VULVODYNIA

Introduction

Vulvodynia is discomfort, pain, and burning sensations in the female external genitalia, also known as the vulva. It is a chronic pain of the vulvar region that may last for years without any known causative agent. The expression of severity and location of the affected area may differ among patients. In some patients, the discomfort is felt on one side of vulva, while in others it affects the whole vulva.

Vulvodynia was previously referred to as Vulvar Vestibulitis, Focal Vulvitis or Vestibulodynia, based on what part of the external genitals were affected. In some cases, the pain is so severe that the affected person cannot sit for a long time and have difficulty using tampons or participating in sexual intercourse. Patients often report discomfort and pain hours or days after sexual intercourse or a pelvic examination.

16% of women in the United States have vulvodynia. The highest number of cases  occur in women between 18 and 25. The lowest number of vulvodynia cases occur in women over 35.

Types of Vulvodynia

There are main two types of Vulvodynia. This classification is based on the affected area and sensations of pain.

Localized Vulvodynia

In this type of vulvodynia, the patient feels the pain or burning sensations only on one side of the vulva. Localized vulvodynia mostly occurs in the surrounding region of the vaginal opening, known as the vestibule. Localized vulvodynia is also referred to as Vestibulodynia or Vulvar Vestibulitis Syndrome (VVS). Localized vulvodynia may also affect the clitoris, which results in the development of clitorodynia.

If pain arises or occurs due to pressure on the vestibule, this is  referred as called Provoked Vestibulodynia. The pressure may be due to a gynecological exam, sexual intercourse, sitting for long periods, tampon use, or wearing tight fitting pants.

In some cases, provoked vestibulodynia occurs when someone participates in sexual intercourse for the first time. This is referred to as Primary Provoked Vestibulodynia. If the pain is not related to sexual intercourse then it is termed as Secondary Provoked Vestibulodynia.

Generalized Vulvodynia

Generalized vulvodynia usually develops across the entire vulva. The discomfort is mostly continuous although some patients have reported pain occurring in intervals, which provides bouts of relief. Burning sensations may occur in one or several areas such as the labia, vestibule, clitoris, and surrounding regions. In severe cases, the pain will extend to the inner thighs and perineum.

Symptoms

In most cases of vulvodynia, early development of the medical condition results in the appearance of symptoms. In some cases, the symptoms may not appear until much later even though the patient has already developed later vulvodynia. The most common symptom is mild to severe pain which may occur continuously or occasionally.

The main symptoms associated with vulvodynia include:

• A burning and stinging sensation in the external genitals.
• Soreness and rawness on the surface of the genitals.
• Discomfort and pain during sexual intercourse.
• Throbbing and itching in the external genital region.
• An appearance of swollen or inflamed vulva tissue (in some cases)

Suspected Causes

Although the cause of vulvodynia is unclear, some contributing factors have been identified. These include:

• Any trauma to the nerves in the vulvar region.
• Irritation or a high degree of inflammation caused by any agent in the vulvar area.
• Conditions that increase the number or density of nerve fibers in the vulva, particularly the nerve fibers responsible for transmitting and sensing pain.
• An abnormal or allergic response of valvular cells to external environmental factors.
• Genetic and hormonal factors
• Weak or unstable pelvic floor muscles.

Risk factors

Risk factors that aggravate the symptoms of vulvodynia include age, ethnicity, and different medical conditions such as fibromyalgia, stress, anxiety, interstitial cystitis, irritable bowel syndrome, post-traumatic stress disorder, and depression. In addition, a previous history of abuse may contribute to vulvodynia.

Medical Complications

Vulvodynia can also make patients prone to additional medical complications. These include psychological problems such as anxiety, depression, relationship issues, sleep disturbances, and sexual dysfunction. Vulvodynia can also decrease a patient’s quality of life. They may develop spasms in the surrounding muscles of the vagina due to fears about participating in sexual intercourse.

Diagnosis of Vulvodynia

Vulvodynia can be diagnosed in different ways. However, before performing the diagnostic procedures listed below, healthcare providers should ask patients about their medical history, including prior surgeries, and discuss any painful sexual experiences. This is important to determine the location and severity of symptoms.

