Vulvodynia - Definition - Prevalence - Treatment

What is vulvodynia?

Vulvodynia (recently classified as dysaesthetic vulvodynia) has much in common withvulvar vestibulitis but the pain and burning, instead of provoked by touch or pressure, is constant. Although the skin appears normal, the nerve fibres in the vulval skin may be damaged or irritated causing pain, burning and aching regardless of touch or pressure. The pain can affect other sites, such as the anal area, and some women experience pain when emptying their bowels. If pain of vulvodynia extends into the clitoris it is referred to as Clitorodynia.

The term vulvodynia can be very confusing. In 1991, the International Society for the Study of Vulval Diseases redefined the term to describe women with unexplained chronic vulval discomfort characterised by burning, stinging, irritation and rawness, i.e. vulval vestibulitis and dysaesthetic vulvodynia.

Like vestibulitis, vulvodynia is diagnosed after all other causes of similar symptoms have been excluded. Treatment can include the same anaesthetic jellies and soothing emollients as for vestibulitis.

Women with vulvodynia avoid sexual intimacy for fear of pain during intercourse.

Adverse life experiences, including conflict, are common in women with vulvodynia. These factors may be important in mediating the genesis of pain through stress-related mechanisms. Sexual interest is diminished in these women. Sexual abuse is not a factor in most of these women.⁰⁸⁰¹

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How can my vulvodynia be treated?

Avoid using soap, bubble bath, antiseptic, scented shower gels and other perfumed products on the delicate vulval skin. Do not scrub with flannels, just gently clean with water only. Topical steroid creams may prove helpful.

Sometimes mild antidepressants such as amitriptyline 25 mg at night may assist with sleep and this often seems to alleviate symptoms. side effects, including fatigue, dizziness, dry mouth and constipation, tend to resolve after a couple of weeks. Increasing your fluid intake and changing to a high fibre diet overcome some of these problems. When an antidepressant is prescribed as part of the treatment for pain it does not mean that your doctor is attributing your pain to a psychological problem. The dose of an antidepressant used for pain is much lower than in the treatment of depression.

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