Vulvodynia
Vulvodynia is chronic discomfort in the vulva--the area containing the external genital organs.
Vulvodynia typically begins suddenly, then becomes a chronic problem, lasting months to years. The cause is unknown. It may be triggered by irritation of or injury to the nerves supplying the vulva (as may occur during cryotherapy or laser therapy). Vulvodynia tends to be more common among women who have infections (especially yeast infections and sexually transmitted diseases), skin disorders, diabetes, precancerous conditions, cancer, or spasms of the muscles that support the pelvic organs. Certain substances (such as soaps, feminine hygiene sprays, menstrual pads, laundry detergents, and synthetic fibers) may cause an allergic reaction or irritate the area, increasing the likelihood of developing vulvodynia. Women who are undergoing hormonal changes or who have a history of sexual abuse are also more likely to develop vulvodynia. Eating certain foods, such as greens, chocolate, berries, beans, and nuts, produces urine that can be irritating.
The vulva may burn or sting. It may feel raw, irritated, or painful. The pain ranges from mild to debilitating and may be constant or intermittent. It can interfere with daily activities, limiting physical and sexual activity. It may make walking and sitting uncomfortable. The vulva may appear swollen and red, or it may appear normal.
Doctors diagnose vulvodynia by ruling out other disorders that can cause similar symptoms. The goal of treatment is to relieve symptoms. Potential irritants should be avoided. Wearing cotton underwear may help reduce irritation in the area. Tight-fitting, restrictive clothing, such as pantyhose, should not be worn. Foods that may produce irritating urine should not be eaten. Physical therapy, including exercises to improve tone in the pelvic muscles, biofeedback, and relaxation exercises, often help, as do support groups.
Topical anesthetics such as viscous lidocaine may reduce the pain. Topical corticosteroids may be rubbed into the skin 2 or 3 times a day to control symptoms.
Disorders that may be contributing to vulvodynia, such as infections, are treated. Some women benefit from tricyclic antidepressants (see Section 7, Chapter 101) or anticonvulsants (see Section 6, Chapter 85).
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