Vulvar pain

COMPLEX VULVAR PAIN

(VULVAR DYSESTHESIA)

Why does the pain occur?

Acute pain is a normal, uncomfortable sensation, triggered by the nervous system to warn us of a potential problem. For example, it happens when we hurt ourselves or develop an infection. Chronic pain is different, however. It can persist for a long time after the cause has disappeared. Some people suffer from chronic pain without there ever being an identifiable injury or cause.

What is the vulva?

It is formed by small folds (lips) surrounding the opening to the vagina, with larger lips enfolding them on the outside. The portion around and below the vagina is known as "the vestibule".

What does vulvar pain consist of?

The pain may be moderate or significant, occasional or constant. It makes sexual relations difficult or impossible. Using tampons may also be painful. Lightly touching or stroking this area may sometimes cause substantial pain. It may be due to an infection, a skin disease or a visible growth. If you find something abnormal, you must tell your doctor. In many cases, vulvar pain is present without anything abnormal being visible on the skin. Today, the pain is divided into localized or generalized vulvar pain (vulvar dysesthesia).

What causes the pain?

No one really knows the reason for this pain, at present. It may be the result of trauma, treatment or chronic or recurring infection. It is thought that the origin of the pain is related to hypersensitive nerve endings in this area. The problem may be inborn or acquired, and causes a sensation of irritation, itching or burning. Other problems of the same type may associated with pain of the bladder, colon or mouth.

What are the symptoms?

Patients find sexual relations difficult and painful. Using a tampon may prove to be impossible. Most women with this problem cannot wear tight pants or go cycling. The pain sometimes occurs spontaneously without the area in question being touched, and it can vary during the menstrual cycle.

What can your doctor see?

NOTHING! The vulva and vagina appear normal in appearance.

How is the diagnosis made?

A number of tests have to be performed before a correct diagnosis can be reached. A small portion of skin (a biopsy) and vaginal secretions can be taken so that various cultures can be carried out to detect any infection. An examination of the patient and her history are the only way to reach a diagnosis. The examination will consist of an inspection of the vulva, testing all areas of the skin using a Q-tip to determine the exact site of the pain.

How can the pain be treatd?

Most patients already feel more confident once the diagnosis has been made. Success depends on a combination of different treatments, which vary a great deal from patient to patient. A temporary interruption of sexual relations is often desirable and the couple should discuss the matter (sometimes with the aid of a professional). The use of a lubricant (jelly, oil) during sexual relations and the elimination of all irritants (soap, tampons, sanitary pads, pants) in the vulvar region is always recommended.

Local anesthetics can be used for a limited time and there are several medications available to reduce the area's sensitivity to pain. The medications are derived from antidepressants, but administered at very low doses. Other forms of treatment can also be used, such as physiotherapy, acupuncture, a low-oxalate diet; still more are being evaluated. Surgery (a vestibulectomy) can be considered, but as a last resort and only for certain patients.

What can you do?

A correct diagnosis is very important. Do not try to do this yourself. It is important to be followed by a doctor and/or team familiar with this type of problem. Obtaining as much information as possible is always useful (reading, Internet, discussions). Managing your daily life so that you can relax and reduce your stress level will probably prove helpful, as well.

Adapted from the International Society for the Study of Vulvovaginal Disease (ISSVD), 12/2003.