By: Jean Johnson for Uterus1“The pain has lasted for months. You're so uncomfortable you can hardly sit. Having sex is unthinkable. Nothing alleviates the pain, burning and irritation, at least not for long.”
Extreme language? We think not since the quote is verbatim from Mayo Clinic literature on vulvodynia – the all-encompassing term for a number of problems that give rise to vulvar pain.
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Self Care Tips for Vulvar Pain Include
Use cold compresses, small amounts of A and D ointment, or Witch Hazel pads.
Staying dry is important. If problems with chronic dampness, try Gold Bond Power or Zeosorb Powder.
Wear loose cotton underclothing and avoid pantyhose and nylon underwear. Wash new clothing before wearing and avoid dyed undergarments.
Avoid soaps and excessive washing or scrubbing of the genital area. Rinse vulva with plain lukewarm water from a cleansing bottle after urinating
Use white, unscented toilet paper and avoid deodorized pads and tampons.
Try an antihistamine at bedtime to reduce itching and promote rest.
Pass on the hot tub.
Stay as active as possible while avoiding exercise like cycling that puts pressure on the vulva.
Experiment with a low-oxalate diet. Oxalate is a chemical substance commonly found in foods of plant origin (e.g., spinach, beets, wheat bran, peanuts, chocolate, and tea). It has long been understood that Oxalate is an irritant that can cause histamine release and burning in tissues.
For support groups and the Low Oxalate Cookbook see the Vulvar Pain Foundation
Consider combining a non-lubricated, non-spermicidal condom and vegetable oil as the lubricant to keep the semen off the skin and reduce post-coital burning and irritation. Water-based products like K-Y Jelly contain chemicals that can irritate the vulvar skin.
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Perhaps even more revealing is a sampling of article titles on the subject of pain in the vulva. They range from “You Are Not Alone!” to “Does Sex Hurt?” to “What You Don’t Talk About Can Hurt You.”If you are getting the idea that this below-the-belt problem has a history of being misunderstood and misdiagnosed, you are right on target.
An Inauspicious History
Vulvodynia (vul-vo-DIN-ee-uh) – vulvo for the vulva or external female genital area and dynia for pain – “has not been well studied” and “most patients consult several physicians before being diagnosed,” according to Julius F. Metts, M.D. of the University of California, Davis, School of Medicine. Worse, Metts observed that “Many are treated with multiple topical or systemic medications, with minimal relief. In some cases, inappropriate therapy may even make the symptoms worse.”
If the above is not problematic enough, here’s the clincher on the syndrome that almost exclusively involves white women who do not have a history of risk-taking sexual behavior, and among whom sexually transmitted diseases are rare.
“Since physical findings are few and cultures and biopsies are frequently negative, patients may be told that the problem is primarily psychological, thus invalidating their pain and adding to their distress,” wrote Metts in a 1999 article in the American Family Physician.
In short, in the past many women with vulvar pain have had to deal not only with the significant physical torment this syndrome brings, but also the idea that they might be so neurotic that their minds have manifested the condition themselves through twisted psychosomatic associations.
A More Enlightened Present
While science has marched on since Metts wrote his 1999 article, the etiology, or cause of vulvodynia remains shrouded. Nonetheless, gynecological researchers now concur that vulvodynia is not a psychosomatic problem. Rather its etiology, or exact cause, may be related to a number of situations including: Frequent yeast infections, frequent use of antibiotics, chemical irritation from soaps or detergents in underclothing, rashes, genital warts, laser treatment and nerve irritation or muscle spasm in the pelvic area.
Vulvodynia is not related to sexually transmitted diseases nor is it associated with cancers. More, according to Metts, age distribution factors run the gamut from young women in their twenties to mature females in their sixties.
Signs and Symptoms
Specifically, the vulva includes the mons pubis at the base of the abdomen, the labia, clitoris, and opening of the vagina. Females suffering from vulvodynia often describe their symptoms as a burning, stinging or itching feeling that has an irritating rawness about it. Pain on sexual intercourse, or dyspareunia, is also a common symptom, and many women find themselves having to limit the range of their daily activities.
This chronic problem may be constant or intermittent and last for months to years. Also, according to the Mayo Clinic, vulvar pain “can vanish as suddenly or mysteriously as it started.”
Treatment
While there is no cure for vulvodynia, a number of palliative methods have been found to lessen these distressing symptoms. Tricyclic antidepressants are useful for their effect on the cutaneous nerves that are implicated in vulvar pain. Metts underscores that patients need to be aware that the medication is not being prescribed to address psychiatric symptoms, but instead prescribed because of its benefit in relieving pain associated with nervous pathways in the skin.
Biofeedback therapy that uses relaxation techniques to decrease pain sensations has also been found to be helpful in some patients. And there are also a number of topical creams and local anesthetics that can be applied to relieve symptoms as well.
Mostly, however, know that there is no one regime that works for all women, and that physicians can have an especially difficult time diagnosing this problem.
One Woman’s Experience
“A 23-year-old woman was treated twice for a suspected urinary tract infection while traveling in Europe. The patient did not know what antibiotic she had taken. On returning to the United States, she continued to experience dysuria [or pain on urination] and urgency with vaginal soreness, slight itching and dyspareunia. Urinalysis, urine cultures, and vaginal and cervical cultures were negative. Over the course of two months, the patient went to emergency departments twice and visited four different family physicians. She was treated with numerous antibiotics… for presumed cystitis. She also was treated with oral fluconazole and over-the-counter topical anti-candidal preparations for presumed candidal infection, with only temporary relief,” writes Metts.
“During the following two months, the patient experienced dyspareunia with intermittent vulvar pain and irritation. She subsequently saw four gynecologists, a urologist, and two primary care physicians. Pelvic examination revealed erythema of the posterior fourchette [an area in the vulva] and a reaction of mild tenderness on swab test. A biopsy of this area was normal. The patient was treated with doxycycline for possible cervicitis; the symptoms were not relieved. She was then given a diagnosis of vulvodynia and was prescribed gradually increasing dosages of amitriptyline, along with oral calcium gluconate three times daily and a low-oxalate diet. She was referred to a support group for persons with vulvodynia and to a physical therapist specializing in women’s health problems for pelvic strengthening, relaxation training, and biofeedback training. Over the next three months, the patient reported a 70 to 90 percent improvement in her symptoms, with occasional mild exacerbations”
