Vulvodynia – painful sensations in the area of the vulva – a complex of female genital organs located outside of the entrance to the vagina. The pain has an acute, dull or itchy character and a long course, which leads to problems in a woman’s intimate life. It is not easy to determine the cause of vulvodynia, since routine gynecological examination (examination on a chair, palpation, smear tests for flora and oncocytology, ultrasound) often do not reveal pathology. Depending on the cause of the pain syndrome, vulvodynia is treated with painkillers, antihistamines, antimicrobials, anti-inflammatory drugs and antidepressants. In some cases, surgical treatment is required.
Vulvodynia is discomfort or soreness in the projection of the vulva, existing for a long time, associated with an infectious process or other disease. The term “vulvodynia” is usually understood to mean any unpleasant sensations in the vulva, including those caused by a fungal, herpetic infection, allergic reaction or physical exposure. Sometimes the cause of vulvodynia cannot be identified – in this case it is regarded as idiopathic and is presented as an exception diagnosis.
Women of childbearing age (average age 25-35 years) suffer from this disorder. According to statistics, from 3 to 10% of women have experienced painful sensations in the vagina or vulva at least once in their lives – symptoms of vulvodynia. Sometimes women are embarrassed to see a doctor because of the sensitivity of the problem. Constant pain in the genital area not only makes you refuse sexual intercourse, but can also cause depression, rejection of your own femininity and sexuality.
Spontaneous and provoked vulvodynia is isolated. In the spontaneous form, unpleasant sensations and pain are present in complete rest – during rest, sleep. Most often, the cause of spontaneous vulvodynia is pathology of the genital nerve (neuropathy, neuritis). Provoked vulvodynia is associated with the appearance or increase of discomfort during sexual intercourse, insertion of a tampon into the vagina, when playing sports, riding, walking or just sitting.
From the point of view of etiology, the following forms of vulvodynia are distinguished: infectious, dystrophic or atrophic, psychogenic, allergic and vulvodynia due to chronic somatic diseases (metabolic disorders, kidney diseases).
Vulvodynia is a symptom of many diseases that have an infectious and non-infectious nature, arising independently or as one of the manifestations of a systemic process. The cause of pain is always an increase in the number of impulses from sensitive nerve endings. Often, vulvodynia is based on neuritis of the genital nerve or vestibulitis – inflammation of small glands located in the vestibule of the vagina. The cause of vestibulitis remains unspecified today. It can be vaginal candidiasis, genital herpes, papillomavirus infection.
Sometimes the trigger factor of vulvodynia is childbirth, gynecological operations (including abortions), aggressive sexual intercourse (rape). In some cases, chronic pain in the genital area has a psychogenic origin. This fact is confirmed by the fact that even after removal of the vestibular glands – the main source of inflammation, vulvodynia (the so-called “phantom pain”) persists. In addition, there is some genetic predisposition to the development of vulvodynia.
The main symptom of vulvodynia is pain. It is acute or permanent, aching in nature, appears at rest or during physical activity. Most often, the location of unpleasant sensations are the labia majora or labia minora, the clitoris and the entrance to the vagina. But sometimes a woman points to pain in the perineum, in the anus.
A typical symptom of vulvodynia is the appearance / intensification of unpleasant sensations when touching the vulvar ring, where numerous glands are located. Sometimes even a light touch with a piece of cotton wool can cause significant suffering. Redness, a feeling of heat, itching and dryness of the vagina do not always accompany vulvodynia, but often obsessive itching can be the equivalent of pain. The pain is always chronic – their duration without treatment can reach up to six months or more.
The diagnostic search begins with a thorough questioning of the woman. The nature of the pain, its duration, connection with sexual intercourse or motor activity is established. The peculiarities of menstruation in the patient (regularity, soreness) are being clarified. The number of pregnancies, births, gynecological, general somatic and allergic diseases is being specified.
After questioning, the gynecologist examines the woman on the chair with the help of mirrors. Be sure to take a smear from the cervix and the posterior arch of the vagina for infectious agents and for cytological examination. With vulvodynia, PCR analysis for HPV and herpes virus, pelvic ultrasound, consultation with an endocrinologist and therapist are prescribed according to indications. If no organic pathology was found during the examination, usually the woman continues treatment with a neurologist, a psychiatrist.
During the treatment period, it is recommended to observe sexual rest and avoid any actions that contribute to the formation of vaginal microtrauma (tampon insertion, active sports). It has been established that a diet with a restriction of foods rich in calcium oxalate (chocolate, strawberries, rhubarb, celery) helps to reduce vulvodynia. An increase in the content of calcium oxalate in the urine is one of the causes of irritation of the vaginal mucosa and vulva, and, therefore, the appearance of unpleasant sensations and pain – symptoms of vulvodynia. If the pain is not acute, it is recommended to carry out special exercises (you can use the Kegel technique) aimed at strengthening weak pelvic floor muscles, relaxing spasmodic muscles. Often, physiotherapy, balneotherapy, and sedentary baths have a good analgesic effect in vulvodynia.
To cure vulvodynia, it is important to consider the cause of its development. Infectious inflammation is stopped by antibiotics and antifungal drugs. Usually medications are applied topically – in the form of vaginal candles and tablets (ternidazole, nystatin, neomycin, osarsol, natamycin). If the process is running or it is impossible to inject the drug into the vagina, an oral or intramuscular route of administration is used. Antiviral agents (acyclovir, inosine pranobex, interferon preparations) are prescribed for herpetic or papillomavirus infection. With dystrophic and atrophic processes in the vaginal mucosa, vaginal creams and candles are used to stimulate the regeneration of the epithelium. If vulvodynia is associated with a lack of female hormones in the menopausal period, hormonal therapy is resorted to.
With itching and pain in the vagina caused by allergies, treatment with antihistamines (chloropyramine, clemastine, cetirizine) is necessary. It is also required to identify and exclude an allergen. To do this, an allergist’s consultation and skin tests are carried out. Severe renal failure or destabilization of blood sugar levels can cause vaginal itching and vulvodynia. In this case, a consultation with a nephrologist or an endocrinologist is required. With the psychogenic nature of pain, vulvodynia is treated together with a psychiatrist. The specialist not only prescribes antidepressant drugs (amitriptyline, hydroxyzine, desipramine), but also conducts courses of psychotherapy.
For any cause of vulvodynia, anti-inflammatory and analgesic drugs (diclofenac, indomethacin, naproxen) are used, as well as multivitamin therapy, herbal sedatives, immunotropic drugs that activate the body’s own defenses. With the ineffectiveness of all therapeutic measures and a clearly limited area of soreness in vulvodynia, surgical treatment is prescribed. The surgeon removes inflamed vaginal glands or areas of hypersensitivity of the skin and mucosa. In some cases, this gives a good result, especially with the parallel use of anti-inflammatory drugs and antidepressants.
Prognosis and prevention
Vulvodynia is an unpleasant symptom of many diseases; it is not dangerous in itself, but it significantly worsens the quality of life and is difficult to treat. To prevent vulvodynia, a woman should be selective in sexual relations, use barrier methods of protection (condom), follow the rules of personal hygiene, undergo regular examination by a gynecologist (at least once every six months). It is recommended to wear underwear made of natural hygroscopic fabrics (cotton, viscose, silk), use hypoallergenic personal hygiene products, be examined by a doctor for chronic diseases, control blood sugar levels, avoid hypothermia and stress.