What are the common symptoms of Vulvodynia?
The most common symptom is pain at the entrance of the vagina. Some patients experience pain upon external touch or stimulation of the vulvar region, while others have symptoms even without any type of stimulation. Patients typically complain of burning, itching, dryness, rawness and a drawing sensation. The symptoms may range from mild to severe. The vulva discomfort ranges from a feeling of being swollen to piercing and stabbing pain. Some patients have clitoral pain; others will experience pain in the posterior fourchette or elsewhere around the vestibule. In terms of the severity of symptoms, some women may have occasional discomfort, while others are uncomfortable on a daily basis and find it difficult to sit or walk. Some may tolerate sexual intercourse, while others may have severe symptoms afterwards. Some patients are so incapacitated by the pain that they refrain from intercourse and avoid tampons slacks or any type of tight clothing. Many patients may also experience some urinary symptoms that appear when symptom severity increases.

Who gets Vulvodynia?
Contrary to earlier perceptions that vulvodynia predominantly affected Caucasian women of fair complexions, white and African American women reported similar lifetime prevalences. However, Hispanic women were 80% more likely to experience chronic vulvar pain. Women with histories of chronic vulvar pain were 7-8 times more likely to report difficulties using tampons during teen years. Although most patients are of childbearing age, the prevalence appears to peak at age 24, but onset of symptoms can occur at any age.

Many doctors are still not familiar with Vulvodynia and as a result, it is frequently misdiagnosed and treated improperly.

Sometimes patients are told “its all in your head.” But the condition is very real. Anxiety and depression my often result from chronic pain, and the condition will cause impairment of sexual function as well as disrupt normal day-to-day life, but the condition is not the result of negative thoughts, emotions or psychological issues.

How is it diagnosed?
Exquisite sensitivity of the tiny gland openings at the entrance of the vagina, to light touch with a cotton-tipped applicator, is the typical diagnostic feature of Vulvodynia. This is called the “touch test.” About two thirds of patients with Vulvodynia have visible, red tiny spots at these points. For the remainder of patients, a doctor may detect inflamed surface blood vessels with a colposcope, which is a magnifying instrument.

What causes it?
The precise cause of Vulvodynia is unknown. Some of the theories on causality include: a viral, fungal or bacterial infection; an allergic response to an environmental irritant; an autoimmune response to the body’s own chemistry; trauma; or the result of pelvic floor muscle instability. There is no clear connection of Vulvodynia to sexually transmitted disease as many of the young women affected are not yet sexually active.

Vulvodynia, like other chronic conditions, can have periods of flare-ups and remissions. At present there are treatments which offer partial to complete relief.

What is Vulvar Vestibulitis?
Vulvar Vestibulits is a form of vulvodynia (“vulvar pain”). It is characterized by swollen glands and sensitivity to touch, pressure or friction. Patients with Vulvar Vestibulitis are able to function well and not experience discomfort except when the area is touched, whereas in Vulvodynia the pain may be a constant discomfort. For further information on vulvodynia terminology, please refer to the section on Vulvodynia Classification.

Is Vulvodynia different from Vaginismus?
Vulvodynia and Vaginismus are two different conditions which may coexist or exist totally independent of each other. Frequently these conditions are confused and misdiagnosed. Vaginismus is an involuntary spasm of the pelvic floor muscles keeping the vagina closed and preventing insertion of tampons or penetration during intercourse. This spasm can be a natural protective and guarding response to prevent exacerbation of pain, or it may be a more chronic spasm of the muscle due to organic irritants or psychological fears. Vulvodynia related symptoms may result in secondary vaginismus, but the real problem of vulvodynia should not be overlooked on account of the muscle spasm, which may be most evident during a medical exam. Both conditions need to be treated individually during therapy. The problem of Vaginismus is much more common than Vulvodynia and responds well to therapy.

What are some of the current treatments?
Because these conditions are not widely recognized, it is best to seek out clinics that are most familiar with these conditions and experienced in treating them. It is essential that the patient be examined carefully to identify possible triggering factors and to ensure that these are medically managed. For example if it is evident that the patient has a chronic yeast infection or a bacterial infection, than these need to be treated. Once the irritants are identified and managed, the burning due to nerve sensitivity may still persist. Specialised biofeedback therapy is most often used to desensitize the affected area. Certain pain medications are also used to reduce the level of discomfort. Patients are also instructed on how to properly care for sensitive vulvar skin. In a small number of cases where conservative therapies have not been affective in resolving the problem, surgical options may also need to be considered.