Vulvodynia

What is meant by vulvodynia?

Vulvodynia is a term which means chronic vulval discomfort or pain characterised by burning, stinging, irritation or rawness of the female genitalia. It does not mean itch. Many skin diseases, infections and injuries can produce vulval pain but in some cases there is no visible skin disease of the vulva or vagina causing these symptoms.

Vulvodynia (vulval pain in patients where NO cause is found) is defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) in the following way:

• Generalised – involving the whole vulva
• Localised – involving a small area on the vulva, usually the vaginal opening (the vestibule)
• Provoked – by sexual intercourse or non-sexual contact such as insertion of tampons, tight clothing
• Unprovoked – spontaneous
• Mixed – vulvodynia can be the result of pressure or touch or can occur spontaneously. If pain occurs in both these situations it is called mixed.

The two most common kinds of vulvodynia where there is no skin disease present are:

1. Women who only experience pain with intercourse and often also with tampon insertion. This is localised provoked vulvodynia, also known as vestibulitis
2. Women who experience constant feelings of burning and rawness involving the whole vulva. This is generalised unprovoked vulvodynia.

In cases where a definite cause or precipitating condition can be found, the above classification is not needed.

The conditions which can cause vulval pain include:

• Skin diseases especially those that cause splitting or blistering
• Infections such as thrush and genital herpes.
• Back problems, particularly that which results in sciatica.
• Nerve disease.
• Spasm of the muscles around the vagina.

The hope is that eventually, the cause(s) and/or precipitating factors can be identified in all women and then management/treatment will be more specific and effective.

Women of any age can have vulval pain. The problem can cause a profound effect on the quality of life because activities such as sitting, bicycle riding and maintaining a sexual relationship can be affected. A woman's self-image may become negative and sometimes this leads to depression.

How is it diagnosed?

By careful history taking, examination and sometimes tests to rule out infection and skin disease.

How is it treated?

Treatment depends on the cause of the vulvodynia. There is no single treatment. Depending on what your doctor diagnoses as the cause this may include oral medications and creams, physiotherapy, psychological therapy, pain management therapy, biofeedback behaviour modification and rarely surgery.

It is often helpful to see a specialist in vulval disorders if you have a problem with vulval pain.

For more information go to DermNet NZ or ISSVD.