Treatment Of Vulvodynia
Medications, Therapies And Surgery To Treat Vulva Pain

OB/GYN problems


Vulvodynia Treatment

Contents

How Is Vulvodynia Treated?
Summary Of Treatment Options
Low Oxalate Diet

How Is Vulvodynia Treated?

Not all women seek treatment for vulvodynia. Instead they adapt to the condition by avoiding triggers, for example by not practicing certain sexual positions and using menstrual pads instead of tampons. Research indicates that it may eventually, in some cases, disappear naturally. However evidence suggests that those who do seek treatment can expect improvement in their condition more quickly.

Summary Of Treatment Options

Treatment Purpose Start Dosage Continued Dosage Side Effects Precautions
Oral Therapies
Amitriptyline (Elavil) tricyclic antidepressant Reduces tissue sensitivity 25mg at night for 10 days then 50mg a day. 50-100 mg (higher doses up to 225 mg are occasionally successful) Fatigue and dry mouth (common); weight gain and constipation (less common). Older patients should be started on lower doses.
Calcium citrate To reduce oxalate levels in the tissues 2 tablets twice a day. 2-4 tablets twice a day. Very little. Generally combined with other treatments.
Desipramine (Norpramin) antidepressant. Decreases tissue sensitivity. 25mg at night for 10 days then 50mg a day. 50-100 mg (higher doses up to 225 mg are occasionally successful) Same as Elavil, but less frequently. Older patients should be started on lower doses.
Gabapentin (Neurontin) traditionally used to treat seizures and nerve pain caused by herpes. Decreases tissue sensitivity. 300mg a day, increasing every 5 days by another 300mg (to dosing 3 times a day) 300mg x3 times daily up to a maximum of 900mgx3 times daily (total, 2,700mg) Fatigue, nausea, vomiting, dizziness (usually passes quickly and is mild)  
Paroxetine (Paxil) antidepressant. Decreases tissue hypersensitivity. 10mg once a day. 20-60mg once a day. Weight gain and fatigue, but rarely. Medication should be stopped gradually.
Venlafaxine (Effexor) used to treat major depression. Decreases tissue hypersensitivity. 37.5mg a day. 75 to 150 mg a day. Digestive problems, anxiety. Your blood pressure, cholesterol and electrolyte levels need to be checked regularly.
Diet Therapy
Low Oxalate Diet Reduces oxalate levels in the vulva tissue. Avoidance of a list of certain high oxalate containing foods (list below)     It should only be continued if a clear benefit is noted. The role of oxalates in vulvodynia is still controversial.
Surgery
Perineoplasty - also called vestibulectomy Surgical removal of most sensitive part of the vulva tissue.     Healing can be slow, although the procedure is usually successful. Only useful if pain is limited to a specific part of the vulva (vulvar vestibulitis). Surgery is usually a treatment of last resort.
Topical Therapies
Lidocaine gel or cream (5 percent) such as Lidamantle or Xylocaine Acts like a local anesthetic to reduce hypersensitivity Apply it to the affected area. As needed before intercourse or nightly on a cotton ball placed inside the vagina.    
Cromolyn cream (4 percent) Helps reduce local inflammation. Apply 3 times a day. Continue 3 times a day.    
Alternative Therapies
Biofeedback training Improves control over muscles in the vulva area. After evaluation by a biofeedback therapist you will be given exercises to practice daily at home. Continue exercises for 16 weeks. You will need between 6 and 16 sessions with your therapist. May be some discomfort. You will need a biofeedback home electromyographic monitor.
Cognitive behavioral therapy Increases the patient's understanding of their condition and encourages them to find ways to minimize symptoms. 8 x 2 hour group sessions over 12 weeks.     May need therapy for up to 18 months.

Low Oxalate Diet

Although still controversial, there is some evidence to indicate that abnormally high levels of calcium oxalate crystals in the blood and urine can lead to vulva pain (and perhaps even other gynecological disorders). Reducing these levels by avoiding foods that contain oxalate and taking calcium citrate tablets (to lower levels) may help ease your symptoms.

Foods High In Oxalate Moderate Amounts
Baked beans in tomato sauce.
Beans
Beer
Beets
Berries
Berry Juices
Black pepper
Celery
Chocolate
Citrus peel
Eggplant
Fruit cake
Green peppers
Grits
Kale
Leeks
Ovaline
Peanuts
Pecans
Rhubarb
Spinach
Squash
Sweet potatoes
Tea
Tofu
Vegetable and tomato soup
Wheat germ
Apples
Apricots
Asparagus
Black currants
Broccoli
Carrots
Chicken soup
Coffee
Corn
Cornbread
Cranberries
Green peas
Iceberg lettuce
Oranges and juice
Parsnips
Peaches
Pears
Pineapples
Plums
Sardines
Spaghetti sauce
Sponge cake
Tomato sauce
Tomatoes
Turnips
Related Articles on Gyno Problems

For more advice see the following:

Reproductive system disorders: List of common reproductive disorders and symptoms.
Vulvitis: Symptoms of vulva inflammation and soreness.
Painful intercourse: Causes, diagnosis and treatment.

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