Vulvodynia - AbsoluteAstronomy.com

Vulvodynia is a chronic pain

Chronic pain

Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...

syndrome that affects the vulvar area and occurs without an identifiable cause or visible pathology categorized in the ICD-9 group 625—specifically ICD-9 625.7, which is for pain and other disorders of the female genital organs. It refers to pain of the vulva

Vulva

The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....

unexplained by vulvar or vaginal infection or skin disease.

The term "vulvodynia" simply refers to "vulvar pain", and does not imply a specific cause.

Symptoms

Pain is the most notable symptom of vulvodynia, and can be characterized as a burning, stinging, irritation or sharp pain that occurs in the vulva

Vulva

The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....

, including the labia and entrance to the vagina

Vagina

The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...

. It may be constant, intermittent or happening only when the vulva is touched, but vulvodynia is usually defined as lasting for years.

Symptoms may occur in one place or the entire vulvar area. It can occur during or after sexual activity, when tampons are inserted, or when prolonged pressure is applied to the vulva, such as during sitting, bike riding, or horseback riding. Some cases of vulvodynia appear random where no particular cause can be determined.

Vulvar vestibulitis

Main article: Vulvar vestibulitis

Vulvar vestibulitis

Vulvar Vestibulitis Syndrome , vestibulodynia, or simply vulvar vestibulitis is vulvodynia localized to the vulvar region. It tends to be associated with a highly localized “burning” or “cutting” type of pain....

Vulvar Vestibulitis Syndrome (VVS), vestibulodynia, or simply vulvar vestibulitis is vulvodynia localized to the vulvar region. It tends to be associated with a highly localized “burning” or “cutting” type of pain. The pain of vulvodynia may extend into the clitoris; this is referred to as clitorodynia.

Vulvar Vestibulitis Syndrome (VVS) is the most common subtype of vulvodynia that affects premenopausal women - the syndrome has been cited as affecting about 10%–15% of women seeking gynecological care.

Possible causes

A wide variety of possible causes and treatments for vulvodynia are currently being explored. The condition is one of exclusion and other vulvovaginal problems should be ruled out.

Possible causes include: genetic predisposition to inflammation, allergy or other sensitivity (for example: oxalates in the urine), an autoimmune disorder similar to lupus erythematosus

Lupus erythematosus

Lupus erythematosus is a category for a collection of diseases with similar underlying problems with immunity . Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, and lungs...

or to eczema

Eczema

Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...

or to lichen sclerosus

Lichen sclerosus

Lichen sclerosus is an uncommon disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin....

, infection (e.g., yeast infections, bacterial vaginosis

Bacterial vaginosis

Bacterial vaginosis or less commonly vaginal bacteriosis is a disease of the vagina caused by bacteria. The U.S. Centers for Disease Control and Prevention states it is not clear what role sexual activity plays in the development. However, it is known that BV is associated with having a new sex...

, HPV), injury, and neuropathy--including an increased number of nerve endings in the vaginal area. Some cases seem to be negative outcomes of genital surgery

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

, such as a labiectomy.

Diagnosis

The condition is one of exclusion and other vulvovaginal problems should be ruled out. The diagnosis is based on the typical complaints of the patient, essentially normal physical findings, and the absence of identifiable causes per the differential diagnosis. A cotton “swab test” is used to delineate the areas of pain and categorize their severity. Patients often will describe the touch of a cotton ball as extremely painful, like the scraping of a knife.

Many sufferers will see several doctors before a correct diagnosis is made. Many gynecologists are not familiar with this family of conditions, but awareness has spread with time. Sufferers are also often hesitant to seek treatment for chronic vulvar pain, especially since many women begin experiencing symptoms around the same time they become sexually active. Moreover, the absence of any visible symptoms means that before being successfully diagnosed many patients are told that the pain is "in their head".

Differential diagnosis

Infections: candidiasis
Candidiasis
Thrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...

