Vulvodynia

Vulvodynia

With vulvodynia, patients suffer from abnormal sensations or even pain in the area of ​​the vulva that cannot be attributed to external causes. In addition to nerve irritation, triggers can be depression, skin diseases and infections with bacteria or fungi. Treatment depends on the primary cause.

What is vulvodynia?

The vulva is all of the primary external sex organs of a woman. The vulva can be divided into the mons pubis, the labia, the clitoris and the vaginal vestibule. This vulva is covered in pubic hair once puberty has set in. As in all skin and mucous membrane areas, there are different mechanoreceptors, temperature receptors and pain receptors in the vulva. For definitions of impingement syndrome, please visit lawfaqs.net.

These sensory cells constantly project stimuli to the central nervous system. This allows sensations such as touch, pain or heat and cold stimuli to be perceived in the area of ​​the vulva. In the case of vulvodynia or vulvodynia, abnormal sensations up to and including pain occur in the vulva.

These abnormal sensations can extend over the entire area of ​​the external primary sex organs and can vary in severity. Like all other abnormal sensations, vulvodynia is probably based on neurogenic causes. The type of discomfort can vary significantly, ranging from a slight burning sensation to severe pain.

Causes

General nerve irritation or neuropathies of nerves in the vulva area can theoretically be responsible for vulvodynia. In practice, however, the cause of vulvodynia remains permanently in the dark in most cases. The development process has not been finally clarified, but in the cases documented so far it is less likely to be attributed to skin reactions.

In individual cases, the abnormal sensations were explained with fungal infections, condylomas or general irritation of the skin. The irritation can be caused, for example, by soaps, care products or personal hygiene products. More rarely, oversensitivity to food ingredients was apparently responsible for the irritation.

In particular, overreactions to certain histamine liberators have been linked to the phenomenon. In this context, the consumption of meals containing oxalate and glutamate causes mast cells to release histamines. These histamines mainly cause stabbing pain in the vulva area. An extremely rare cause of vulvodynia is neurodermatitis in the vulva area.

Symptoms, Ailments & Signs

With vulvodynia, the slightest touch in the area of ​​the vulva causes unpleasant irritation and discomfort. For example, many patients complain that touching normal underwear or clothing causes pain. Vulvodynia can vary in severity.

Often the discomfort is just a burning sensation. In some cases severe pain is also indicated. Last but not least, abnormal sensations in the external primary sex organs affect the intimate life of those affected. Tender touches in this area can cause uncomfortable sensations. In the worst case, patients develop a general aversion to intimacy due to the unpleasant sensations over time.

In order to prevent such consequences, a quick presentation to the doctor is absolutely necessary. The accompanying symptoms of vulvodynia depend on the primary disease. For example, fungal diseases can clearly manifest themselves on the skin of the affected area and cause itching in addition to the discomfort. In addition to physical causes, mental illnesses such as depression can also lead to discomfort.

Diagnosis & course of disease

Women with vulvodynia often hesitate to see a doctor for a long time. They are ashamed of their discomfort and are reluctant to bring the problem to doctors because it is located in the intimate area. The diagnosis is often made late. In most cases, the doctor makes a diagnosis of exclusion as part of the diagnostic process.

This exclusion diagnosis includes examinations for infections such as fungi, bacteria and condylomas. A tissue sample may be taken under colposcopic vision to rule out autoimmune disease in the affected tissue. The anamnesis also plays a decisive role in the diagnosis.

Depending on whether the patient describes the pain as dull, radiating, stabbing, localized, wandering, pulsating, constant, dependent on the time of day, dependent on the cycle, or dependent on exertion, individual causes may appear more obvious or less likely. Visual diagnostics, which allow the doctor to identify any redness or swelling, are also important. The prognosis depends on the cause.

Complications

Depending on the cause, vulvodynia can cause various complications. Initially, the abnormal sensations are accompanied by increasing discomfort, combined with painful itching and sometimes bleeding. If the symptoms are caused by depression, the mood can deteriorate further as the illness progresses.

There is also a risk that other mental illnesses will set in and further reduce the well-being and quality of life of the patient. If an autoimmune disease is the cause, other symptoms usually set in, such as chronic rashes, gastrointestinal problems or even muscle paralysis and permanent sensory disturbances. Complications increase as the disease progresses, eventually leading to chronic health problems.

Fungal infections, condylomas and similar triggers also lead to far-reaching symptoms if no adequate treatment is given. However, complications can also arise during therapy. Prescribed antifungal drugs can lead to headaches or nausea. Severe physical reactions are possible in the event of intolerance, allergies or liver disease.

