How many women have vulvodynia

Women who suffer with vulvodynia report difficulties exercising, being intimate and taking part in other daily activities. Even sitting for long periods of time can trigger vulvar pain episodes in some women.

Almost two out of three 60 percent of women with vulvodynia cannot have sexual intercourse because of the pain. The sheer anticipation of vulvar pain can heighten anxiety and lead many women to avoid sexual intercourse. Refraining from sex affects a woman's self-image, and the repeated episodes of pain combined with anticipation of pain may also result in spasms of the muscles around the vagina vaginismus , making it even more difficult to achieve vaginal penetration. In addition, some women with vulvodynia may be burdened by other health problems, including interstitial cystitis, fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, temporomandibular joint or muscle disorders.

Lack of awareness about this condition among medical professionals, coupled with the stigma women associate with genital disorders, makes diagnosis and treatment more challenging. As a result, many women are left not knowing why they have such severe, often debilitating vulvar pain, which can strain a couple's sexual relationship.

Some women are hesitant to discuss sexual issues with their health care providers, while others who do sometimes report being told the pain is "all in your head. If untreated, chronic pain can lead to:. And the severity of the pain can worsen when women with this condition are stressed, depressed or anxious. Vulvodynia is poorly understood and, as with many pain conditions, can be difficult to diagnose.

Vulvodynia is diagnosed when other causes of vulvar pain, such as infections, skin problems or neurologic disorders, are evaluated and ruled out. Women with vulvodynia often report having one or more of the following symptoms in the vulvar area:.

To make a diagnosis, your health care professional will begin by reviewing your medical history. He or she will ask you specific questions about your symptoms, treatments you may have already tried, your menstrual cycle, feminine hygiene, sexual history, previous medical problems or surgeries, as well as any medications you use including over-the-counter medicines.

You should also discuss any difficulties you have using tampons or having sexual intercourse. Your health care provider will then do a pelvic exam and carefully inspect your vulva. A cotton swab test is often used to map vulvar pain. For this evaluation, your doctor will use a moist, cotton-tipped swab to place pressure on various parts of the vulva to identify the location and intensity of your pain.

You will be asked to rate the extent of the pain at each site; for example, how would you describe the pain on a scale of 0 to 10 no pain to extreme pain? Your health care professional may use a diagram to visually note where you feel discomfort, as well as the degree and nature of the pain, such as burning, throbbing or stabbing.

A positive cotton swab test one that causes significant pain, especially in the vestibule most strongly suggests the diagnosis of vulvodynia. Your doctor may use a large magnifying instrument called a colposcope to take a closer look at the vulvar skin.

While there may be redness and inflammation, vulvar skin usually appears normal in women with vulvodynia, despite the occurrence of pain.

Any abnormal appearing areas may need biopsy to rule out other disorders. Explain how chronic vulvar pain impacts your daily life. Are there certain activities you avoid, such as exercise, use of tampons or sex? You may want to keep a pain diary with detailed information about your pain—when it occurs and for how long, things that make it better or worse and any other symptoms. This can provide important clues and will help your health care professional make a diagnosis.

There are treatments available to provide symptom relief. Adjunct therapies, such as acupuncture, massage therapy and cognitive behavioral therapy, are also being explored. There is no known cure for vulvodynia. The main goals of treatment are to manage your pain, improve your quality of life e.

The chronic nature and complexity of vulvodynia often require multiple treatment strategies. Finding the right treatment or combination of therapies may take some time, especially because each woman's symptoms and response to treatment are different. Your health care provider will recommend a treatment approach based on your condition s , level of pain and preferences. The following section provides a snapshot of available treatments that have been beneficial in reducing pain symptoms listed in no particular order :.

Basic vulvar care. These suggestions will be helpful in all women, not just those with vulvar pain. Some common suggestions for vulvar care include:. Topical anesthetic ointments provide quick, temporary pain relief and comfort and may be used overnight or applied 15 to 20 minutes before sexual activity or throughout the day as needed. Ice packs also provide temporary relief and may be helpful when you can't avoid sitting for long periods, such as lengthy car rides.

Topical estrogens, and occasionally testosterones, may be used in women who are estrogen deficient, such as women who are postmenopausal or those who are premenopausal and take certain medications that lower estrogen levels. Low doses of tricyclic antidepressants may be recommended to treat vulvodynia because of their pain-blocking properties, particularly amitriptyline Elavil , desipramine Norpramin and nortriptyline Pamelor.

Gabapentin, an antiseizure medication, is effective for pain relief in some women and offers an alternative to women who are unable to use tricyclic antidepressants or have side effects from them. Pregabalin Lyrica , which is used to treat nerve and muscle pain, also may be considered.

