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Vulvar Pain
By peace | November 2, 2006
The Beauty Within By Sodd
Vulvodynia refers to vulvar pain. The pain may be chronic or it may come and go. A woman may experience vulvar pain with intercourse or when wearing pants or even just sitting watching TV or driving a car. The pain may be sharp or dull.
Vulvodynia means pain in the vulva. This is a medical condition suffered by an estimated 14 million women in the United States and up to 16% of all women worldwide. It may occur at any age. The pain is usually described as a burning, stinging, itching, irritating or a raw feeling. Sexual intercourse, walking, sitting or exercising can make the pain worse.
Vulvodynia is more common in white women. It’s rare in women of other races. It usually starts suddenly and may last for months to years. Although it isn’t life-threatening, the pain may cause the women to suffer severe alteration in quality of their life. The pain and discomfort interfere with normal daily activities such as exercising, walking, cycling and sitting. These in turn make them upset or depressed. It might even cause problems in the relationship with their spouse or partner. This is because sexual intercouse or sexual activities can be too painful to attempt. The symptoms can lasts for days, weeks, months or years and can lead to depression.
Vulvodynia has been classified into the following subtypes:
1. Generalized (or dysesthetic) Vulvodynia
Dysesthetic Vulvodynia symptoms may be diffuse or in different areas at different times. Pain may be present in the labia majora, labia minora, and/or the vestibule. Some women experience pain in the clitoris, mons pubis, perineum and/or the inner thighs. The pain may be constant or intermittent. Symptoms are not necessarily caused by touch or pressure to the vulva, i.e., with intercourse or bicycle riding, but these activities often exacerbate the symptoms.
2. Vulvar Vestibulitis Syndrome
Women with VVS have pain only in the vestibule, and only during or after touch or pressure is applied. Burning sensations are the most common symptom and may be experienced with some or all of the following: sexual intercourse, tampon insertion, gynecologic examination, bicycle riding, and wearing tight pants.
There are several other conditions that cause chronic vulvar pain and may coexist with Vulvodynia. The most common of these are listed below:
Cyclic Vulvovaginitis
Women with cyclic vulvovaginitis have recurrent burning and itching symptoms at the same stage of the menstrual cycle. Many have cyclical bouts of yeast infections and some have other causes for their symptoms.
Vulvar Dermatoses
There are many dermatologic conditions that may cause pain in the vulva. The most common include: allergic or contact dermatitis, lichen sclerosus, lichen simplex chronicus and lichen planus. These conditions may cause symptoms of itching and burning. Scratching the vulva and overusing topical medications may inflame the tissue, causing swelling and additional pain.
Causes
The exact cause of vulvodynia isn’t known. Some factors that may be involved include:
- Frequent yeast infections
- Frequent use of antibiotic medicines
- Chemical irritation of the external genitals (from soaps or detergents in clothing)
- Rashes on the genital area
- Previous laser treatments or surgery on the external genitals
- Past or present genital warts
- Nerve irritation or muscle spasms in the pelvic area
Symptoms
The main symptom of vulvodynia is pain in your genital area, which can be characterized by:
- Burning
- Soreness
- Itching
- Stinging
- Rawness
- Painful intercourse (dyspareunia)
- Throbbing
The pain you experience may be constant or intermittent and can last for months or even years but can vanish as suddenly or mysteriously as it started. A similar condition, vulvar vestibulitis, may cause pain only when pressure is applied to the area surrounding the entrance to your vagina.
Vulvar tissue may look minimally inflamed or swollen. More often, your vulva appears normal.
Diagnosis
You may need to have a pelvic exam and tests to check for bacteria and yeast. If any test results don’t seem normal, your doctor may want you to have a colposcopy or a biopsy. Colposcopy is an exam of the genital area that uses a special magnifying glass. If you have a biopsy, your genital area is numbed with a painkiller, and a small piece of tissue is taken to be looked at with a microscope.
Treatment
Treatments for vulvodynia focus on relieving symptoms. No one treatment works for every woman, and you may find that a combination of treatments works best for you. Available options may include:
* Medications Tricyclic antidepressants such as amitriptyline can help lessen chronic pain. This type of antidepressant may work better than some of the other types of antidepressants, such as fluoxetine (Prozac, Sarafem) or sertraline (Zoloft), for this condition. Anticonvulsants such as carbamazepine (Tegretol) and gabapentin (Neurontin) also may lessen the pain of vulvodynia. Antihistamines such as hydroxyzine can reduce itching.
* Biofeedback therapy This therapy can help reduce pain by teaching you how to control specific body responses. The goal of biofeedback is to help you enter a relaxed state in order to decrease pain sensation. To cope with vulvodynia, biofeedback can teach you to relax your pelvic muscles, which can sometimes contract in anticipation of pain and actually cause chronic pain itself.
* Local anesthetics Using medications such as lidocaine can provide temporary relief from the pain.
* Topical creams Creams that contain estrogen or cortisone can help alleviate the pain.
* Sitz baths Bathing the area around your external genitals and buttocks in a saline solution can sometimes help make you feel better, but it also has the potential to aggravate your discomfort.
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