Vulvodynia

What is vulvodynia?

In most women with the condition, the appearance of the vulva is normal and the problem lies with the nerve fibres. Although the pain may be felt inside the vagina, the problem's actually on the outside.

The sensory nerve endings appear to become so sensitive that even light touching of the skin triggers an unpleasant and painful sensation.

Symptoms

The most common symptoms are burning, stinging, irritation, aching or rawness of the genital area. The pain may be constant or it may only occur intermittently - when the vulva is touched, for example. The pain may also be felt around the urethra, back passage, tops of the legs and inner thighs.

Each woman can have different symptoms, with varying degrees of severity.

As with most chronic pain conditions, vulvodynia adversely affects quality of life. Not only can it prevent women from engaging in and enjoying sexual activity, but daily activities may also be impaired. Some women with vulvodynia are unable to exercise, for example, or drive a car. For some, even sitting becomes a challenge.

When a condition has a detrimental impact on work, family and social life, low self-esteem, poor self-image and depression often develop. This can exacerbate the symptoms, dragging the woman into a negative downward spiral.

Causes and risk factors

No definite cause has been established, which means it's difficult to prevent it. Some theories are that thrush or skin irritation from soaps and bubble baths may trigger it, but what's clear is that vulvodynia isn't infectious or related to cancer.

It's estimated that up to 15 per cent of women suffer with vulvodynia. It can affect women of any age, although it's more common in younger and middle-aged women. It's more common among women with sensitive skin or who are stressed, or after having a baby.

Treatment and recovery

A number of different approaches may be tried before vulvodynia is treated successfully.

The drug amitriptyline (most commonly used as an antidepressant but also used to treat pain) has been found to be the most effective treatment. There are several other treatments available, including other antidepressants and anticonvulsants used to treat painful conditions.

Improvement is usually gradual and it's important to acknowledge that it may take months. Applying creams, lotions and gels (for example, anaesthetic gel) to the vulval area can help, as can using lubricants during intercourse.

If depression is present, this can be treated with counselling and/or antidepressant medication.

Pain and/or stress management counselling are usually recommended.

The following advice may help to relieve symptoms and prevent recurrent episodes:

• Wear cotton underwear and loose-fitting trousers or skirts
• Avoid scented toilet paper, bubble bath, feminine hygiene products and perfumed creams or soaps
• Avoid or limit exercise that puts direct pressure on the vulva, such as cycling, or anything that causes friction in the vulval area
• Don't sit for prolonged periods, or use a rubber ring to relieve pressure
• There is no evidence to suggest that dietary changes such as low oxalate diets or anti-candidal diets help in vulvodynia.