, herpes, HPV
Inflammation: lichen planus
Lichen planus
Lichen planus is a chronic mucocutaneous disease that affects the skin, tongue, and oral mucosa. The disease presents itself in the form of papules, lesions, or rashes. Lichen planus does not involve lichens, the fungus/algae symbionts that often grow on tree trunks; the name refers to the dry and...
Neoplasm: Paget's disease
Extramammary Paget's disease
Extramammary Paget’s disease , also Extramammary Paget disease, is a rare, slow-growing, usually non-invasive intraepithelial adenocarcinoma outside of the mammary gland and includes Paget's disease of the vulva and the extremely rare Paget's disease of the penis...

, vulvar carcinoma
Neurologic disorder: neuralgia
Neuralgia
Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central...

secondary to herpes virus, spinal nerve injury

Treatment and disease management

There is no uniform treatment approach for vulvodynia or vulvar vestibulitis. Women have shown improved symptoms from a variety of treatments. Some find 100% relief from particular treatments, while others may experience only temporary or partial relief. Responses to the various and many treatments being tried are highly variable, with many patients often trying several treatments over the course of their diagnosis depending upon their levels of relief, the preferred method(s) of their doctor(s), and the affordability of these treatments; many treatments are still experimental and often not covered by health insurance — or the particular doctor using them does not take insurance. Treatments include:

Over the Counter Care: Wearing cotton
Cotton
Cotton is a soft, fluffy staple fiber that grows in a boll, or protective capsule, around the seeds of cotton plants of the genus Gossypium. The fiber is almost pure cellulose. The botanical purpose of cotton fiber is to aid in seed dispersal....

underwear (no synthetics); avoidance of vulvar irritants (douching, shampoos, perfumes, laundry detergents); gently wash the vaginal area and labia with cool water only - using a washcloth is most effective - but do not use soap; cotton menstrual pads; rinsing and patting dry the vulva after urination
Urination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...

; using a pad when sitting to alleviate pressure.
Lubrication: (for intercourse or used daily to minimize irritation) If you have problems with yeast, or are worried you will, avoid lubricants with glycerine in them, which acts like a sugar and will only add to your problems. Neem oil is a good topical treatment for irritation that is also anti-fungal so very safe if you are prone to yeast, and Astroglide and Pjur water-based lubricant are often suggested by doctors. Vitamin E and olive oil can also create bacterial growth so avoid using them topically.
Diet: Following a low-oxalate
Oxalate
Oxalate , is the dianion with formula C2O42− also written 22−. Either name is often used for derivatives, such as disodium oxalate, 2C2O42−, or an ester of oxalic acid Oxalate (IUPAC: ethanedioate), is the dianion with formula C2O42− also written (COO)22−. Either...

diet may help those whose urine oxalate levels are high and may be causing or exacerbating irritation. The level of oxalates can be tested by taking a 24-hour urine sample. Those following a low-oxalate diet often take a calcium citrate supplement. There is no evidence that this diet helps sufferers with normal oxalate levels in their urine.
Alternatives to Penetration: Sufferers are often encouraged to explore sexual activity besides penetrative intercourse, which is often a major source of pain. Patients may seek the assistance of a sex therapist to learn specific techniques and ways to maintain a positive image of sexual intimacy and one's body.
Education and accurate information about Vestibulodynia: Gynaecologist-led educational seminars delivered in a group format have a significant positive impact on psychological symptoms and sexual functioning in women who suffer from Provoked (caused by a stimulus such as touch or sexual activity) Vestibulodynia.
Medications: Patients have found variable success using topical creams and gels including estrogen and/or testosterone, often specially made through a compounding pharmacy; oral medicines including testosterone, antidepressants also used for pain disorders (e.g., nortriptyline, amitriptyline), and anti-anxiety drugs; and injectable medications including anesthetics, estrogens, tricyclic antidepressants compounded into a topical form or systemic, local steroids.
Biofeedback
Biofeedback
Biofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...

