Your health: vulvodynia

VULVODYNIA, or vulvar pain of an unknown cause, has a significant negative impact on a woman’s health, self-esteem, relationships, quality of life, and work productivity.

According to obstetrician-gynaecologist Dr Ryan Halsall, vulvar pain is either from a specific cause, or from no identifiable cause at all. As such, management must be directed towards a wide range of potential causes.

Characteristics of the condition, according to Dr Halsall, include chronic vulvar pain of at least three months’ duration. This pain may be at one particular point or may involve the entire vulva. Sometimes there’s a trigger like a chemical or an action, and other times the pain starts on its own. It varies widely in terms of timing of onset as well as the characteristic of the pain. Some women have sharp pains while others have dull aches or even burning.

The assessment of women with chronic vulvar pain involves a detailed history that includes discussion of pain symptoms, sexual practices, gynaecological and medical issues, and a comprehensive physical examination.

Dr Halsall explained that because vulvodynia is a chronic condition in which symptoms are managed but may be ongoing and characterised by periods of remission and flare, one goal of treatment is to set realistic expectations.

He added that part of this includes reviewing behaviours that can be helpful or harmful and educating women on vulvar hygiene, stress relief, symptom reduction, lubrication and exercise.

With regards to vulvar hygiene, Dr Halsall said good vulvar hygiene is the first and easiest step women can take to alleviate irritation and discomfort. It is best to avoid applying soap, fragrance or other products to the affected area, as any product can cause atopic dermatitis. Plain water or a plain glycerine soap will suffice, as the vagina naturally cleanses itself. Douching, bubble baths and spraying deodorant down there is also not recommended.

During your periods, it might be beneficial to use hypoallergenic menstrual products. Cloth pads and silicone cups aren’t commonly used locally, but would likely cause less irritation than commercial pads and tampons.

Additionally, he recommends wearing non- constrictive cotton underwear during the day and none during hours of sleep; avoiding panty-hose, tights, and tight pants.

Regarding sex, use water-based non-scented, non-warming, non-allergenic lubricants. If necessary, apply cool gel packs to the vulva before and/or after sex to reduce pain and swelling.

Other approaches to ease the discomfort of vulvodynia include:

1. Symptom relief — Soaking in warm baths with Epsom salts. Application of ice packs to the vulva for 10 to 15 minutes at a time every four to six hours can reduce burning sensations.

2. Stress reduction — Doctors encourage stress reduction and relaxation techniques because data suggests that women with vulvodynia have higher levels of stress and anxiety than healthy controls. Stress may exacerbate symptoms of vulvodynia, and the symptoms tend to worsen stress. Stress reduction may break this cycle.

3. Lubrication — Over-the-counter personal lubricants can be both helpful and harmful to women with vulvodynia and female sexual pain. Topical lubricants that moisturise the skin or reduce friction during sexual contact are typically helpful. Products that contain alcohol (gels) or warming agents can worsen symptoms.

4. Exercise — While exercise can be helpful to reduce stress and anxiety, doctors advise avoiding activities that can directly irritate the vulva, such as spinning class or bicycling, at least while the patient is symptomatic.

Other forms of treatment are:

1. Pelvic floor therapy.

2. Psychological interventions which focus on reducing pain, restoring sexual function and strengthening the couple’s relationship by targeting the thoughts, emotions, behaviours, and couple interactions associated with sexual pain. These interventions include cognitive behavioural therapy such as sex and couple-based therapy that can address the impact of the pain on sexual function.

3. Non-surgical medical therapy such as the use of topical preparations, oral medications, and injection therapy.

4. Surgery, though generally considered a treatment of last resort, particularly for women with localised, provoked vulvodynia, is performed on a case-by-case basis.