What is Vulvodynia?
The term vulvodynia is derived from "vulva" and the Greek word "odynia" meaning pain (pronounced vul-vo-DIN-ee-ah).
There are four basic types of vulvodynia, and they are not always easy to distinguish from each other: vulvar vestibulitis, dysesthetic vulvodynia, cyclic vulvovaginitis (yeast-related), and vulvar dermatoses.
Many doctors are still not familiar with vulvodynia
and, as a result, patients are frequently misdiagnosed
or go undiagnosed altogether.
The pain of vulvodynia isn't always accompanied by visible skin changes and sometimes patients are told, "It's all in your head." But the condition is very real.
Your Vulva: What You Should Know
The vulva is considered to be the visible parts of the female genitals. The parts most often affected by vulvodynia include the inner labia, the clitoral glans, the paraurethral (Skene's) glands located on each side of the urethral opening, the vulvovaginal (Bartholin's) glands located on each side of the vaginal opening, the membranes surrounding the vaginal opening (called the "introitus"), small "minor" vestibular glands around the vaginal opening, and the hymen.
Four Types of Vulvodynia
The four types of vulvodynia are described. Careful diagnostic evaluation is important in order to distinguish these conditions from each other and from others with similar symptoms and to choose the most effective treatment. ·
Vulvar vestibulitis -
Inflammation around the "vestibule," or opening to the vagina. This condition may occur alone or in combination with other types of vulvar pain.
Symptoms of vulvar vestibulitis include :sensations of burning, dry, raw, or tight skin, and may range from mild to severe. Pain is usually caused by external touch, or by pressure caused by intercourse, tampon insertion, tight pants, bicycling or horseback riding.
A few patients, however, may have symptoms without touching or pressure. Some patients with vulvar vestibulitis only have discomfort with intercourse.
Others are uncomfortable on a daily basis and find it difficult to sit or walk. Some women cannot tolerate intercourse, but others can, although there is usually some degree of discomfort. Women with severe, enduring pain may develop vaginismus, a spasm of the pelvic floor muscles that makes intercourse or tampon insertion difficult or impossible.
·Dysesthetic vulvodynia -
Vulvar pain caused by irritated or inflamed nerves. Pain may encompass the inner labia, or may extend beyond the vulva to the anus or groin area, or down the inner thighs. Some women experience sharp pains or deep aching. This type is most common in post-menopausal women and women with fibromyalgia, and may also be seen with interstitial cystitis. ·
Cyclic vulvovaginitis -
The yeast Candida normally inhabits the mouth, vagina, intestinal tract, and skin. If Candida overgrows in the vagina or on the vulva, it can cause itching, burning, inflammation, and swelling.
Candida may affect the vulva without causing any obvious vaginal discharge. Skin may tear or split from swelling. The cause of chronic Candida is unknown, but various theories have suggested an allergy to yeast or fermented products, immune suppression, or some type of autoimmune response to yeast. Symptoms may flare around the time of menses (hence, "cyclic"). ·
Vulvar or mucous dermatoses -
Skin disorders which occur on the vulva's membranes may also cause chronic itching or burning. When scratched, these areas become inflamed, more irritated and hypersensitive, and can be caused, or made worse, by overuse of topical medications or frequent douching.
This category includes several skin eruptions characterized by the term "lichen," which merely describes a tough, scaly, or peeling appearance. The most common is lichen simplex, but lichen sclerosis and lichen planus are two other skin problems which affect the vulva.
Who Gets Vulvodynia?
For reasons that are unclear, approximately 70% of women with vulvodynia are white with fair complexions. Most patients are of childbearing age, but young girls and postmenopausal women can get the condition as well. Vulvar vestibulitis and dysesthetic vulvodynia are the most common forms of vulvodynia that occur in IC patients. A recent study published in the journal Urology (May '97) revealed that 10% of women with interstitial cystitis also have symptoms of vulvodynia.
What Causes Vulvodynia?
The precise cause of vulvodynia is unknown. Various theories suggest infection (viral, fungal, or bacterial); an allergic response to environmental irritants; an autoimmune response to the body's own chemistry; increased or high concentration of oxalate crystals in the urine; irritation of the muscles that support the bladder, uterus, and rectum (called the "pelvic floor muscles"); or irritation of the nerves that innervate the vulva. There is no evidence that vulvodynia is a sexually transmitted disease - except for Candida which can be passed from partner to partner during sexual activity.
How is Vulvodynia Diagnosed?
The hallmark of vulvar vestibulitis is an exquisite sensitivity of the tiny gland openings at the entrance to the vagina when touched with a cotton-tipped applicator. This is called the "touch test." In addition, about two-thirds of patients with vulvar vestibulitis have visible, tiny red spots at these points.
Others may have inflamed surface blood vessels that the doctor can see with the aid of a magnifying instrument called a colposcope.In dysesthetic vulvodynia there may or may not be visible skin irritation and generalized sensations of irritation or burning, not related to touch or pressure. If skin rashes are present, their cause should be investigated.
Even when Candida is suspected of causing chronic vulvar irritation, it cannot always be seen on cultures. It is thought that some women with a history of Candida infections may develop a hypersensitivity to very low concentrations of Candida.Vulvar dermatoses are skin disorders, but it is important to rule out overuse of medications (especially topical steroids), or infectious causes (such as herpes, human papilloma virus and allergic reactions).
Skin lesions need to be evaluated and classified in order to choose the most effective treatment, so a biopsy may be helpful in this category.
