tegretol) and gabapentin (Neurontin) also may lessen the pain of vulvodynia. Antihistamines such as hydroxyzine can reduce itching.
Biofeedback therapy. This therapy can help reduce pain by teaching you how to control specific body responses. The goal of biofeedback is to help you enter a relaxed state in order to decrease pain sensation. To cope with Vulvodynia, biofeedback can teach you to relax your pelvic muscles, which can sometimes contract in anticipation of pain and actually cause chronic pain itself.
Local anesthetics. Using medications such as lidocaine can provide temporary relief from the pain.
Topical creams. Creams that contain estrogen or cortisone can help alleviate the pain.
Phytotherapeutic agents. Plant extracts.
Sitz baths. Bathing the area around your external genitals and buttocks in a saline solution can sometimes help make you feel better, but it also has the potential to aggravate your discomfort.

Vulvodynia Self Care

The following tips may help you manage the symptoms of Vulvodynia:
Cold compresses. Cool compresses placed directly on your external genital area may help lessen pain and itching.
Avoid tight fitting pantyhose and nylon underwear. Tight undergarments restrict airflow to your genital area, often leading to increased temperature and moisture that can cause irritation. Wear cotton underwear to increase ventilation and dryness.
Avoid hot tubs. Spending time in a hot tub may lead to discomfort and itching.
Avoid excessive hygiene. Washing or scrubbing the affected area harshly or too often can increase irritation.
Try an antihistamine at bedtime. This may help reduce itching and help you rest better.
Look for triggers and avoid them. The triggers that can make vulvar pain worse tend to be different for each woman. Your observations of what causes you pain are important. Avoid potentially irritating soaps, clothing dyes, creams and bath products.
Work with your doctor. Over time you can work with your doctor to identify the approaches that work best for you.
Exercise and stay active. Regular exercise can help ease chronic pain, but stay away from exercises that put pressure directly on the vulva, such as bicycling.
Accept small steps of progress. Don't expect instant cures. Have confidence that you'll feel better over time.

Resources for Vulvodynia

National Vulvodynia Association
P.O. Box 4491
Silver Spring, MD 20914-4491
Phone: (301) 299-0775
http://www.nva.org