If you never had pain on the vulva, you can never imagine how painful it is. Chronic vulvar pain is known as vulvodynia which only obtained the name about 30 years ago. It is not unknown now. Channel 4 a British BAFTA-award winning reality medical television programme Embarrassing Bodies introduced this condition vulvodynia. With up to 15% of women suffering with this condition, you can be sure that you’re not alone, if you have vulvar pain. It is a persistent burning or stinging pain of the vulva. It could be constant pain and get worse when under pressure or it could be only painful under pressure such as using tampon or sex. The pain can be only on the vulvar area. It can also spread to the thigh, tummy or back. Women with vulvodynia could have severe period pain, heavy periods, frequent urination and pain and changed bowel habit. Before vulvodynia is diagnosed, other causes of vulvar burning must be excluded. These include fungal, bacterial and viral infections, inflammatory dermatoses such as lichen sclerosus and lichen planus, contact sensitivity and eczema, and lesions such as surgical scars and recurrent fissuring. Vulvodynia can affect women of all ages. The possible causes of vulvodynia may include nerve irritation, abnormal response in vulvar cells to an infection or trauma, genetic factors that make the vulva respond poorly to chronic inflammation,, hypersensitivity to yeast infections, muscle spasms, allergies or irritation to chemicals or other substances, hormonal changes, history of sexual abuse, frequent antibiotic use. It is a distressing condition and affects women’s quality of life. The treatments are limited. Antidepressant and anti-epilepsy drugs can be used to treat vulvodynia and help reducing pain. However the effect is not satisfactory. NICHD-funded research found that amitriptyline (a tricyclic antidepressant) with or without topical triamcinolone (a corticosteroid used to treat skin conditions) was no more effective than self-management approaches (which included components of education and cognitive-behavioral, physical, and sex therapy) in managing vulvar pain, although the number of people in the study was small. Other NICHD-supported investigators conducted a randomized, controlled trial and found that oral desipramine (a tricyclic antidepressants) and topical lidocaine (an anesthetic), alone or in combination, were no better than placebos in helping women with vulvodynia. These drugs have many side effects. Make sure you know the side effects before you take the drugs.
Acupuncture can help treating the vulvar pain. In 1999, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE published a paper by Powell and Wojnarowska about acupuncture for vulvodynia. They selected twelve patients with vulvodynia aged from 18 to 68 years. All had vulvar pain and burning without other abnormalities on examination. All had experienced severe distress and impairment of sexual function. Many had tried suggested treatment without success. These patients were offered weekly acupuncture for ten weeks. As a result of acupuncture, Two patients felt so much improved that they declared themselves 'cured'; three believed their symptoms had improved and wished to continue acupuncture; four felt slightly better and judged acupuncture more effective than any other treatment; and three noted no effect at all. There were no obvious side effects for the treatment. A study from Sweden investigated the effect of acupuncture on vulva vestibulitis. They found that after three month acupuncture treatment patient’s quality of life was improved significantly. More recently Curran et al were using acupuncture for treatment of provoked vestibulodynia which is also a genital pain condition. There were 80 patients involved in this study. After 10 treatments there were significant decreases in pain with manual genital stimulation and helplessness. There were also strong effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and showed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants.
A new research from Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA has shown that acupuncture treatment significantly reduced vulvar pain in women with vulvodynia. In this study, thirty-six women with vulvodynia were involved. The women were randomly assigned either to the acupuncture group or to the wait-list control group. 10 sessions of acupuncture were offered to women in acupuncture group. Reports of vulvar pain and dyspareunia were significantly reduced, whereas changes in the aggregate FSFI scores suggest significant improvement in sexual functioning in those receiving acupuncture vs. those who did not. Their conclusion is that this was the first randomized controlled pilot study to examine the use of acupuncture for the treatment ofvulvodynia. The acupuncture protocol was feasible and appeared to reduce vulvar pain and dyspareunia with an increase in overall sexual function for women with vulvodynia.
What does GP say about vulvodynia?
Here are the points
It is not well known condition, but it has great impact on women’s life. Vulvodynia is something that many people have not heard of. For women with vulvodynia, even the gentlest touch in their genital (vulval) area can result in intense, burning pain.
The cause of vulvodynia are not fully understood because when women with vulvodynia are examined there are no obvious abnormalities seen.
It can be difficult to diagnose. As a result, some women may face several years of symptoms and pain before receiving the right diagnosis. The approach is to rule out other possible diagnoses first.
Living with vulvodynia
Vulvodynia is classed as a chronic pain condition, but like other long term pain conditions you can have good and bad days. Vulvodynia can vary from a mild discomfort to severe pain.
Experiencing chronic pain can understandably affect your behaviour, activities and relationships. In particular, it may affect your sex drive or cause you to feel depressed.
Pain in the genital area especially is often difficult to talk about with family or friends, so you may be feeling isolated, which makes the problem feel even worse. If you don’t feel you can talk to your partner or friends, please talk to your doctor. Organisations such as the Vulval Pain Society give good information and also signpost to a number of support groups that are available.
Having sex with vulvodynia. When even the slightest touch can result in a deep burning or stabbing pain, it is understandable why women with vulvodynia can sometimes struggle to enjoy sex, or prefer to avoid it entirely.
There are some cases that are treated with acupuncture successfully
A 34 year old lady had vulvar pain for 3 years. The pain is worse when pressure is applied such as having intercourse. She always had very painful periods. There was tightness in her thigh and back. She was treated with antidepressant and physiotherapy, but the pain has not improved. There was no pain when passing water and no change with bowl habit. She decided to try acupuncture. After 8 acupuncture treatments, the pain was reduced significantly and she was able to stop taking antidepressant.
A 29 year old lady had vulvar pain for 2 years. There was burning sensation when passing water with frequent urination. The vulva pain was unendurable when having intercourse. It was impossible to use tampon. She also had lower back pain. Her periods were very painful. She was treated with various medications, but the pain was not improved at all. She has heard from a friend that acupuncture can help with her condition and decided to try it. After 3 month treatments, the pain has completely gone. There was no pain when passing water and no intercourse pain.
A 43 year old lady had severe vulvar pain for 1 year companied with period pain and intercourse pain. She had irregular periods and she also had frequent urination and urgency. The pain goes to lower abdomen, thigh and lower back. She took antidepressant, but the pain was still there. Local injection of steroids did not have any improvement. She decided to try acupuncture to see if it helps. After 5 treatments the pain significantly improved and another 10 treatments, the pain was completely disappeared.
My book can help you understand more about vulvodynia. http://www.amazon.co.uk/Vulvodynia-vulval-pain-your-mind-ebook/dp/B010R2596K
Powell and Wojnarowska J R Soc Med (1999) 92:579-81
Curran S et al J Sex Med (2010) 7:981-95
Danielsson L et al Acta Obstet Gynecol Scand (2001) 80:437-41
Schlaeger JM et al J Sex Med (2015) 12: 1019-27