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Vulvodynia

Alternate Names

  • essential vulvodynia
  • pudendal neuralgia
  • chronic essential vulvar pain

Definition

Vulvodynia is the medical term for pain in a woman's vulva, the external genital region. The term is generally reserved for chronic pain in the vulva.

What is going on in the body?

The vulva is a general term for the external part of a woman's genitals. The vulva includes the area of skin directly above the vagina, the clitoris, the inner and outer labia or lips of the vagina, the opening to the vagina, and the urethra. The urethra is the tube that carries urine from the bladder to the outside of the body.
Pain in the vulva can be due to many known conditions. These include infection, inflammation, nerve sensitivity, growths, injury, and allergic reactions to medications, soaps, or feminine products. When no specific cause can be found, the problem is called vulvodynia.

Risks

What are the causes and risks of the condition?

Though different theories exist as to why this condition occurs, the exact cause is unknown. Vulvodynia occurs most often in middle-aged white women. The most important consequences of this condition are pain, trouble having intercourse, and depression. True vulvodynia does not result in any physical health risks and is not related to cancer.

Prevention

What can be done to prevent the condition?

There are no ways known to effectively prevent this condition.

Diagnosed

How is the condition diagnosed?

Before a diagnosis of this condition can be made, treatable causes of pain in the vulva must be ruled out by a careful history and physical exam. The healthcare professional may:
  • take swabs of the vulva to check for infections
  • suggest that the person stop using soap, fabric softeners, scented toilet paper, and any feminine products to make sure there is no allergic reaction causing the pain
  • prescribe certain medications, such as antibiotic pills or ointments, to treat a possible underlying infection
  • take a biopsy of the vulva. This is a procedure to remove a small piece of tissue from the vulva. This tissue can then be looked at with a microscope.
If these tests and procedures do not reveal a cause for the pain, vulvodynia is generally diagnosed.

Long Term Effects

What are the long-term effects of the condition?

There are no long-term physical effects from this condition. Affected women may become frustrated or depressed, however, and their relationships may suffer.

Other Risks

What are the risks to others?

There is no risk to others, because this is not a contagious condition.

Treatments

What are the treatments for the condition?

There is no known cure for this condition. Many different types of treatment may be tried. Different women respond to different treatments, and some women do not respond at all.
Common treatments include:
  • avoidance of soaps and other products that may irritate the area
  • special diets, such as a diet low in oxalate. Oxalate is found in many different foods, such as celery and grapes.
  • local "numbing" creams, which can be used before sex to reduce discomfort in some women
  • antidepressant drugs, such as amitriptyline or fluoxetine, which work for pain as well as for depression
  • chronic pain drugs, such as gabapentin, a drug sometimes used to treat seizures
  • biofeedback. This is a process by which people learn to control certain body functions of which they are not usually aware. For instance, women can be taught to reduce muscle spasms in the vagina.
  • support groups, which help women deal with their frustration by meeting others with a similar problem
  • surgery, which is only used for severe cases that do not respond to any other treatments
Treatment must be tailored to each woman. Many women get better eventually, even without treatment.

Side Effects

What are the side effects of the treatments?

All medications have possible side effects. These include allergic reactions, stomach upset, and others. Specific side effects depend on the drugs used. Surgery carries a risk of bleeding, infection, scarring and reaction to any pain medicines used.

After Treatment

What happens after treatment for the condition?

No treatment is guaranteed to be effective. Many women go through many treatments before they find one that works for them. The course of the condition is unpredictable. Some women have symptoms that come and go, whether treatment is used or not.

Monitor

How is the condition monitored?

Women generally monitor their symptoms at home. They should report any changes to their healthcare professional.

Sources

National Vulvodynia Association website: [hyperLink url="http://www.nva.org/" linkTitle="www.nva.org"]www.nva.org[/hyperLink]

Kistner's Gynecology, 1990, Ryan et al.

American Academy of Family Physicians website: [hyperLink url="http://www.aafp.org/" linkTitle="www.aafp.org"]www.aafp.org[/hyperLink]

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