All Star Pain Management | Vulvodynia
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The vulva is the area of female sex organs that lies outside of the vagina and includes the folds of sensitive tissue called the labia (labia means “lips”). Vulvodynia is a condition characterized by chronic vulvar pain without an identifiable cause. It can be an extremely difficult condition to live with and can be indeed very difficult to treat. The location, constancy and severity of vulvodynia vary among in patients. Sometimes, the pain is confined in the vulva, while others may experience pain deeper in the vagina or in the groin or perineal regions. The pain tends to be of the burning variety but others have reported it to be a sharp knife-like pain instead. Furthermore, it may be constant or intermittent, concentrated in one area or spread out.

Most women have pain at only one vulvar site – often the area surrounding the vestibule, called vestibulodynia, and it is often provoked by local pressure during sexual intercourse, tampon insertion, a gynecologic examination, prolonged sitting, and/or wearing fitted pants. A less common form is the localized vulvodynia, also known as clitorodynia (pain in the clitoris).

Vulvodynia can be primary or secondary. Primary vulvodynia is when the patient has experienced vestibular pain since the first attempt at vaginal penetration. On the other hand, secondary vulvodynia is when the patient has had experienced pain-free sexual intercourse prior to the development of vulvar pain. Generalized vulvodynia is when the pain occurs spontaneously and is relatively constant.

The cause of vulvodynia is not known but multiple factors are implicated. It may be caused by an injury to or irritation of the nerves that supply and receive input from the vulva, or it could result from a localized hypersensitivity to yeast. Alternatively, it may occur due to an allergic response to environmental irritants or high levels of oxalate crystals in the urine, or may indeed be due to the spasm and/or irritation of the pelvic floor muscles. There is no evidence to support that vulvodynia is caused by a sexually transmitted disease.

Because we don’t know what causes vulvodynia, treatment options are mainly geared toward symptomatic relief. Different patients respond to these options differently, and it often requires a combination of treatments to achieve adequate pain relief. Current vulvodynia treatments include discontinuation of Irritants and taking oral painkillers, which include tricyclic antidepressants, Serotonin-Norepinephrine Reuptake Inhibitors, anticonvulsants, and even opioids (although these should be avoided given their addiction potential). Topical medications include hormonal creams (e.g., estrogen, testosterone), topical anesthetics (e.g., lidocaine), topical anticonvulsants, topical antidepressants, etc. In addition to pharmacotherapy, other approaches that can be successful include pelvic floor muscle therapy, nerve blocks, neurostimulation and spinal infusion pumps, etc. Alternative methods of pain relief, such as acupuncture can also attempted but have variable results. However, for severe, refractory cases, and especially so for provoked vulvodynia, surgery may have to be considered as the last resort.

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