Vulvodynia is defined as vulvar pain of a long duration. Vulvar pain refers to pain of a chronic duration at the vulva that means pain at the area of the opening of the vagina. It may be the cause of severe pain, burning and irritation which may make sitting for a long period of time uncomfortable and severe pain during sexual intercourse. It is a long lasting condition mainly over months or years. However in a clinical set up the reported cases of vulvodynia are very less. This is probably due to failure of women to recognize the condition and treat it as a medical condition or reluctance of women to talk about their symptoms and seek help in that regard. However it is a common condition but largely under reported.
Causes: In most cases the cause of this condition is unknown and remains idiopathic. However most women have a history of recurrent vaginitis or vaginal bacterial or yeast infections. Some women have a history of sexual abuse.
Symptoms and signs: The main symptoms of vulvodynia are burning, soreness, itching, rawness, dyspareunia or painful sexual intercourse. On examination the vulva may appear red, inflamed and sore. In other cases, the vulva may appear normal on inspection. It is important to rule out other causes of pain in the vulvar region. A pelvic examination may be performed by the examining doctor. Even if the vagina and vulva appear normal on inspection and palpation, it is best to collect swabs from the vagina to check for yeast infections or bacterial vaginosis. The swab can also be used to detect other causes of pain. Smears of the swab will help find any abnormal cells and thus help rule out malignancies or tumours as a cause of pain.
Treatment: In cases where an active infection has been found, it is advisable to first treat the infection. Vulvodynia treatments should at relieving the pain and discomfort of the patient and enable her to lead a normal and healthy life. There are a variety of treatments available. The options available are as follows:
Medications like tricyclic antidepressants such as amitriptyline and desipramine help relieve pain to a great extent. Anticonvulsants medication such as Carbamazepine (Tegretol) and gabapentin also help to relieve the pain in vulvodynia.
Biofeedback therapy is a therapy which can help reduce pain where in the patient is trained to control body responses. It helps the patient to relax the pelvic musculature and eventually the patient learns to relax during relatively painful conditions like sexual intercourse or local vaginal examinations.
Local anaesthetics: Many local anaesthetic ointments are available that provide relief of pain. Lignocaine or lidocaine gel applied 30 minutes before sexual intercourse helps to reduce the amount of pain and discomfort.
In cases where the patient finds no relief of pain by using the above mentioned options, surgical intervention is the last option available. The patient must point at the exact spot of extreme pain and discomfort, that part of the skin may be removed surgically.
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