Vulvar pain syndrome

Vulvodynia

A woman who has experienced vulva pain knows that it is highly uncomfortable and distressing. If you are the one experiencing it, you should know that Vulvar pain is common and is treatable.

In this article, we will look at the most common causes and symptoms of Vulvar pain along with the treatment options. In most cases, pelvic floor physical therapy can ease the discomfort of Vulvar pain.

What is the vulva?

Source: http://www.cancer.gov/types/vulvar/hp

The vulva is the external visible parts of the female genitalia, including the clitoris, labia, hymen, vestibular glands, introitus membranes, paraurethral glands, and the vulvovaginal glands. Vulvar pain is defined as pain in and around the vulva. The condition is most commonly seen in premenopausal women and girls.

Types of vulvar pain:

Vulvar pain can be many types like:

Generalized vulvodynia – It is one of the commonest types of vulvodynia. Generalized vulvodynia is defined as pain throughout the vulvar region. The pain is widespread, affecting labia, perineum, clitoris, vestibule, and inner thighs. Pain can be constant or intermittent.

Localized vulvodynia Localized vulvodynia is the term given to the pain in one part of the vulva. The woman complaints of burning and stinging sensation, which is triggered by any kind of touch and pressure. The pain can be triggered by sexual intercourse, and it can persist for an extended period of time.

Vestibulodynia Vestibule is an area where vulva meets vagina. It is one of the most sensitive parts of the body, and it also has Bartholin’s gland and urethra. The symptoms may vary from woman to woman. However, the common complaint is experiencing hypersensitivity on the light touch to the vestibule, which may happen during tampon insertion and intercourse. The former term for Vestibulodynia was Vestibulitis.

Cyclic Vulvitis Cyclic Vulvitis is a term used to refer to the recurrent itching and burning of the vulva that occurs at the same phase of the menstrual cycle. The main causes of Cyclic Vulvitis are Candida infection, Bacterial overgrowth, and reaction to the progesterone that is produced during the luteal phase of the menstrual cycle.

Symptoms of Vulvar Pain:

Women having Vulvar pain, complaints of discomfort in the vaginal area during sex, inserting tampons and sitting. In some women, pain may be constant. A woman may experience the following symptoms in and around the vulva:

1.     Stinging

2.     Soreness

3.     Burning sensation

4.     Itching

5.     Aching

The pain may be so severe that it affects the sexual life of the female. The fear of pain during sex may cause an involuntary muscle spasm in the vagina called vaginism. In addition, continuous itching can also increase vulvar pain.

Causes of Vulvar pain:

1.     Thrush infection – Thrush infection or yeast infection affects both pregnant and non-pregnant women.  A woman may feel irritation, itching and burning around the vulva if she has a thrush infection.

2.     Pressure around the vulva – Some women may complain of vulvar pain when there is pressure in that area. This pressure may be the result of:

a. Tampon insertion

b. Tight pants or undergarments

c. Wrong sitting position

Other activities like cycling, horse riding etc., can harm the vulvar nerve, ending resulting in vulvar pain.

3.     Genetic disorder – Some women may have genetic differences that cause body tissues to overly react to inflammation and hormones. This overreaction leads to inflammation resulting in pain in the vulvar region.

4.    Physical trauma – Sometimes, vulvodynia is caused because of the damaged Vulvar nerve during childbirth, sex without enough vaginal lubrication and sexual abuse.

5.  Allergies – Perfumed soaps and other hygiene products like vaginal sprays, douches and lubricants can cause overreactions which are known as contact dermatitis, which causes burning, itching and pain, which may or may not involve swelling and rashes. These allergies automatically resolve when the application of irritants is stopped. Sometimes, menstrual pads may also cause irritation resulting in pain and inflammation of the vulva.

6.     Frequent yeast infection – Frequent yeast infection leads to increased nerve fibres’ production, which also results in vulvar pain. A study proved that women with a history of vaginal infections are more prone to vulvar pain (Bachmann et al., 2006)

7.     Hormone therapy – One study proves that women with chronic vulvar pain are more likely to have gone for hormonal therapy when compared to the ones who didn’t have pain (Mitro et al., 2016). There is another study that showcases the association between birth control pills and vulvar pain (Reed, 2013).

8.     Chronic pain condition – Studies prove that women with vulvodynia are more prone to have chronic pain conditions like irritable bowel syndrome, fibromyalgia etc. (Reed et al., 2012). So, such vulvodynia may be associated with inflammation as well.

