There are several treatments for Vulvodynia that are used to treat patients, including vulvar care measures, topical, oral, and injection medicines, psychotherapy, physiotherapy, a low-oxalate diet, calcium citrate supplements, and surgery are all options. Acupuncture, hypnosis, nitroglycerin, and botulinum toxin are some of the newer treatment for vulvodynia. In this article, we are going to discuss treatment for Vulvodynia as well as treatment outcomes.
Vulvodynia is a persistent painful condition that affects 9–12% of the population. The condition’s increasing prevalence represents a major issue. This has resulted in a greater emphasis on origin and treatment, although the definition also needs consideration. Traditional concepts state that the problem is exclusively a psychiatric condition have been dismissed, since inflammatory processes and hereditary factors, as well as psychosexual components, have been discovered to be involved in the etiology..
Vulvodynia is characterised by chronic pain in the vulvar area, which can range from minor to severe and incapacitating. The discomfort is frequently present during and after intercourse, and other circumstances may aggravate it (For example, riding a bicycle, inserting a tampon, sitting for an extended period of time, wearing tight clothing). Pain occurs spontaneously in some women. If you’ve had enough painful treatment for vulvodynia that hasn’t provided any relief, it’s time to try something new. Syren is a miraculous medication that can take away your pain in a matter of minutes. It’s never too late to put an end to your suffering! Stop suffering and try Syren today to live a happier life.
The diagnosis of Vulvodynia is based on a detailed history, followed by a confirmed physical examination. The history should include details about the start and nature of the pain, aggravating and alleviating events, previous medical assessments, and tried treatments and their results on the pain. Sometimes the patient is unaware that the sensitivity is at the area of the introitus, and she describes the discomfort as being deeper in the vagina or pelvis. Confirmation throughout the examination will usually clear this up.
The physical examination is a critical component of the diagnostic procedure. In women with Vulvodynia, the vulva may be erythematous, but the appearance of a rash or changed mucosa or skin is not associated with Vulvodynia and need additional assessment or biopsy. Several areas on the labia, introitus, and hymenal remnants are slightly indented (about 5 mm) using a cotton swab.
This pressure will cause discomfort in virtually all Vulvodynia patients; the most common locations of heightened sensitivity are the posterior introitus and posterior hymenal remnants. Although some women experience spontaneous pain that is not triggered by a cotton swab, a lack of sensitivity in all of these regions is rare in women who have provocable pain.
The existence of a current candida vulvovaginal infection should be determined using vaginal secretions. If an infection is discovered, antifungal medicine should be administered before treatment for Vulvodynia. Treatment for a probable yeast infection is not indicated without confirmation by highly positive potassium hydroxide microscopy (i.e. budding spores or hyphae), and a yeast culture should be conducted if infection is suspected. Although Candida may be present in women with Vulvodynia, eradication of Candida typically does not help the patient’s symptoms.
There is an absence of data on the effectiveness of various Vulvodynia treatment choices, and many of the often suggested treatment for vulvodynia have not been carefully evaluated in randomized controlled studies (RCTs). Nonetheless, various therapies have been employed with varied degrees of effectiveness, and the reactions to these treatments imply that most women with Vulvodynia may expect to heal.
Because Vulvodynia pain appears to be neuropathic, several drugs that have been used well in the treatment of other neuropathic illnesses have been tried in Vulvodynia patients. Tricyclic antidepressants (TCAs) are frequently used as first-line treatment. Many patients handle TCAs well after one week, but chronic lethargy, constipation, and weight gain may necessitate a change in medicine or dose.
When using TCAs, dry mouth is frequent but seldom causes cessation. Amitriptyline has been the most commonly used TCA, however other TCAs with less severe symptoms, such as desipramine (Norpramin), may also be beneficial. Although selective serotonin reuptake inhibitors (SSRIs) are not widely used to treat neuropathic pain, many individuals who cannot tolerate TCAs have reacted effectively to SSRIs. Venlafaxine (Effexor) is increasingly being used to treat Vulvodynia. Gabapentin may be beneficial in the treatment of several forms of neuropathic pain. However, current dose guidelines of three times per day limit the ease with which this medicine can be taken.
Calcium citrate treatment has only been tested in combination with a low-oxalate diet, therefore there is limited data on which to make recommendations. However, some people find it beneficial, and the negative effects are minor. Prolonged therapy with oral fluconazole (Diflucan) has been suggested on the basis of the hypothesis that persistent candidal infections may lead to Vulvodynia, but findings have been inconclusive. This treatment should only be used for individuals who have a verified candidal infection. Nonsteroidal anti-inflammatory medications and acetaminophen have not proven effective as narcotics or analgesics.
