About Vulvodynia and Vulvar Vestibulitis
What Is Vulvodynia?
Vulvodynia is a painful condition (dynia = pain) characterized by discomfort or pain (stinging, burning, irritation) of the vulva. While the cause of vulvodynia is not known, some possible causes may include genetic abnormalities or hormonal factors, inflammation, infection or post-infection syndromes, or neurologic changes.
Vulvodynia is often classified by the location of symptoms (diffuse or localized to a specific area) and whether they are caused by pressure or touch (provoked) or occur even without the area being touched (unprovoked). The pain may occur in different areas and may be constant or intermittent but is always in the genital area: labia minora, labia majora, vestibule, clitoris, mons pubis, perineum or inner thighs.
What is localized provoked vestibulodynia (LPV)?
Localized provoked vestibulodynia is a very common type of vulvodynia. The term is used to describe pain or irritation that occurs in the vestibule, or the area of the female vulva that surrounds the opening of the vagina. LPV can occur in women of all ages, and whether or not they have ever been sexually active. LPV used to be called vulvar vestibulitis.
Patients who have LPV experience pain with any kind of pressure or touch at the vestibule. Intercourse, tampon use, tight clothes, bicycle-riding, and sometimes just sitting or standing for long periods, can be painful. Often, there is redness on the skin where the pain is located.
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How is LPV diagnosed?
LPV can be diagnosed during a pelvic exam. A cotton swab is used to locate areas of tenderness during the exam. In diagnosing LPV, it is crucial to rule out other causes of vulvar pain such as infections or skin abnormalities that can cause vulvar pain.
How is LPV treated?
It may not always be possible to completely cure LPV, but it is possible to control symptoms so that they do not interfere with daily activities and allow sexual activity to be enjoyable. Because women with LPV have different symptoms that may be due to different and perhaps unknown causes, there are many different methods of treatment including: topical or oral medications, injections, physical therapy, biofeedback, dietary changes and surgery. It is often necessary to use a combination of treatments or to try several treatments before one is found that will provide relief of symptoms.
The first treatment for LPV is to identify and treat any infections or skin conditions that may be present, for example, vaginal yeast infections. Sometimes this treatment alone will provide some relief of symptoms. Topical corticosteroids (like hydrocortisone but stronger) applied to the vulva are often used as a first therapy for chronic inflammation. Other possible treatments include the use of amitriptyline, a common antidepressant medication, that is often used to treat nerve pain. Amitriptyline can be taken by mouth or used as a cream. LPV may also involve spasm of the pelvic floor muscles, so physical therapy may be prescribed in addition to medication. For women who have pain that is localized to a specific area of the vestibule, a surgical procedure called partial vestibulectomy can greatly improve or eliminate pain in many cases.
What else can I do to lessen symptoms of LPV?
Because there are many personal care products that can worsen vulvar symptoms, it is important to use only those products that are least likely to be irritating to skin in the genital area. This includes, for example, minimal use of soap on the vulva or use of a mild soaps such as Neutrogena, elimination of any deodorized sanitary products, and avoiding tight clothing, especially those containing spandex, Lycra and other synthetics.
The use of all over-the-counter creams and yeast products should be avoided unless they are recommended by a clinician. For comfort, petroleum jelly, coconut oil and ordinary Crisco are very soothing and help to keep skin moist without causing additional irritation. A list of recommended personal hygiene products and practices is available at the Drexel Vaginitis Center.
There is much ongoing research into the cause and treatment of LPV and also on the emotional toll on women who have chronic vulvar pain and who may not be able to enjoy some forms of sexual activity. It is important to continue to be intimate with a partner during treatment in ways that are comfortable for both partners; counseling can be a great help to women and their partners as they work through issues relating to sexuality and relationships. There are support groups available, and the National Vulvodynia Association website, www.NVA.org, is a great place to find information on vulvodynia, including current research, conferences and publications.
The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.
The images being used are for illustrative purposes only; any person depicted is a model.
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