What is vulvodynia?
Vulvodynia is a term used to describe pain affecting the vulva when the cause of the pain is unknown.
Vulvodynia is defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) as vulvar pain of at least 3 months duration, without a clear identifiable cause, which may have potential associated factors.
In 2015, the ISSVD recognised that vulvodynia can be localised or generalised. It may be provoked by sexual intercourse or other non-sexual factors (insertion of tampons, tight clothing etc), or spontaneous, or mixed (provoked and spontaneous). Its onset can be primary or secondary, and temporal pattern intermittent, persistent, constant, immediate or delayed.
- Vestibulodynia refers to localised provoked vulvodynia (this was previously known as vulvar vestibulitis).
- Localised vulvodynia can also affect the clitoral area; this is clitorodynia
- Generalised vulvodynia refers to spontaneous or mixed vulvodynia (previously known as dysaesthetic vulvodynia).
Refer to DermNet's page on genital skin problems for conditions that may cause vulvar burning, stinging, irritation and rawness.
Who gets vulvodynia?
Vulvodynia generally occurs in adult women between the mid-'20s to late '60s. These women are usually healthy active women with no history of chronic health problems or sexually transmitted diseases. Vulvodynia is no more or less common in women who have had one or more sexual partners.
The actual incidence of vulvodynia is unknown but can be as high as 15%.
Factors that have been associated with vulvodynia include.
- Co-morbidities and other pain syndromes (eg, painful bladder syndrome, fibromyalgia, irritable bowel syndrome, temporomandibular disorder)
- Musculoskeletal (eg, pelvic muscle overactivity, myofascial, biomechanical)
- Neurologic mechanisms (cutaneous dysaesthesia):
- Central (spine, brain)
- Psychosocial factors (eg mood, interpersonal relationships, coping, role, sexual function)
- Structural defects (eg perineal descent)
Research indicates that hormonal factors and inflammation are not related to vulvodynia. Psychosocial and psychosexual factors may precede or follow the onset of vulvodynia.
What problems are associated with vulvodynia?
Vulval pain and discomfort can have a profound effect on the quality of life. Simple activities such as sitting at a desk, bicycle riding, social events and maintaining a sexual relationship, are impacted upon. A woman's self-image is negatively affected and may lead to depression (and women that are depressed are more likely to suffer from vulvodynia).
How do you treat vulvodynia?
Because by definition, the cause of vulvodynia is unknown, treatment may be challenging. Treatment of vulvodynia usually requires a multidisciplinary approach that may include:
- Physiotherapy (eg, five exercises aimed at easing pain prior to vaginal penetration - a video by Dee Hartmann)
- Psychological therapy
- Pain management therapy
- Behaviour modification
Specific treatment of vulvodynia is described under each subtype. However, regardless of the type of vulvodynia, treatment for all must encompass a holistic approach taking into account the woman's physical and psychological needs.
Vulvodynia resolves spontaneously in about 40% of patients.