Persistent Pain In The Vulva

OB/GYN problems



What Is Vulva Pain?
What Are The Symptoms?
What Causes It?
How Is It Diagnosed?
How Is Vulvar Pain Treated?
What Is The Outlook?

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Gynecological Disorders
The Female Body
What Is Vulva Pain?

Pain or discomfort in the vulvar area that lasts more than 3 months may be diagnosed as vulvodynia. Vulvodynia is characterized by pain which ranges from mild to severe. It is usually present during or after intercourse and other factors may exacerbate it such as inserting a tampon or riding a bike. In some women the pain comes out of the blue while in others it is persistently in the background. The cause of vulvodynia has not been identified but examination of tissue from the affected area under a microscope usually reveals chronic inflammation without evidence of allergy. For years vulvodynia was dismissed as a 'being in the head' condition because there is no obvious physical cause or cure. Some women spent years going from doctor to doctor looking for a diagnosis of their nameless disease. Many were diagnosed incorrectly with other vulva disorders and underwent painful and unnecessary laser or electrocautery surgery. And others were dismissed as being 'frigid' and accused of not embracing their womanhood. It was only in 1983 that recognition of vulva pain and the effects it has on the lives of women all over the world led to the adoption of the term “vulvodynia” by the International Society for the Study of Vulvovaginal Diseases (ISSVD). Even today however, some doctors work on the assumption that vulvodynia symptoms are rooted in the emotions, despite growing evidence that it is physical (although the cause has not yet been identified).

Vulvodynia Pain

Factors that make pain worse
Factors that relieve pain
Intercourse (91 percent of cases)
Tight clothes (57)
Partner touch (56)
Riding a bicycle (42)
Use of tampons (40)
Prolonged sitting (28)
Loose clothing (38 percent)
Not wearing underwear (32)
Applying ice to the area (25)
Doing something to keep your mind off it (19)
Lying down (19)

What Are The Symptoms?

It is estimated that up to 200,000 American women suffer from vulvodynia, often to point where their family and work life suffer. The symptoms include:

• Burning, painful stinging sensation in the vulva. Ranges from mild to severe.
• May be itching but whether this is symptom of vulvodynia remains controversial.
• Pain can begin suddenly when provoked (by intercourse for example). It can take hours to days to dissipate (particularly after intercourse or a pelvic examination). It is not relieved by painkillers.
• Pain may be constantly in the background but worsen with provocation.

What Causes It?

Vulvodynia is a complex condition, the cause of which has not yet been identified. It may stem for a number of different physical causes such as:

• Chronic herpes infection.
• Autoimmune response to the HPV virus.
• High levels of calcium oxalate crystals in the blood and urine.
• Disturbances of brain chemicals (neurotransmitters) which makes the patient more sensitive to pain.

Scientists who argue that vulvodynia is emotionally based point to the fact that the condition is more prevalent in depressed or suicidal women. The counter argument to this of course is that any chronic pain which is undiagnosed and untreated is a logical cause of depression. Its a chicken and egg situation.

How Is It Diagnosed?

A diagnosis of vulvodynia can only be made after ruling out other possible causes, including:

• Recurrent yeast infection (also known as a thrush infection).
• Recurrent herpes (simplex) infection.
• Allergic reactions to something touching the vulva such as bubble bath or soap.
• Drop in estrogen hormone levels caused by menopause, childbirth or breastfeeding.
• Lichen sclerosus or lichen planus (skin conditions that can cause intense soreness and irritation of the vulva).
• Behcet's disease (a blood vessels disease that can cause genital ulcers).
• Sjogren's syndrome (immune system disorder that can cause vaginal dryness).

The doctor will carry out a physical and pelvic examination. As some scientists believe that calcium oxalate may play a role in the condition your doctor may ask for a urine sample to check for elevated levels of this substance. He may also order a CT scan or MRI scan of the lower back to ensure that no tumors or cysts are compressing a nerve.

How Doctors Differentiate A Diagnosis

Condition Clinical Signs
Allergic vulvitis (inflammation of the vulva caused by an allergen) Pruritus (itching), irritation, burning. History consistent with allergen exposure; no obvious infection.
Chronic candidal vulvovaginitis (yeast infection affecting the vagina and vulva). Erythema (red sore skin), thick white discharge; pruritus. KOH whiff test or culture proves positive (see diagnosis of vaginitis).
Lichen planus. White lesions, vaginal discharge, pruritus, burning, dyspareunia, and bleeding with intercourse.
Lichen sclerosis Thinning vulva tissue, whitening and wrinkling of the skin. Pruritus may be severe.
Pudendal canal syndrome, where the pudendal nerve (located in the pelvis) is trapped. Pain on one side of the vulva, often increases with sitting.
Vaginismus Pelvic floor muscle spasm which is clearly visible during an examination.
Vulvar atrophy Pale, thinning vulva tissue, possible vulva tears. White blood cells and parabasal cells present in vaginal discharge.
Vulvar intraepithelial neoplasia (VIN), considered a pre-cancer condition (vulva cancer). White or multicolored elevated lesions, possibly warty. Patient may be asymptomatic or have pruritus.

How Is Vulvar Pain Treated?

In some instances vulva pain disappears on its own without treatment. Other women adapt by finding sexual positions that make painful intercourse less likely. Women who do seek treatment may be prescribed medications. Even if they have no signs of depression, low doses of antidepressants such as Elavil can help alleviate what is known as 'neuropathic' pain. If pain is linked to high levels of calcium oxalate, medications such as calcium citrate can help to reduce levels and relieve symptoms. If pain is localized in one specific part of the vulva (known as vulva vestibulitis), surgical excision of the area may be recommended (procedure is called vestibulectomy or perineoplasty). For more see, treatment of vulvodynia.

What Is The Outlook?

Doctors still do not understand the natural progression of vulvodynia. Many women have it for years and it is considered chronic (ongoing). Yet, recent research shows that nearly 50 percent of women who were once diagnosed with the condition, no longer have it. Hence it is thought that in many instances, it eventually clears on it’s own. The prognosis for those who receive treatment is very good. One study at the University of Michigan suggested that those who received treatment had a very good recovery rate.

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Reproductive system disorders: Check your symptoms.
How menopause affects the body: When estrogen dries up!

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