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Dyaesthetic vulvodynia
What is dyaesthetic vulvodynia?
Dyaesthetic vulvodynia has been the name used to describe one of the most common types of vulvodynia. The International Society for the Study of Vulvovaginal Diseases (ISSVD) in 2004 has reclassified the condition and it should now be referred to as ‘generalised vulvodynia’ (unprovoked, provoked or mixed), to distinguish it from ‘localised provoked vulvodynia’ or vestibulodynia (previously known as vulvar vestibulitis).
Dyaesthetic or generalised vulvodynia is characterised by widespread pain throughout the vulvar region. Pain may be present in the labia, clitoris, vestibule, perineum, mon pubis, and inner thighs. Pain may be constant or unprovoked by touch or pressure to the vulva. However activities such as intercourse, bicycle riding, and horse riding may make symptoms worse.
What are the symptoms of generalised vulvodynia?
Some of the symptoms of generalised vulvodynia as described by patients include:
- Widespread, generalised vulvar discomfort and pain, not altered by position or activity (vulvar burning only when sitting suggests pudendal nerve entrapment)
- Burning, raw feeling, irritation, throbbing, stinging sensation in the vulva
- Poking, as if needle stuck in the vulva
- Pain is generally not initiated by touch or pressure, but it can be in some patients
- Pain and discomfort sometimes experienced in the urethra or rectum
- Associated stress-related and chronic pain conditions such as headaches, face, tongue amd mouth pain, fibromyalgia, irritable bowel syndrome, fatigue, sleep problems and eating disorders
What causes generalised vulvodynia?
Generalised vulvodynia appears to be due to hypersensitive nerves but the cause is not yet clearly defined. One or more of the following may have a role to play in the development of this condition.
- Neuropathic causes i.e. stretched, inflamed nerves in the vulvar area or sometimes from spinal problems (pudendal nerve entrapment or pudendal neuralgia)
- Trigger points or sensitised nerve endings in the skin
- Chronic yeast infection (thrush) or its treatment with irritating antifungal agents
- Previous vulvar skin disorder, surgery or childbirth
- Hormonal changes causing vulvar dryness, especially during menopause
- Sensitivity/allergy to substances touching the vulva (chafing, irritant contact dermatitis)
- Emotional stress
- Herpes simplex (similar to post herpetic neuralgia from herpes zoster infection)
Who gets generalised vulvodynia?
Generalised vulvodynia is more common in older women who are either peri-menopausal or post-menopausal, but it may also occur in younger women.
Many affected women are not sexually active but those that are may experience a range of symptoms during sexual activity. Intercourse may occur normally without aggravation of symptoms or it may be unpleasant and difficult or even impossible due to the discomfort.
Management of generalised vulvodynia
Women who suffer from generalised vulvodynia require a range of treatments to help overcome their cycle of endless pain. A combination of therapies should be used and may include:
- Physical therapy and pelvic floor exercises to relieve muscle spasms and generalised vulvar pain. These may also help associated urethral and bowel problems.
- Amitriptyline, a tricyclic antidepressant, has been found to relieve pain from vulvodynia. However, side effects such as drowsiness, weight gain, and dry mouth occur in up to 50% of patients. Desipramine or nortriptyline may be better tolerated but there is less experience with these medications.
- Anticonvulsants such as carbamazepine and gabapentin may control chronic pain. Referral to a pain specialist may be helpful.
- Support and education: both the patient and their partner and families need to understand and learn how to cope with the stresses that the condition can place on relationships.
Related information
Self-help books
- The V Book: A Doctor's Guide to Complete Vulvovaginal Health
- The Vulvodynia Survival Guide: How to Overcome Painful Vaginal Symptoms & Enjoy an Active Lifestyle
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On DermNet NZ:
- Vulvodynia
- Vestibulodynia
- Cyclic vulvovaginitis
- Pruritus vulvae
- Vulval/vaginal problems in prepubertal females
- Genital skin problems
- Menopause and the skin
- Candida