How is vulvar pain diagnosed?

When suspecting Vulvar pain syndrome, your doctor will take your medical and sexual history. You will be asked if

a.   You have been treated for vaginal infections in the past.

b.     Your sex makes your pain worse.

c.      You have vaginal dryness.

Your physician will do a pelvic exam to look for the signs of inflammation. A tissue sample will be taken to confirm any bacterial or yeast infection. You may be further evaluated to determine if your pain is localized or generalized in nature.

How is Vulvar pain treated?

Treatment for Vulvar pain mainly focuses on relieving pain. Not one treatment works on all women, so in some cases, a combination of treatments may work best. In other cases, symptoms may subside on their own. Treatment strategies include:

Change in the lifestyle

a.   Avoid tight clothes and activities that directly puts pressure on your vulva.

b.   Avoid using perfumed female hygiene products like soaps, douches etc. which may result in overreaction.

c.     During sex, use lubricants.

Use of local anaesthetic creams Local anaesthetic creams will temporarily numb the area before intercourse.

Medications – Your physician will prescribe you some medications like steroids, pain killers, anticonvulsants and antidepressants.

Physical therapy – Physical therapy can be very effective in Vulvar pain syndrome (Bergeron, 2002). Pelvic floor physical therapy can treat many abdominopelvic conditions, including Vulvar pain (Hartmann, 2014). Vulvar pain and other similar conditions can be caused by pelvic floor muscle tension. Pelvic floor muscles support external genitals, so when there is high tension in these muscles, they compress the vulvar nerves and causes pain (Prendergast, 2017). Pelvic floor muscle tension also changes the way your pelvis moves, and if there is too much friction from the clothes, it may increase the irritation of the vulvar tissue. So, in some women, reducing this tension may eliminate the pain.

Manual interventions like internal manual techniques applied directly on the pelvic floor and external techniques to improve joint mobility can be very effective in reducing pelvic muscle tension and pain. Strengthening other associated muscles that work with pelvic floor muscles can be helpful to ensure that the pelvic floor muscles are not working very hard.

Biofeedback is another treatment option that your therapist might look into. Biofeedback helps in muscle stretching and reducing tension (Tassone Shawn, 2015). It gives a visual representation of how the pelvic floor muscles work. A woman can learn how to relax her pelvic floor muscles using biofeedback.

The vulva is a very sensitive area for a woman, and you should regularly consult a health professional to rule out any serious condition like vaginal cancer, vulvar cancer etc. If you are experiencing vulvar pain, reach out to the experts in Progressive Care who will help you in understanding your condition and will help you along the path of recovery.

References:

1. Bachmann, G. A., Rosen, R., Arnold, L. D., Burd, I., Rhoads, G. G., Leiblum, S. R., & Avis, N. (2006). Chronic vulvar and other gynecologic pain: prevalence and characteristics in a self-reported survey. The Journal of reproductive medicine, 51(1), 3–9.

2. Mitro, S.D., Harlow, S.D., Randolph, J.F. et al. Chronic vulvar pain in a cohort of postmenopausal women: Atrophy or Vulvodynia? women’s midlife health 2, 4 (2016). 

3. Reed, B. D., Harlow, S. D., Legocki, L. J., Helmuth, M. E., Haefner, H. K., Gillespie, B. W., & Sen, A. (2013). Oral contraceptive use and risk of vulvodynia: a population-based longitudinal study. BJOG : an international journal of obstetrics and gynaecology, 120(13), 1678–1684. 

4. Reed, Barbara D. MD, MSPH; Harlow, Siobán D. PhD; Sen, Ananda PhD; Edwards, Rayna M. MPH; Chen, Di MPH; Haefner, Hope K. MD Relationship Between Vulvodynia and Chronic Comorbid Pain Conditions, Obstetrics & Gynecology: July 2012 – Volume 120 – Issue 1 – p 145-151

5. Bergeron, S. (2002). Physical therapy for vulvar vestibulitis syndrome: a retrospective study. PubMed. https://pubmed.ncbi.nlm.nih.gov/11995597/

6.  Hartmann, D. (2014). Chronic pelvic floor dysfunction. PubMed

7. Prendergast, S. A. (2017). Pelvic Floor Physical Therapy for Vulvodynia. Obstetrics and Gynecology Clinics of North America, 44(3), 509–522. 

8. Tassone, Shawn. (2015). Vulvodynia and Biofeedback as Therapy. 10.13140/RG.2.1.4134.4164.

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