Dear Doctor Column, October 11, 2004

Vulvodynia Painful, Treatments Few

Question:

The entrance to my vagina hurts and burns almost constantly. My doctor says it's probably vulvodynia. What causes this and is there a cure?

Answer:

Vulvodynia refers to a group of pain syndromes affecting the vulva — the outer tissue surrounding the vagina and urethra. Women who suffer from the disorder experience burning, stinging, or aching that may be triggered by touch or activities such as sexual intercourse or even inserting a tampon, in the absence of infection or vaginal diseases.

Vulvodynia, as with most chronic pain conditions, can have a profound impact on a woman's quality of life, affecting her ability to engage in sexual activity and interfering with daily functioning, e.g., sitting at a desk, engaging in physical exercise, and participating in social activities. These limitations can negatively affect self-image and lead to depression.

Until recently, physicians did not know how many women suffered from vulvodynia. However, in the first comprehensive analysis of its kind, researchers at Brigham and Women's Hospital (BWH) in Boston found the prevalence of this debilitating and chronic vulvo-vaginal pain disorder has been significantly underestimated.

According to the research, approximately 16% of respondents to a Boston-based population survey reported histories of chronic vulvar pain for at least 3 months or longer; nearly 7% of respondents were experiencing pain at the time of the survey. White and African American women reported similar incidence rates. However, Hispanic women were 80% more likely to experience symptoms compared with white and African American women.

Based on their findings, BWH researchers estimate that approximately 5% of all women will experience this condition before age 25, and it is likely that the true figures are much larger. They also point out that approximately 10 million doctor's office visits for vulvo-vaginal problems occur every year, and upwards of 14 million women may suffer from vulvodynia during their lifetime.

There are three types of vulvodynia — cyclic vulvitis, vulvar vestibulitis, and essential vulvodynia. Women with cyclic vulvitis have recurrent burning and itching symptoms 1 or 2 weeks before menses and after intercourse. Many have cyclical bouts of yeast infections and some have other causes for their symptoms, such as a hypersensitivity to estrogen or progesterone.

Women with vulvar vestibulitis have pain at the vaginal entrance 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.

In essential vulvodynia, burning or aching is present most of the time. Physicians believe this may be due to hypersensitive nerves under the skin.

There currently is no "cure" for vulvodynia. Treatments are directed toward alleviation of symptoms and may provide partial or complete relief. Keep in mind that the cause of vulvodynia is unknown and each woman's symptoms are unique; no single treatment works all the time or is appropriate for every patient. Some women respond very well to a particular treatment, while others respond poorly or experience unacceptable side effects. It takes time to find a treatment or combination of treatments that will decrease or alleviate your pain.

Some of the current treatments available include lidocaine jelly, tricyclic antidepressant medications, topical estrogen cream, and a diet low in oxalate, which may irritate vulvar tissues.

For more information visit the National Vulvodynia Association Web site at www.nva.org or the Vulvar Pain Foundation Web site at www.vulvarpainfoundation.org. The foundation offers suggestions to help reduce vulvar pain, including:

• Taking baths in plain, lukewarm water several times a day You may want to add instant oatmeal or baking soda.
• Rinsing the vulva every time you urinate using a squirt bottle.
• Avoiding the use of fabric softener in the washer or dryer.
• Wearing 100% cotton underwear and stockings.
• Avoiding tight-fitting clothes or jeans. Don't sit around in a wet swimsuit for a long time.
• Reporting any increased discharge and irritation to your doctor so yeast and bacterial infections can be treated right away.