Chronic Vulvar Pain in Post-Menopausal Women: Atrophy or Vulvodynia?
“Although postmenopausal vulvar pain is frequently attributed to vaginal atrophy, such symptoms may be due to vulvodynia, a chronic vulvar pain condition” [1]
Vulvovaginitis
The bad news is that whilst in the majority of cases, vasomotor symptoms brought on by the menopause become easier, as women get older, vulval symptoms advance. In fact, data from the Women’s Health Initiative Study indicate that: “vulvovaginal symptoms, including dryness, irritation and itching, affect up to 27% of postmenopausal women” [1], in other words, more than one woman in every four.
Vulval atrophy is commonplace in post-menopausal women, and sufferers frequently report numerous non-specific symptoms such as: irritation, soreness, dyspareunia and dryness. Moreover, atrophy brought about by lower oestrogen levels renders the vaginal walls thinner due to increased friability and a loss of collagen [1].
“Growing literature suggests that vulvar atrophy may not be the sole cause of postmenopausal vulvar pain. Postmenopausal women may be experiencing new onset, exacerbated &/or long-term vulvar pain consistent with a diagnosis of vulvodynia” [1]
Booking an appointment with an experienced Pain Specialist, such as one of the doctors at the Vulva Pain Clinic is essential, as general practise doctors do not have the necessary expertise in this highly complex area. They will review your medical history, ask you various questions related to your own personal issues, and conduct a comprehensive examination which may include various tests. Prior to giving you a diagnosis, your Pain Specialist will first exclude other causes.
“Although vulvar pain symptoms can occur at any time over the life span, it is not uncommon for symptoms to begin for the first time after menopause. The prevalence of chronic vulvar pain in mid-life women has been estimated to be 8.9-38%, making chronic vulvar pain a major health concern for women in this age group” [1]
“Dyspareunia may be experienced by as many as 40% of sexually active menopausal women but, as only a third of women seek help for vulvovaginal symptoms of any kind” [2]
Vulvodynia
This very unwelcome condition defines vulval discomfort, and various symptoms such as burning pain. It is sub-classified it into provoked vulvodynia or unprovoked vulvodynia, which is either localised or generalised. As many women suffer in silence, it is important to know that: “the pain, burning or irritation associated with vulvodynia can make you so uncomfortable that sitting for long periods or having sex becomes unthinkable. The condition can last for months to years [3].
Getting Things Sorted
Regardless of whether you are suffering from atrophy or vulvodynia, after your diagnosis, your pain specialist will be able to recommend a personalised treatment plan which will involve one or more conventional and/or the latest cutting-edge modalities. All clinic visits will be scheduled to fit in with your work and family commitments.
References
[1]. Mitro, S.D., Harlow, S.D., Randolph, J.F. et al. Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia?.Women’s Midlife Health 2,4 (2016).
https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0017-z#citeas
[2]. Kingdton, A. (2009). “Review The Postmenopausal Vulva.” Royal College of Obstetricians and Gynaecologists.
https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.11.4.253.27528
[3]. [1]. Mayo Clinic (2020). “Vulvodynia.”
https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-