Vulvodynia

Vulvodynia ("vul-vo-din-ee-a") is chronic pain or discomfort of the vulva (the area surrounding the outside of the vagina) that lasts for three months or longer without any evidence of other skin or gynecological causes. Vulvodynia is usually characterized by burning, stinging, irritation or rawness of the area. The most common complaint is a burning sensation.
Vulva Anatomy
Labia-the folds just outside the vaginal opening Vestibule-the portion of skin at the vaginal opening that contains the opening of the urethra, vagina and lubricating glands Perineum-the area between the vaginal opening and the anus

Some women experience discomfort of the entire vulva area (generalized pain). Others have localized pain, which affects a specific part of the vulva, such as the vestibule or clitoris. Symptoms may be constant or come and go. The pain may be provoked by sexual and/or nonsexual contact (e.g., inserting a tampon, during a pelvic exam, wearing tight-fitting pants), unprovoked (spontaneous), or mixed (provoked and unprovoked).
The two types of vulvodynia are:
Generalized vulvodynia—refers to generalized, unprovoked vulvar pain.
Vulvar vestibulitis—is characterized by pain experienced when pressure is applied to the area surrounding the vaginal opening. In this case, chronic vulvar pain may be triggered by sexual activity, tampon insertion or gynecological exams, or when wearing tight-fitting pants or even when sitting.
It is estimated that up to 18 percent of women—roughly 14 million—will suffer with chronic vulvar pain at some point in their lives. Still, vulvodynia remains poorly understood and is often misdiagnosed.
Many women suffer with unexplained vulvar pain for months—even years—before a correct diagnosis is made and an appropriate treatment plan is determined. A recent survey found that 40 percent of women chose not to seek treatment, even when symptoms limited sexual intercourse. Of those who sought medical advice, more than half (60 percent) saw at least three doctors. Only one out of 10 women was correctly diagnosed with chronic vulvar pain; the rest were diagnosed as having other vaginal or pelvic infections or problems associated with this type of pain.
While vulvodynia affects women of all age groups, the onset of symptoms is most common among women between the ages of 18 and 25. This risk drops significantly in those 35 years and older. Hispanic women are much more likely to experience chronic vulvar pain compared to white and African American women, who have similar risk.
Causes and Risk FactorsThere is no simple answer to the question, "What causes vulvodynia?" We do know that it is not caused by infection, the human papillomavirus (HPV) or other sexually transmitted diseases, cancer or neurologic disorders. It can only be diagnosed after other potential causes of vulvar pain, such as yeast infections, have been ruled out; also called a diagnosis of exclusion.
Early difficulty or pain when using tampons appears to predict those at high risk for future vulvodynia. Women with chronic vulvar pain are seven to eight times more likely to report difficulty and discomfort with first tampon use. These women also have higher levels of inflammatory markers, such as interleukin-1 and TNF alpha, and lower pain thresholds.
Research shows the following may contribute to vulvodynia:
pelvic nerve damage or irritation spasms or weakness of the muscles that support the pelvic organs abnormal response of cells in the vulva to environmental factors, such as infection or injury allergies to certain detergents or soaps hormonal changes genetic factors, including susceptibility to inflammation recurrent yeast infections increased oxalates in urine frequent use of antibiotics or topical medications previous laser treatments or surgery external to the vagina Impact on Quality of LifeVulvodynia can cause significant physical, sexual and psychological distress. Women who suffer with vulvodynia report difficulties exercising, being intimate and taking part in other daily activities. Even sitting for long periods of time can trigger vulvar pain episodes in some women.
A recent survey of 76 women with vulvodynia found:
More than half (60 percent) feel "out of control" of their bodies.
Two out of five women (42 percent) say the condition interferes with their enjoyment of life.
Almost two out of three (60 percent) cannot have sexual intercourse because of the pain.
The sheer anticipation of vulvar pain can heighten anxiety and lead many women to avoid sexual intercourse. Refraining from sex not only affects a woman's self-image, but it may also result in spasms of the muscles around the vagina (vaginismus), making it even more difficult to be intimate with her partner.
In addition, more than half of women with vulvodynia may be burdened by other health problems, including interstitial cystitis, fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome and recurring yeast infections.
Lack of awareness about this condition among health care professionals and patients alike, coupled with the stigma frequently associated with genital disorders, makes diagnosis and treatment more challenging. As a result, many women are left not knowing why they have such severe, often debilitating vulvar pain, which can strain to a couple's sexual relationship. Some women report being told the pain is "all in your head" by health care providers, who are often unaware that vulvodynia is a legitimate medical problem.
If untreated, chronic pain can lead to:
low self-esteem anxiety depression reduced quality of life And the severity of the pain can worsen when you are stressed, depressed or anxious.
Call for More ResearchThe National Women's Health Resource Center, in partnership with the Office of Research on Women's Health, and other federal and non-federal partners, such as the National Vulvodynia Association, have launched the "Vulvodynia Awareness Campaign" in response to a Congressionally recognized need to bring more attention to this chronic pain syndrome among health care providers and patients alike. Vulvodynia affects roughly one in five women in the U.S. Investigations into the role of inflammation and genetic factors, as well as the association of vulvodynia with other conditions, such as interstitial cystitis, fibromyalgia and irritable bowel syndrome, are ongoing.