Vulvodynia

What is it?

Vulvodynia is persistent, unexplained pain in the vulva (the skin surrounding the entrance to the vagina) and can affect women of all ages. According to www.patient.co.uk it is more common than first thought, with up to 8% of the female population reporting symptoms. It often occurs in women who are otherwise healthy and is one of the most severe types or neuropathic or nerve pain.

Symptoms:
The main symptom of vulvodynia is persistent pain in and around the vulva. The vulva usually looks normal.
The pain may be:
• a burning, stinging or sore sensation
• triggered by touch, such as during sex or when inserting a tampon
• constantly in the background and can be worse when sitting
• limited to part of the vulva, such as the opening of the vagina
• more widespread – sometimes it can spread to the buttocks and inner thighs.

How to control it:
Lifestyle tips may help with the symptoms. These include wearing 100% cotton underwear and loose-fitting skirts or trousers. Scented hygiene products such as feminine wipes, bubble bath and soap should be avoided as they may aggravate symptoms – an emollient is a good substitute for soap.
Applying cool gel packs to the vulva may soothe the pain.
Using petroleum jelly before swimming to provide protection from chlorine.

What about sex?
Try not to avoid sex or touching your vulva completely, as this may make your vulva more sensitive – if sex is painful, try to find a position that’s more comfortable, or if penetration is painful do other sexually intimate activities together until you’ve sought advice. Stress can increase the pain of vulvodynia.

Medical treatments:
Applying lidocaine, which is an anaesthetic gel to your vulva about 10 minutes before sex may make it more comfortable.
If your pain is more constant, applying lidocaine regularly throughout the day may help. Lidocaine can also be used overnight. A tip is to put some on a cotton make-up removal pad and put it onto the sore area so it’s held in place by your underwear.

It’s very common to have some burning when the lidocaine is initially applied which can last several minutes before going numb. Try to give the lidocaine time it to work, but if the burning continues for 10 minutes, wash it off thoroughly.

Tubes of 5% lidocaine gel, cream or ointment can be bought over the counter from a pharmacy, although it’s a good idea to get a doctor’s advice before trying it.

Vaginal lubricants and aqueous cream (also available over the counter) may soothe the area and help moisturise the vulva if it’s dry. Speak to your pharmacist about these treatments.

Conventional painkillers such as paracetamol won’t usually relieve the pain of vulvodynia, but several medications available on prescription can help.

Amitriptyline and nortriptyline which are anti depressants can be prescribed and offer relief to some women. However, possible side effects include drowsiness, weight gain and a dry mouth. Gabapentin and pregabalin which are from a group of drugs known as pain modulators may also help although the side effects from these medications include dizziness, drowsiness and weight gain

Your doctor will probably start you on a low dose and gradually increase it until your pain subsides. You may need to take the medication for several months.

A TENS machine (transcutaneous electronic nerve stimulation) may also be used to reduce your pain. This is where a machine is used to deliver a mild electrical current to the painful area.

Non-medical treatments:
A physiotherapist can teach you some pelvic floor exercises (such as squeezing and releasing your pelvic floor muscles) to help relax the muscles around your vagina.

Another technique to relax the muscles in the vagina and desensitise it involves using a set of vaginal trainers. These are smooth cones of gradually increasing size and length which can be inserted into your vagina in the privacy of your own home.

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act. It can often help women cope with the impact that vulvodynia has on their life.

CBT focuses on the problems and difficulties you have now, and looks for practical ways you can improve your state of mind on a daily basis.

Psychosexual counselling is helpful when pain is affecting intimacy between you and your partner. This is a type of therapy that aims to address problems such as fear and anxiety about sex, and to restore a physical relationship with your partner.

Still need help?
Only in very rare cases, surgery to remove part of the vulva may be an option. Pain however can recur and it’s usually not recommended.

More recently botox injections have been used to help with symptoms. Botox (Botulinum Toxin A) is derived from a strain of bacteria called Clostridium Botulinum. When Botox is injected into a muscle, it blocks the signals sent from the brain which tell the muscle to contract. Botox targets the muscles involved by effectively disarming them and ensuring that they do not send panic signals throughout the body. The body believes that there is no pain being experienced. Botox can help to keep the muscle relaxed for anywhere from three to six months, after which it is hoped that the muscle will be able to contract normally without pain or spasms. This is available privately from the London Pain Clinic.

Vaginal laser rejuvenation for example NU-V has also been shown to be very effective in treating the symptoms of vulvodynia. Like botox, this is not currently available on the NHS but has had very good results for many women and is available at The Women’s Health Clinic.