Pelvic Exam

External genitals are inspected during a pelvic examination. The healthcare provider looks for signs of vaginal infections and, in the case of unknown symptoms, vaginal tissue cells are taken for a culture test. The culture test is processed to investigate any underlying bacterial and fungal vaginosis. For better results, vaginal secretions may also be taken into account during the pelvic examination.

Cotton Swab Test

In a cotton swab test, a moistened cotton swab is used to check for sensations of pain in the vulvar region. Gentle pressure is applied to suspected sites with the cotton swab, and the patient is asked about the location and severity of any pain.

Management of Vulvodynia

Various treatment options are available for vulvodynia. These options may help avoid a lifetime of symptoms.

• Avoiding Irritants: Patients are advised to remove any irritants that may trigger vulvodynia.
• Medications: Certain medications may prescribed depending on the severity of a patient’s vulvodynia. In most cases, steroids, tricyclic antidepressants, SSRIs, opioids, and anticonvulsants are used to reduce chronic pain. Antihistamines are also effective in managing the itching associated with vulvodynia.
• Pelvic floor therapy:Patients are trained to strengthen their pelvic muscles, which helps reduce their pain. Pelvic floor therapy also helps relax tense pelvic muscles. Another option, similar to pelvic floor therapy, is biofeedback therapy, which helps reduce pain through various methods of relaxing and controlling the pelvic muscles.
• Nerve blocks: Sometimes local nerve block injections are used to overcome vulvodynia. Nerve blocks are recommended for those who have long-standing pain and who do not respond well to other treatment protocols.
• Surgery: Surgery is mostly recommended for patients who have provoked vestibulodynia.
• Topical Anesthetics:Topical anesthetics are medications that can be applied directly to the affected area to relieve symptoms. Applying topical anesthetics an hour before sexual intercourse may be recommended in patients with severe pain. Topical anesthetics often contain Lidocaine, a local anesthetic. They may cause mild stinging, but they provide quick relief from vulvodynia. According to customer feedback, one of the best topically applied formulations to relieve vulvodynia is Syren Intimate Relief.

Syren Intimate Relief contains 4% Lidocaine, which blocks pain signals after it has been absorbed by the body. This effect provides quick and long-lasting relief from mild to severe vulvodynia pain. Syren Intimate Relief also relieves dryness and soothes burning and itching sensations. The rapid relief of symptoms greatly improves quality of life, allowing patients to return to healthy and normal pursuits. Users also recommend Syren Intimate Relief because it allows them to participate in sexual activity, which helps strengthen their intimate relationships.

Syren Intimate Relief is scent-free, stain-free, non-sticky and easy to apply. It smoothly covers the affected area, absorbing quickly into the skin. While users have reported a mild stinging sensation, that has not outweighed its benefits and effectiveness.

User feedback regarding Syren Intimate Relief is below:

“I’m glad to share my opinion. I was diagnosed with vulvodynia around 6 months ago. I’ve tried oral medication, topical prescriptions, pelvic floor PT and nothing made a difference until I tried this product. The problem I face is painful intercourse, and so I found this product and figured I’d give it a try. This was genuinely the first time I’ve had non-painful intercourse in what seems like forever. I want to cry at the feeling of relief I have from finding this product. Definitely recommend.”

“I have suffered for years not being able to have sex without pain due to menopause dryness and I thought it was something I would have to live with because nothing worked for me. Then I tried this product and from the first time using it I couldn’t believe how well it worked, it was like the good days all over again. I can’t tell you enough how wonderful this product is, it has literally given me back my feeling of sex appeal and sexual desire. This is a must try for anyone who has pain during sex, you won’t be sorry you did. I really can’t praise [it] enough.”

“When you first apply this product, you have stinging. Within a few seconds it disappears. If you have any vaginal itching or pain it is almost immediately gone. I only apply it first thing in the morning. I would recommend this product. I will also be reordering.”

“This gel helped tremendously with itching or any pain I had in my vulvar region. It is [a] smaller container than I thought it would be, but you only need a very small amount. It is small enough to keep in my purse in case I need it while I’m out. Great product.”