As vulvar pain treatment, many topical medicines have been tested. Stopping all treatments may reduce symptoms in women who have been taking various topical drugs for a long time. The most frequent topical medicine is lidocaine ointment 5% (Xylocaine jelly 2% or ointment 5%; AstraZeneca Pharmaceuticals LP, Wilmington, DE), which is applied as indicated for symptoms and 30 minutes before sexual activity. These can result in stinging or hypersensitivity. Male sexual partners should prevent oral contact if they develop penile numbness.
Long-term usage of topical lidocaine overnight may reduce feedback amplification of discomfort and allow for recovery. At evening, patients apply a liberal amount of 5% lidocaine ointment to the afflicted region and place a cotton ball amply covered with the 5% lidocaine ointment on the vestibule to ensure nightly contact with the area (for 8 hours or more). After a period of 7 weeks, 76 percent can be able to intercourse after treatment, as compared to 36 percent at the beginning.
With sexual intercourse, there was a considerable reduction in discomfort. Because there have been cases of lidocaine toxicity, it is important to practise caution while taking excessive doses of lidocaine. Benzocaine, the anesthetic in Vagicaine (Clay-Park Laboratories, Inc., Bronx, NY) and Vagisil (Combe Inc., White Plains, NY), is known to cause allergic contact dermatitis and should be avoided. Diphenhydramine (Benadryl; Warner Wellcome, Morris Plains, NJ) is used in many topical anesthetic and anti-itch medicines; it is also a frequent sensitizer to avoid.
According to one randomized controlled trial, cognitive behavioral therapy is related with a 30% reduction in reported vulvar discomfort during intercourse. Although psychological predispositions have not been demonstrated to be linked to Vulvodynia, the discomfort may be linked to interpersonal or individual psychological issues. Sexual, individual, and marital counselling should also be addressed for people who have recurring problems in these areas.
Biofeedback and physical therapy have been used to assist women regain control of their muscles and reverse changes in the pelvic floor musculature, including enhancing strength and relaxation. According to research, these remedies can help with Vulvodynia symptoms.
Although the effectiveness of most local treatment approaches has not been proven, women with vulvodynia are sometimes advised to avoid using harsh detergents and scented items in the vulvar area and to use all-cotton underwear. Many of the symptoms of Vulvodynia, according to some experts, are caused by dermatologic diagnosis (e.g., atopy, dermatographism, irritant contact dermatitis) and candidiasis, and Candidiasis is responsible for many of the symptoms of Vulvodynia, and therapy with antihistamines or antifungal drugs, and also avoidance of potentially irritating contactants, is recommended.
Topical corticosteroids and estrogens have typically not proven effective in reducing Vulvodynia discomfort, and these therapies are reserved for people with special reasons (e.g., estrogen deficiency, lichen sclerosus). Similarly, the administration of steroids and interferon to women suffering from localized symptoms has shown mixed findings and recommendations.
Topical lidocaine (Xylocaine) has been used as needed (up to three or four vulvar treatments per day) and lately on a nightly basis in the introitus to reduce vulvar discomfort, with promising results. In a case series, topical cromolyn sodium looked to be beneficial, but an RCT found that the results were comparable to those in the placebo group.
Surgery is one of the oldest therapies for localized vulvar vestibulodynia, however it is usually reserved for women who experience severe, debilitating pain in the introitus. According to several studies, 60 to 80 percent of women who underwent surgery claimed subjective pain improvement. Until recently, the bulk of research was case series, which had the inherent limitations of selection bias, reporting bias, and weak confounder controls.
A three-arm treatment trial comparing surgery with biofeedback and cognitive behavioral therapy discovered that women who had perineoplasty experienced higher pain reduction than those who received biofeedback or cognitive behavioral therapy. Despite this, most physicians do not advise surgery for women with this illness until their symptoms are severe and other therapies have failed. Considering new findings that Vulvodynia may be temporary in a significant proportion of women, avoiding surgical procedures wherever feasible appears wise.
For numerous years, carbon dioxide laser surgery for the vulva and vestibule was used, but it is no longer advised due to the scarring and exacerbation of symptoms that can occur. The use of alternative dye laser procedures is debatable. Other treatments have been attempted, with inconclusive outcomes. Isolated case studies indicate that hypnosis, inosine pranobex (Isoprinosine; not available in the US), and acupuncture may be useful therapies and treatment for vulvodynia, but further research is needed.
A substantial percentage of women with persistent vaginal problems (including some with Vulvodynia) use or have used alternative therapy. There is a scarcity of data on which to base recommendations for or against these therapies. Physicians should inquire about alternative therapies that patients are using or contemplating.