Vulvodynia: Diagnosis and Management
“Treatment of vulvodynia is optimized with a multidisciplinary approach that includes psychotherapy, pelvic physical therapy, medical therapy [& more]. Treatment of any type of vulvodynia should be individualized” [1]
Getting a Diagnosis From A Pain Specialist
This is the first positive step on the way to ending, or at the very least, ameliorating your suffering. Prior to giving a vulvodynia diagnosis, your Vulvodynia Specialist will thoroughly review your medical history, and ask you a number of questions. These will include: details of your sexual history (that you feel comfortable talking about); whether you are experiencing any psycho-social problems; which areas are painful, what exacerbates the pain, and how long you have been experiencing symptoms [2]. After this, depending on your personal case, your doctor may conduct various tests and examinations. These include:
• A pelvic examination of your vagina and external genital for visible signs of an infection (e.g. bacterial vaginosis or a yeast infection); or other pain triggers. If your Pain Specialist cannot find any infection just by examining the region, then he/she might take a cell sample to send to the lab
• A cotton swab test. This involves the gentle use of a moistened cotton swab which allows the medic to check for particular, localised pain within your vulva area
• A musculoskeletal examination. This focuses on your pelvic floor muscles [2].
So What Treatments Are On Offer?
“No one treatment works in every case. For many, a combination of treatments works best. It can take time to find the right treatments, & it can take time after starting a treatment before you notice relief” [2]
There are a number of treatment options available, and leading clinics such as the Vulva Pain Clinic, are always abreast of the latest research-backed cutting-edge treatments. Popular options include:
• Medications: steroids, anticonvulsants and tricyclic antidepressants can help ameliorate long-term vulvodynia pain. Further, antihistamines may reduce itching in some patients
• Biofeedback therapy: this modality teaches you how to relax the muscles in your pelvis, as well as how to manage the way your body reacts to vulvodynia symptoms
• Local anaesthetics: Medications (for instance lidocaine ointment), can offer temporary relief from your symptoms. For example, in order to lessen your discomfort, your Pain Specialist could recommend that you apply topical lidocaine half an hour prior to having intercourse
• Nerve blocks: local nerve block injections may help patients who are suffering from chronic pain which has not been helped by other treatments
• Pelvic floor therapy: a large percentage of vulvodynia sufferers hold extreme tension in their pelvic floor muscles (which support the bowel, bladder and uterus). Specific exercises and machines can help to relax these muscles, and thus reduce the pain from vulvodynia
• Surgery: while this is a less popular option, when a woman has localized vulvodynia or vestibulodynia, in some instances, surgery (known as vestibulectomy) may be recommended in order to remove the affected skin and tissue [2].
References
[1]. Stenson, AL. Vulvodynia: Diagnosis and Management. Obstet Gynecol Clin North Am. 2017 Sep;44(3):493-508.
https://pubmed.ncbi.nlm.nih.gov/28778645/
[2]. Mayo Clinic (2020). “Vulvodynia.”
https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427