A newer class of antidepressants, known as SSNRIs Effexor, Cymbalta , have also demonstrated benefit with fewer side effects for some women than the tricyclic antidepressants; however their use in women with vulvodynia has not been well studied. Like the older tricyclic class of antidepressants, these medications can also help relieve symptoms of depression. Ask your health care professional about various medications and their common side effects. When using certain medications, keep in mind it can take up to six to eight weeks for symptoms to improve, and that you will not necessarily achieve complete relief.

Physical therapy and biofeedback training. Some women have associated spasms or weakness of the pelvic floor muscles that may either contribute to the vulvar pain or develop due to the pain. Your health care professional will evaluate your pelvic floor muscles and may refer you to a pelvic floor physical therapist for full evaluation of the muscles, joints and nerves in the pelvic area. Treatments may include exercises, education and manual therapies, such as massage. Biofeedback, which helps you enter a relaxed state to reduce pain and teaches you control of the contraction and relaxation of the pelvic muscles, is an integral part of the physical therapy.

Learned control of these muscles will aid in situations where pain may occur, such as intercourse or a pelvic exam, by allowing conscious relaxation of these muscles to occur.

Relaxation and breathing techniques. Like biofeedback, learning to recognize when you are tensing your pelvic floor muscles due to stress and then learning specific relaxation techniques to reduce stress and anxiety can help alleviate pain.

Diet modifications. Talk with your provider about the pros and cons of eliminating certain types of foods from your diet, such as those high in oxalates or sugar. To test for food sensitivity and to determine which foods, if any, are affecting you, eliminate one food or food group at a time. Use a food diary to record your results—you might begin to notice an association between your symptoms and certain foods you wouldn't have otherwise suspected.

This may be especially helpful in women who also have interstitial cystitis. Nerve blocks. Injections of lidocaine or lidocaine plus a steroid may provide at least temporary and sometimes long-term relief from vulvar pain.

These injections may be local into trigger points or especially tender areas at the entrance or a short distance in the vagina, or they may be aimed at the larger, pudendal nerve, which carries most of the nerves from the vulvar area to the spinal cord. The pudendal block can be performed through the vagina with the injection into the area at the top of the vagina, near the cervix or through the buttocks this is usually done by an anesthesiologist trained in pain control, not a gynecologist.

Women who have a muscle spasm as the primary contributing cause to the vulvar pain may benefit from Botox injections into the affected muscle. Neurostimulation and spinal infusion pump. If other treatment forms haven't helped and your pain is severe, your health care professional may have you consult with a professional skilled in neurostimulation or in the use of a spinal infusion pump. With neurostimulation, an electronic device delivers low-voltage electrical stimulation to a targeted nerve or the spinal cord in an attempt to substitute a tingling sensation for pain.

A spinal infusion pump is an implanted device that constantly administers a small dose of medication to the spinal cord and nerve roots to help dull pain. Experience treating vulvodynia with these interventions is limited.

Women with severe vulvodynia localized in the vestibule who have failed to find relief with other remedies may consider vestibulectomy, a surgical procedure that removes the painful tissue of the vulvar vestibule. This surgery is usually reserved only for women with vulvar vestibulitis who have not responded to more conservative therapies and understand that, despite the surgery, the pain may not resolve afterward.

Vulvodynia can limit daily activities, interfere with interpersonal and intimate relationships and diminish quality of life. Women who suffer with chronic vulvar pain may also experience depression and feelings of low self-worth. Regardless of what strategies are being employed to manage the vulvar pain, psychological counseling can help women develop coping strategies and deal with sexual intimacy issues.

For many, it is a valuable part of their overall treatment plans. Cognitive behavioral therapists or individual, marriage or sex therapists may be considered.

Because we don't know what causes vulvar pain, we really don't know how to prevent it. Vulvodynia occurs in women of all ages, including adolescents, and is prevalent in women of all races, religions and ethnic backgrounds. Research studies find that as many as 16 percent of women in the U.

The highest incidence of symptom onset is between the ages of 18 and The lowest incidence is after age 35 Harlow For women who suffer from vulvodynia, sexual intercourse is painful or impossible. Many young women are too embarrassed to date. It breaks up loving marriages. Living with the pain and so many physical limitations leads to feelings of depression and hopelessness NVA , Pukall According to an NIH-funded Harvard study, 60 percent of affected women consult three or more doctors before receiving a diagnosis of vulvodynia.

Sadly, 40 percent of women seeking treatment for vulvodynia are not accurately diagnosed after seeing as many as three doctors Harlow Women consult doctor after doctor seeking a diagnosis for their private burning pain.

Many have been repeatedly treated for non-existent yeast infections, which can exacerbate the pain. There is no special test for vulvodynia — only tests to prove the pain is not caused by other conditions. Your doctor will usually do a physical exam and may take and test samples of your vagina and vulva to rule out other irritations like thrush or eczema. Lubrications and medications applied to the affected area may provide some relief. Physiotherapy can also help to relax the pelvic floor muscles.

If all else fails, your doctor may recommend surgery to remove the tender area. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.