Vaginal Pain (Vulvodynia) Causes, Symptoms and Treatments

Are you frustrated or embarrassed because you are suffering from vaginal pain? Has your sex life been ruined because of the pain you are having during sex? Well, you may have the condition called as Vulvodynia, a fairly common condition seen in young and mid-aged women. Living with vulvodynia can be hard and telling other or doctors about the condition can be even harder. But don’t hesitate to seek help just because you are embarrassed or you don’t have any visible signs. There are several treatment options that can help ease the symptoms.

What is Vulvodynia?

Vulvodynia is a chronic pain and discomfort around the vagina in absence of any obvious sign or infection. Most women describe the pain as burning, stinging, and irritating or a raw feeling. It is thought to occur due to irritation or hypersensitivity of the nerve fibers in the vulval region as a result nerve ending in that area becomes very sensitive and painful. Sexual intercourse, walking, sitting or exercising can make the pain worse. Vulvodynia isn’t sexually transmitted or is a sign of cancer. This condition can last for months to years.

Vulvodynia Symptoms

Although symptoms may differ from individual to individual, commonly encountered symptom is pain. Pain can be associated with the following:

Sharp vaginal pain
Burning vaginal pain
Vaginal pain during sex or after sex
Soreness of vagina
Rawness
Stinging vaginal pain
Throbbing pain
Itching

Some females may just experience an occasional pain, or pain only when the vulva is touched, while for some pain may be constant and may last for months to years. However, in some cases pain may just suddenly go. Pain may be aggravated by sexual intercourse, tampons or when prolonged pressure is applied to the vulva like walking, sitting or exercising. In most cases pain may be localized to vaginal area, but it can also radiate to urinary tract, the buttocks and the upper thigh.

What causes Vulvodynia?

Although exact cause of vulvodynia is not known, several contributing factors play role that are listed below:
Chronic vaginal infection (both bacterial and yeast infections)
Irritation or injury of the nerves surrounding the vulvar region
Chronic allergies
Hormonal changes
Chemical irritation around the vagina (soaps, feminine hygiene products or detergents in clothing)
Previous laser treatments or surgery on the external genitals
Diabetes and precancerous or cancerous conditions on the cervix

It is always better to visit the doctor so he/she can examine you and see if you condition was caused by easily manageable disease like bacterial, fungal or yeast infection in the vagina. Moreover, he/she may perform some tests to rule out other chronic conditions like diabetes.

Home Remedies and Lifestyle changes to minimize Vulvodynia

Always wear 100% cotton underwear and loose fitting clothes (avoid underwear during nights)
Avoid scented or fragranced toilet paper, wipes, soaps, shampoos, bubble bath and detergents
Avoid douching
Always use clean plain water to wash vaginal area
Pat the area dry after washing or bathing and apply good moisturizers
Always rinse the area and pat dry after urination
Never use hair drier on vaginal areas
Use only 100% cotton unscented menstrual pads
During sex apply adequate lubricants and try to find a comfortable position (women on top)
Use icepacks/cool packs to the genital area for soothing comfort (no direct application, wrap with cloth)
Use barrier creams like petroleum jelly before swimming in the pools
Avoid long walking, sitting or any exercise that can have prolonged pressure on vulva
Avoid anxiety and stress

Treatment of Vulvodynia

Because the actual cause of vulvodynia is uncertain, treatment can be very challenging and unsatisfactory. Also, effectiveness of treatment may be experienced only after several weeks and there is no guarantee for complete cure. Several treatment options are being used to treat vulvodynia with varying results. These include topical, oral, and injectable medications, pudendal nerve blocks, physical therapy, dietary modifications, cognitive behavioral therapy, biofeedback training, sexual counseling and surgery. These medications can be used alone or with combination (works well)

Newer treatments with lasers, acupuncture, hypnotherapy, botulinum toxin, and topical nitroglycerin have been tried but with mixed results. Vestibulectomy has been helpful for many patients with localized pain that has not responded to previous treatments

Topical estrogens, nitroglycerin and gabapentin are also being used to treat vulvodynia. Some may try with topical corticosteroids, testosterone, and antifungals but are not useful.

Prescription medications like amitriptyline (tricyclic antidepressants) may help relieve the pain of vulvodynia in women. Your doctor may prescribe with low dose slowly increasing till the symptomatic relief. Other medications like anticonvulsants (gabapentin and pregabalin) can also help relief the pain in vulvodynia. It may take up-to 3 weeks for both medications to reach its full effectiveness.
Also, as stress and anxiety is thought to be one of the causative factor of vulvodynia, managing stress might help ease the symptom.

Biofeedback and physical therapy for vulvodynia

Biofeedback and physical therapy are also being used for the management of vulvodynia. In addition to other pain management options, physical therapy can be quite effective. If done properly as advised by your doctor or specialist you can experience much improvement in sexual function and symptomatic relief, as a whole improvement in quality of life. This physical therapy includes the following:

• Internal and external soft tissue mobilization and myofascial release
• Trigger-point pressure
• Active pelvic floor retraining
• Bladder and bowel retraining
• Electrical stimulation
• Visceral, urogenital, and joint manipulation
• Therapeutic exercises
• Therapeutic ultrasound
• Home vaginal dilation
• Instruction in dietary revisions

Acupuncture

Although accupunture has shown good result in pain management, it is less effective in case of vulvodynia. Studies show no significant difference in pain after treatment.

Laser therapy for vulvodynia
Laser therapy is the most popular treatment options for several diseases with good results, but not in the case of vulvodynia.

Vulvodynia and Sex

As most women with vulvodynia may find sex impossible, there are few things that can be tried for relief. You may apply over the counter lubricants to the area that help moisturize the area and also fascilate the sex. Applying topical anaesthetic gel prior to sex can also help with sexual function, but some women may find it irritating. If you are applying condom wipe the area before sex.

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