What is vulvodynia? What are the causes?

What is vulvodynia?

Vulvodynia is a chronic pain. Most often the patient feels discomfort, a type of burning.

The diagnosis of vulvodynia is a diagnosis of elimination. Before evoking a vulvodynia, we will eliminate the possibilities of dermatosis, that is to say an attack of the skin, but also a neurological attack and a genital malformation. Then the diagnosis of vulvodynia will be retained.

The diagnosis of vulvodynia is not simple and often leads to speeches such as "it's in your head, ma'am" when the pain is really present.

What are the symptoms of vulvodynia?

The symptoms of vulvodynia are most often pain all along the vulva, including the labia majora. If the pain is only localized at the entrance of the vagina, then it is called vestibulodynia. Most of the time the pain is characterized by burning associated with tingling, pulling, dryness or pinching. These pains can be sudden but can also be provoked by contacts (sexual intercourse, bicycles, tight clothes...)

People who have vulvodynia may experience other pains more frequently, such as

• a regular urge to urinate
• pain in the lower abdomen
• fibromyalgia
• irritable bowel syndrome

What causes vulvodynia?

Vulvodynia is caused by a disturbance in the pain system. Normally, pain is a signal to warn of tissue damage. When there is vulvodynia, the brain receives the information of "pain" when there is actually no tissue damage and the pain blocking system fails.

How to cure vulvodynia?

The management of vulvodynia is long and must be multidisciplinary. The treatment is done by a gynecologist, a dermatologist, a physiotherapist, and in rare cases, a psychotherapist, a sexologist or a surgeon (in exceptional cases).

First of all, a local topical treatment will be proposed, i.e. creams to be applied locally to the vulva. The problem is that with these creams, the treatment is often disappointing.

Then a medicinal treatment will be proposed, consisting of antidepressants. Antidepressants act on the central nervous system, and therefore on the nerve impulses of pain. Prescribing antidepressants therefore helps to reduce pain. It is therefore often important to teach patients about pain by explaining to them how the brain works, how the nerves work, and why they have been prescribed an antidepressant when they are not depressed and the pain is not in their head, but that this treatment does indeed reduce neurological pain. The key here is to work with mental health professionals. Sophrologists can also work on relaxation and on the fact of being less afraid of pain at the time of penetration.

This is why behavioral psychotherapy can be considered.

As for physical therapy, pelvic re-education, assisted by electrostimulation and biofeedback can also help. We are talking here about electrostimulation in terms of TENS, i.e. painkillers that can be put on the lower back for example, to work on the nerves. Even in the field of physiotherapy, the treatment is plural. We often focus on perineal relaxation because without necessarily talking about vaginismus - (reflex contraction of the muscles at the entrance to the vagina), this can be one of the consequences of vulvodynia, but it is not necessarily linked - patients often have a hypertonic perineum because they contract as a result of having pain. They are contracted, so the muscles being contracted, they squeeze the nerve a little bit. It's a vicious circle. The main treatment in physiotherapy is therefore perineal relaxation by manual biofeedback, which consists of giving information to the patient so that she relaxes her perineum. It can also be coupled with respiratory work to relax the diaphragm. Specialized physiotherapy is therefore one of the pillars of treatment for people suffering from vulvodynia.

Finally, as a last resort, and in exceptional cases, surgery can be proposed.

How to take care of your vulva?

First of all, the basic periods of hygiene to take care of your vulva:

- After sexual intercourse or after going to the bathroom, wipe from front to back. If you do it from the back to the front, bacteria from the anal area will come to the vulva and risk infecting the vaginal and vulvar area.

- Do not sleep with tight underwear because it will promote infection.

- Use sanitary napkins or menstrual panties made of cotton, and if possible of organic cotton. This is what Elia menstrual panties offer. These are very soft and comfortable compared to other protections that can be used during menstruation and that can increase the irritation already present.

On the same subject : What is vestibulodynia ?