, Physical Therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...

and Relaxation: Biofeedback, often done by physical therapists, involves inserting a vaginal sensor to get a sense of the strength of the muscles and help a patient get greater control of her muscles to feel the difference between contraction and relaxation. Sessions are linked with at-home recommendations including often Kegel exercises (e.g., hold for 9 seconds, relax for 30 for 10-15 sets) and relaxation (breathing deep into the gut). Other physical therapy involves direct manipulation of the muscles; the therapist may go inside the vagina and physically press on and stretch the muscles. (One may practice stretching along with Kegel's at home using a dilation kit or series of different size dildos. This is a common treatment for those suffering primarily from vaginismus, but may also help individuals with vaginismus that results from and worsens preexisting pain.) Other therapists encourage strengthening one's core muscles, believing that the pelvic region overcompensates for the work the core muscles should be doing, causing strain and pain.
Injection: This may be performed under CT, flurosocopy/C-arm or ultrasound guidance where the pudendal nerve
Pudendal nerve
The pudendal nerve is a sensory and somatic nerve in the pelvic region which is a large branch of the sacral plexus that innervates the external genitalia of both sexes, as well as sphincters for the bladder and the rectum...

is identified in its canal (where it is commonly compressed). Usually cortisone and local anaesthetic is injected and in rare cases, the nerve may be destroyed (ablated), if the pain is severe and unrelenting. In the latter instance, the trade off is permanent vulval numbness.
Surgery: Vestibulectomy. During a vestibulectomy, the innervated fibers are excised. A vaginal extension may be performed, in which vaginal tissue is pulled forward and sewn in place of the removed skin. The success rate of a vestibulectomy varies from a low of 60% to as high as 93%. There are over 20 studies citing a success rate greater than 80%.

Mental health

Like many other people suffering from pain disorders, those afflicted with vulvodynia may often be impacted by the frustration of finding a diagnosis, subsequently confronted with an area of medicine that is still in relative infancy. The cause is still unknown and treatment success varies. Therefore, many become frustrated and sometimes depressed with a lower quality of life.

Vulvodynia in the media

In Season 4, Episode 2 "The Real Me" of Sex and the City
Sex and the City
Sex and the City is an American television comedy-drama series created by Darren Star and produced by HBO. Broadcast from 1998 until 2004, the original run of the show had a total of ninety-four episodes...

, Charlotte is diagnosed with vulvodynia and prescribed antidepressants. This episode was received with much criticism, notably from the National Vulvodynia Association, which objected to the portrayal of the condition as a fleeting, minor condition. Season 1, Episode 3 ("In Which Addison Finds the Magic") of Private Practice includes a couple seeking treatment for vulvar vestibulitis and vaginismus

Vaginismus

Vaginismus, sometimes anglicized vaginism, is the German name for a condition which affects a woman's ability to engage in any form of vaginal penetration, including sexual intercourse, insertion of tampons and/or menstrual cups, and the penetration involved in gynecological examinations...

.

Susanna Kaysen

Susanna Kaysen

-Life:Susanna Kaysen was born and raised in Cambridge, Massachusetts. She is the daughter of economist Carl Kaysen, a professor at MIT and former advisor to President John F. Kennedy, and his wife Annette Neutra Kaysen. Kaysen has one sister and is divorced...

, well known for her novel, Girl, Interrupted
Girl, Interrupted
Girl, Interrupted is a best-selling 1993 memoir by American author Susanna Kaysen, relating her experiences as a young woman in a psychiatric hospital in the 1960s after being diagnosed with borderline personality disorder...

, and its film adaptation, has also published The Camera My Mother Gave Me, a novel concerning her own experience with vulvodynia and its debilitating symptoms.

Vulvodynia was featured in the TLC documentary television series Strange Sex
Strange Sex
Strange Sex is a 6-part TLC documentary television series produced by Sirens Media about sexual dysfunction that premiered on 18 July 2010...

episode "Pleasure and Pain".

Vulvodynia (and female sexual dysfunction) was featured in the season 9 True Life
True Life
True Life is a documentary series running on MTV since 1998. Each episode follows a particular topic, such as heroin addiction as in the first episode, "Fatal Dose." The show is created by following a series of subjects by a camera crew through a certain part of their lives.-Topics covered:True...

episode "I Can't Have Sex."

External links

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