Anticonvulsants also carry risks. This can lead to memory lapses, speech disorders and, in interaction with alcohol, life-threatening respiratory depression. Antibiotics occasionally cause headaches, muscle pain and skin irritation.

When should you go to the doctor?

In the event of vulvodynia, the person concerned should definitely consult a doctor. It is a serious disease that must be treated by a doctor in any case. It can also not come to an independent healing, so that the person concerned is always dependent on professional treatment. The sooner a doctor is contacted about vulvodynia, the better the further course of this disease. A doctor should be contacted if the person concerned suffers from severe pain after touching laundry and clothing.

There is a strong burning sensation and itching. This pain can also occur after touching people in some cases and has a very negative impact on the life of the sufferer. If these symptoms occur over a longer period of time and do not go away on their own, a doctor must be consulted in any case. First and foremost, a general practitioner or a dermatologist should be consulted. Since vulvodynia can also lead to depression or psychological upsets, a psychologist should also be consulted.

Treatment & Therapy

Vulvodynia is treated as causally as possible. The individual treatment steps depend on the cause in each individual case. In order to rule out food hypersensitivity, a two-week diet with less irritating foods is followed. Ideally, this diet can cure vuvlvodynia caused in this way.

Antimycotics are given for causes such as fungal infections. If the infection occurs again and again, tablet treatment should be used instead of cream treatment. If the creams are used too frequently, the ingredients can additionally irritate the skin and thus cause even greater discomfort. Bacterial infections are treated with a specific antibiotic depending on the type of bacteria.

In extreme cases, nerve irritation can be stopped by shutting down the affected nerve. In this case, however, the administration of anticonvulsants, which reduce the sensitivity to pain and itching, is usually sufficient. Tricyclic antidepressants are tried if no cause can be identified or if the history suggests psychological upsets.

Autoimmunological causes such as neurodermatitis can require prophylaxis in addition to acute treatment. If the patient has already developed a fear or aversion to any kind of intimacy as a result of the abnormal sensations, cognitive behavioral therapy can allow a reassessment of intimacy situations.

Prevention

Bacterial and fungal vulvodynia can be prevented to some extent. The best possible hygiene is a prerequisite for this. A clean environment makes colonization more difficult for microorganisms.

Aftercare

Depending on the underlying causes of the vulvodynia in the respective patient, an up and down of the symptoms may be noticeable for years to come. Therefore, the affected patient should take special care of her vulva. Soap should be avoided in daily personal hygiene because it could irritate unnecessarily. An alternative is pH-neutral cleaning lotions or just warm water.

Tight-fitting clothing could also constrict the vulva and irritate it. Targeted pelvic floor training helps women to better localize and compensate for their complaints. Corresponding courses are usually offered by the regional adult education centers. Women who have had vulvodynia also benefit from a fresh, high-fiber diet, as it ensures regular bowel movements.

A constipation, for example, would unnecessarily increase the pressure on the vaginal region and thus the symptoms. Many patients affected by vulvodynia have to regain their sexual excitability. Heat packs or hot water bottles are helpful here to relax the abdomen. Local self-massage with oil and training with vaginal dilators can bring back the sexual feeling.

Physical sports such as Pilates or yoga support this process. Joining a self-help group may also help. The Interstitial Cystitis MICA association (www.ica-ev.de) offers appropriate assistance here. Although this self-help organization is intended for patients with interstitial cystitis, it also takes care of vulvodynia patients.

You can do that yourself

Since the causes of vulvodynia are often unclear or varied, the self-help of those affected also consists of observing their own symptoms closely and ideally keeping a record of possible triggers. A pain diary, which also includes daily activities, can help to discover a connection between the event and pain.

Due to the lack of clarity, an exchange with other patients can also be helpful. Self-help groups are suitable for this. In addition, the pain can be relieved with targeted pelvic floor exercises. Those affected can practice these regularly at home. Breathing exercises and meditation can also help to specifically counteract the pain. It also helps some of those affected to act on the painful part of the body with direct heat or cold, using cold compresses, heat patches or heat pads. Even light physical exercise such as yoga, Pilates or Qi-Gong can in some cases contribute to a temporary reduction in pain.

In addition, importance should be attached to a balanced diet and a healthy lifestyle. Stress factors in everyday life should be identified and reduced if possible. Conscientious hygiene can also help to improve general well-being.

Vulvodynia