2023-10-10 17:00:00
Definition: what is vulvodynia?
Vulvodynia corresponds to chronic pain in the area of the vulva or at the entrance to the vagina at the vestibule (we then speak of “ vestibulodynia “). These symptoms have lasted for more than 3 months without an identifiable cause. Indeed, the doctor’s examination does not reveal any lesion of the mucosa or any underlying disease.
Vulvodynia can impair the quality of life and sexual relations of most affected women. Treatment helps relieve the symptoms of this disorder, which can sometimes disappear spontaneously.
According to the definition proposed in 2003 by the International Society for Vulvar Disease, “vulvodynia corresponds to a chronic vulvar discomfortmost often burn type, without relevant visible lesion and without clinically identifiable neurological disease.
Vulvodynia affects more young woman. We do not know the prevalence of this genital disorder in France. However, we can assume that this disorder is common, as illustrated by a study carried out in the Boston area which reveals that 16% of women in this geographical area have already suffered from persistent vulvar pain for more than three months (source 1).
Causes: what causes vulvodynia?
The cause of vulvodynia is unclear. According to doctors Martine Shollhammer and Micheline Moyal-Barraco: “It might be the consequence of a dysfunction of the pain modulation system. Normally, pain is an alarm signal to prevent the occurrence of tissue damage. In the case of vulvodynia, the brain receives the “pain” information in the absence of any tissue damage and the pain blocking mechanisms then fail” (source 2).
It is not uncommon for this dysfunction to follow a traumatic life event (source 3) whether on a physical level (genital infection, surgery of the genital area, childbirth) or psychological (mourning, separation, abortion, divorce , sexual abuse, etc.).
Studies show that certain disorders are often associated with vulvodynia such as urinary disorders (source 4), fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, chronic migraines, intolerance to multiple medications, intolerance to noise and light (source 5)… In addition, it has been shown that women suffering from vulvodynia have a reduced contact pain threshold in other areas of the body (source 6).
Pain in the vulva or at the entrance to the vagina, burning sensation: what are the symptoms of vulvodynia?
Vulvodynia is pain that can occur spontaneously or following pressure, friction (wearing tight clothing, tampon insertion, sex…).
The pain can be diffuse all over the vulva or localized at a specific location such as the clitoris (clitoridynie), hemivulva (hemivulvodynia) or vestibule located at the entrance to the vagina (vestibulodynia)…
The pain is described as burning sensations sometimes, throbbing, tingling or even tightness.
The pain is daily and often lasts for many months or even years. When there are remissionsthey do not last more than a few weeks.
Diagnosis: how do you know if it’s vulvodynia?
L’gynecological examination puts the doctor on the path. The description of pain associated with the absence of vulvar lesion or underlying pathology is sufficient to confirm the diagnosis of vulvodynia.
Sometimes Additional tests are necessary to verify that the pain is not the consequence of an infection (mycosis, herpes, etc.), an inflammatory disease (lichen planus, bullous dermatosis, etc.), a cancer (Paget’s disease, squamous cell carcinoma …) or a neurological condition or neuropathy (linked to a herpes virus or spinal cord compression).
Treatments: how to cure vulvodynia?
The listening and empathy of the doctor (who does not question the pain) sometimes provides sufficient supportive therapy.
Which cream for vulvodynia?
- THE sitz baths with water as well as emollient creams (vaseline, cold cream, cerate, sweet almond oils, etc.) or healing (Jonctum®, Cicalfate®) have a soothing effect for certain patients.
- The lidocaine (2 to 5% in gel or nebulizer form) may be prescribed by some doctors.
- Many other local treatments can be offered: gabapentine locale (source 7), capsaicin (source 8), local injections of topical corticosteroids and lidocaine (source 9)…
Medications prescribed for vulvodynia
Certain medications may also be offered such as:
- THE painkillers (aspirin, paracetamol, non-steroidal anti-inflammatory drugs, dextropropoyifen, codeine) although they are actually not very effective for vulvodynia.
- THE tricyclic antidepressants are sometimes used in cases of vulvodynia (source 10). The most used molecule is amitriptyline (Laroxyl® or Elavil®). The dose is lower than that given for mood disorders.
- THE serotonin reuptake inhibitor antidepressants would be effective at high doses.
- THE antiepileptics such as clonazepam (Rivotril®) or gabapentin are sometimes used once morest vulvodynia. Their effectiveness is uncertain (source 11).
Other therapies for vulvodynia
- Sessions of perineal rehabilitation consisting of massages of the perineal muscles and exercises of biofeedback help reduce the tension of the perineal muscles, a factor in maintaining pain (source 12).
- Recourse to a psychotherapist is sometimes necessary, particularly in cases of associated psychiatric disorder(s) (depression, anxiety disorder, etc.). The most often recommended approach is cognitive behavioral psychotherapy (source 13).
- Consultations with a sexologist can complete the treatment. Vulvodynia sometimes occurs in a context of marital difficulties and its sexual consequences. In this case, a couples therapy may prove useful.
Rarely surgery may be considered
Surgery in severe cases is rarely considered. This is vestibulectomy which involves removing the painful vestibular mucosa. Some specialists resort to it in the event of failure of medical treatments for genital pain (source 14).
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