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Pelvic Pain

The vulva is the external part of the female genitalia. Vulvodynia is chronic vulvar discomfort or pain, for which no cause can be found. The symptoms include vulval burning, stinging, irritation or rawness. Burning sensations are the most common, but the type and severity of symptoms vary from patient to patient. Pain may be constant or intermittent, localised or diffuse.

To explain a little more about vulvodynia, we need to explain some key terms: The outer and inner lips of the vulva are called the labia majora and labia minora. The vestibule surrounds the opening of the vagina and the urethra, and the openings to the Skene’s and Bartholin’s glands are located within the vestibule. The perineum is the area between the bottom of the vulva and the anus.

Vulvodynia has been classified into the following subtypes:

Generalized (Dystetic) Vulvodynia

Generalized Vulvodynia symptoms may be diffuse, which means that they arise in different areas at different times. Pain may be present in the labia majora, labia minora, and/or the vestibule. Some women experience pain in the clitoris, mons pubis, perineum and/or the inner thighs.

Symptoms can be caused by touch or pressure to the vulva, for example, during intercourse, when inserting tampons or bicycle riding. Dystetic Vulvodynia can also present as a burning sensation. The pain itself may be constant or intermittent and can be triggered by clothing rubbing, even gently, against the skin of the vulva.

Vulvar Vestibulitis Syndrome (VVS)

Women with VVS only experience pain in the vestibule (entrance to the vagina) and only during or after touch or pressure is applied. Burning sensations are the most common symptom and may be experienced with some or all of the following: sexual intercourse, inserting tampons, gynaecologic examination, bicycle riding and wearing tight pants.

There is also a range of dermatologic conditions that may cause pain in the vulva. Scratching the vulva and overusing topical medications may inflame the tissue, causing swelling and additional pain.

Vulvodynia, as with most chronic pain conditions, can have a profound impact on a woman’s quality of life. It typically affects her ability to engage in sexual activity and may interfere with daily functioning in the most fundamental ways. Sitting at a desk, taking exercise, and even participating in social activities can be painful and difficult. These limitations, if left unaddressed, can negatively affect self-image and lead to depression.

  • Many women may suffer from vulvodynia for years before an accurate diagnosis is made. Thrush is often mistakenly assumed to be the cause of symptoms.
  • To diagnose Vulvodynia, your doctor will carefully review your medical history. You will be asked questions about your symptoms, your sexual activity, diet, feminine hygiene, previous medical problems and medication use.
  • Dr. McCaffrey will also carefully examine the vulva, vagina and any vaginal secretions to investigate other causes of your pain such as infections and skin disorders. She may also perform routine vaginal cultures to make sure that an infection is not causing – or worsening – any irritation or burning.
  • The doctor may also use a ‘Q-tip test’ as part of your exam. During this test, different areas of the vulva and vestibule are touched with a Q-tip to help determine the location and severity of your pain. With vulvodynia, even the slightest touch can trigger pain and tenderness.
  • If the doctor sees areas of skin that look suspicious during your exam, she may recommend a biopsy. She may also use a magnifying glass to look more closely at any lesions in the vulva, or may recommend a colposcopy, a test in which an instrument is used to look at the vulva more closely.
  • Our treatments are directed toward easing symptoms, and may provide partial or indeed complete relief. It’s important to remember that the cause of vulvodynia is unknown. Each woman’s symptoms are unique, and no single treatment works all the time or is appropriate for every patient.
  • Some women respond very well to a particular treatment, while others respond poorly or experience unacceptable side effects. It takes time to find the treatment, or combination of treatments that work for you.

Some of the current treatments include:

  • Lifestyle changes, including avoiding possible irritants like bleaches or shower gels.
  • Local anaesthetic gels (i.e. lidocaine)
  • Amitriptyline
  • Tegretol, Neurontin
  • Nerve Blockades
  • Topical estrogen cream
  • Pelvic floor therapy (for patients who have pelvic floor muscle abnormalities as measured by surface electromyography)
  • Physical therapy
  • Diet modification
  • Surgery is very rarely necessary, and the only for vulvar vestibulitis syndrome

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