By Gerald F. Joseph, Jr, MD
President, The American College of Obstetricians and Gynecologists
Vulvodynia is a condition that causes chronic pain or discomfort in the vulva, the external part of the female genitalia. An estimated 18% of women will experience the symptoms of vulvodynia, yet many will never seek treatment.
The painful symptoms—including burning, stinging, itching, rawness, aching, soreness, throbbing, or swelling of the labia or the area that surrounds the opening of the vagina—can severely affect a woman’s quality of life. Pain often occurs after physical contact with the vulvar area, such as during sex, tampon insertion, a gynecologic exam, or while wearing tight pants. Exercising, urinating, or simply sitting can also be irritating.
The causes of vulvodynia are unknown. It is not a sexually transmitted disease, nor is it caused by inflammation, cancer, nerve disorders, or any commonly identified infection such as yeast, herpes, or human papillomavirus (HPV). Vulvodynia is usually diagnosed when no other cause can be found for a woman’s vulvar pain.
Women with vulvodynia may have a hard time working or being active, and may experience emotional and mental health problems, such as depression and anxiety. The condition can also contribute to sexual dysfunction—some women may become fearful of having sex which can lead to vaginismus, spasms of the muscles around the vagina that can make sex painful and sometimes impossible.
If you experience the symptoms of vulvodynia, talk to your doctor. He or she will perform a physical exam and tests to rule out other causes of your pain. Tell your doctor about your symptoms, lifestyle (eg, diet, exercise, clothing, and any hygiene, skin, deodorant, cosmetic, or laundry products that you use), any recurrent infections or skin problems, and medications that you currently take or have used in the past.
Several treatments that have been used to reduce pain and irritation include medication, physical therapy, dietary changes, sex counseling, surgery, acupuncture, hypnotherapy, nitroglycerin, and Botox injections.
Some women may also be able to reduce irritation by wearing 100% cotton underwear; using mild soaps while bathing and cleaning the vulva with water only; avoiding perfumes, dyes, shampoos, and detergents around the vulva; avoiding douching and vaginal wipes; using extra lubrication during sex; patting the vulva area dry after bathing and then applying a topical emollient without preservatives (such as vegetable oil or plain petroleum jelly) to hold moisture in the skin; and applying cool gel packs to the vulva area.
No one treatment works all the time for everyone and some therapies can take weeks or months to relieve symptoms. Most women will need to try several different treatments to see which helps with their discomfort.
The ACOG Patient Education Pamphlet “Vulvodynia” is available in English and Spanish at www.acog.org/publications/patient_education. ?
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