What is vulvodynia?
Vulvodynia is chronic pain. Most often, the patient feels discomfort, a kind of burning.
The diagnosis of vulvodynia is one of elimination. Before evoking vulvodynia, we rule out the possibility of dermatosis, i.e. skin involvement, but also neurological involvement and genital malformation. The diagnosis of vulvodynia is then made.
The diagnosis of vulvodynia is not a simple one, and often leads to "it's all in your head, ma'am" speeches, when the pain is really there.
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 vaginal entrance, it's called vestibulodynia. Most of the time, the pain is characterized by a burning sensation associated with tingling, pulling, dryness or pinching. These pains can be sudden, but can also be triggered by contact (sexual intercourse, bicycles, tight clothing, etc.).
People who have vulvodynia may be more frequently confronted with other pains such as :
- regular urination
- pain in the lower abdomen
- 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 vulvodynia occurs, the brain receives "pain" information when in fact there is no tissue damage, and the pain-blocking system fails.
How can vulvodynia be cured?
The treatment of vulvodynia takes time and requires a multidisciplinary approach. A gynecologist, dermatologist, physiotherapist and, in rare cases, a psychotherapist, sex therapist or surgeon (in exceptional cases) are all involved.
In the first instance, a local topical treatment is proposed, i.e. creams applied locally to the vulva. The problem with these creams is that treatment is often disappointing.
A course of antidepressants is then proposed. Antidepressants have an effect on the central nervous system, and therefore on the nerve impulses responsible for pain. Prescribing antidepressants therefore helps to reduce pain. So it's often important to explain to patients how the brain and nerves work, and why they've been prescribed an antidepressant, even though they're not depressed and the pain isn't in their head, but that this treatment does help to reduce neurological pain. The key here is to work with mental health professionals. Sophrologists can also help with relaxation and reducing fear of pain during penetration.
This is why behavioral psychotherapy can be considered.
Physiotherapy can also help with pelvic re-education, assisted by electrostimulation and biofeedback. We're talking here about TENS electrostimulation, i.e. painkillers that can be applied to the lower back, for example, to work on the nerves. Even in the field of physiotherapy, treatment is multi-faceted. We often focus on perineal relaxation, because without necessarily talking about vaginismus (reflex contraction of the muscles at the entrance to the vagina) - which can be one of the consequences of vulvodynia, but is not necessarily linked - patients often have a hypertonic perineum, because they contract from pain. They're contracted, so when the muscles are contracted, they squeeze the nerve a little. It's a vicious circle. The main physiotherapy treatment is therefore perineal relaxation using manual biofeedback, which involves giving the patient information to relax her perineum. It can also be combined with respiratory work to relax the diaphragm. Specialized physiotherapy is therefore one of the pillars of treatment for people suffering from vulvodynia.
As a last resort, and in exceptional cases, surgery may be proposed.
How to care for your vulva
First, the periods basic hygiene tips for caring for your vulva:
- After intercourse or using the toilet, wipe from front to back. If you wipe from back to front, bacteria from the anal area will come to the vulva and risk infecting the vaginal and vulvar area.
- Do not sleep in tight underwear, as this will encourage infection.
- Use cotton sanitary towels or menstrual pants, and organic cotton if possible. That's what Elia menstrual panties are all about. They're very soft and comfortable, compared with other pads that can be used during periods and can increase the irritation already present.
In the same vein: What is vestibulodynia?