Vulvodynia is a chronic disease characterized by pain in the vulva (the external female genitalia). The exact cause of the pain is not known, but it is thought that it may be triggered by nerve damage, an abnormal cellular response, genetic factors, infections, allergies, irritations, hormonal changes, muscle spasms, or taking antibiotics. For women suffering from this disorder, the diagnostic and therapeutic process can be frustrating. The gynecologist must rule out a long list of other diseases and possible causes, and then conclude that it is a psychosomatic pathology. Furthermore, since the specific symptoms vary from person to person and there is no single effective cure for all, it is not at all easy to manage and treat vulvodynia; it usually proceeds by trial and error.
Steps
Part 1 of 4: Diagnosing Vulvodynia
Step 1. Make an appointment with your gynecologist
Don't feel embarrassed to discuss the pain you are experiencing. Before proceeding with the treatment, you must be sure that it is not another pathology.
- Vulvodynia has only one main symptom: pain in the vulva. Each woman describes it differently. For some it is a burning, itchy, dull, throbbing, stinging or penetrating pain, usually located around the labia, clitoris or vaginal opening; in some cases it is not always present and can be triggered by touch or pressure.
- Some women with vulvodynia experience pain only on specific occasions, such as during exercise or sexual intercourse.
Step 2. Take the tests
If your gynecologist suspects you have vulvodynia, they will most likely perform a vulva exam. There are a few procedures and tests that you may be subjected to, and all of them are helpful in identifying problems that aggravate your symptoms.
- It is not uncommon for doctors to order blood tests to check hormone levels (estrogen, progesterone and testosterone).
- A tampon will also be performed. The gynecologist will apply gentle pressure to various points of the vulva with a cotton swab, asking you to describe the pain you feel and its intensity.
- If specific areas are particularly painful, or if the skin appears inflamed or suspicious for any reason, then your doctor may find it helpful to perform a biopsy.
Step 3. Other possible pathologies must be ruled out
Vulvodynia is diagnosed only after ruling out any other disease or disorder that can cause vulvar pain. Your gynecologist will want to test you for sexually transmitted infections, skin conditions, yeast infections, hormonal imbalances, and other diseases that may be responsible for your symptoms. If all of these disorders are ruled out, then a formal diagnosis of vulvodynia can be made.
Step 4. Get a specific diagnosis
There are two types of vulvodynia: vulvar vestibulitis and dysesthetic vulvodynia. Your doctor will diagnose which category your problem belongs to, based on your symptoms. Give the gynecologist as much information as possible.
- Vulvar vestibulitis involves a painful response to pressure or touch around the vaginal opening. Women who suffer from it typically experience pain during intercourse, inserting tampons, gynecological examinations, and any other occasions when pressure is applied to the vestibule (the area around the opening of the vagina).
- Dysaesthetic vulvodynia, on the other hand, involves generalized pain over the entire vulva that affects the large and small labia, the clitoris, the perineum, the anus, the mount of Venus, the urethra and / or the inside of the thighs. It is a disorder that arises suddenly and, although the pain is always present and with varying intensity, the other symptoms are alternating. Touch or pressure does not cause pain, but it can aggravate symptoms.
Step 5. Get a second opinion
If you feel that the gynecologist does not take your problem seriously, then consult another professional. Some doctors do not understand that vulvodynia is a real problem and not an imaginary disorder. You need a gynecologist who listens to what you have to say, who offers you support, and who finds the best treatments for your situation. Be determined to come to a diagnosis and don't give up on yourself.
Part 2 of 4: Treating Vulvodynia
Step 1. Give topical medications a try
Local anesthetics can provide temporary relief from symptoms. You can use a 5% lidocaine ointment to be applied in thin layers several times a day, as needed. EMLA cream contains 2.5% lidocaine and 2.5% prilocaine; usually a thin layer is applied 15-20 minutes before sexual intercourse to avoid pain.
- Do not use a local anesthetic if the skin is irritated or broken.
- Local anesthetics increase the chances of the condom breaking due to the alcohol content which can tear the latex. You and your partner should get tested for sexually transmitted diseases and use another type of birth control.
Step 2. Ask your gynecologist about hormone therapies
Some patients with vulvodynia find relief by taking estrogen in the form of tablets or creams. These can reduce pain, itching, dryness, redness, urinary problems, and discomfort during intercourse.
Step 3. Consider antidepressants
These drugs are sometimes effective for treating chronic pain that has no obvious cause. Your doctor may recommend tricyclic antidepressants (which alter the neurotransmitters in the brain responsible for the pain signal) to treat vulvodynia.
- Among these, the most prescribed medicine is amitriptyline. Patients usually start with a dose of 10 mg to be taken by mouth in the evening. The dosage is increased by 10 mg per week until an effective amount for pain control is reached (never exceeding 150 mg / day). Your gynecologist will advise you to continue taking the effective dose for three months before starting the tapering process. In some patients, the symptoms of vulvodynia no longer manifest after treatment.
- Remember that tricyclic antidepressants have side effects. The most common are drowsiness, weakness, fatigue, dry mouth, headache and constipation. Tell your doctor if these adverse reactions do not go away or get worse. Go to the emergency room immediately if you experience a rash, itching, swelling, or difficulty breathing while taking medications.
Step 4. Ask for anticonvulsant medications
This type of drug can be effective in managing chronic painful conditions, including vulvodynia. The most prescribed, in these cases, is called gabapentin and works by altering the transmission of pain signals to the brain.
The dosage for gabapentin can vary considerably. Patients generally start with 300 mg / day taken by mouth and then gradually increase the amount, until reaching the effective dose (but never more than 3600 mg / day). Common side effects include sleepiness, dizziness, headache, fatigue, nausea, dry mouth, constipation, fever and instability. Tell your doctor if these problems persist or get worse
Step 5. Take extra medications as needed
Your doctor may also recommend corticosteroids or antihistamines if you also feel itchy and your vulva is swollen or inflamed. They may also prescribe fluconazole to treat yeast infections. Discuss with your doctor to make sure you are taking all medications safely.
Step 6. Consider the surgical option with your gynecologist
This solution should only be considered when any alternative diagnosis has been ruled out and all available treatments have proved ineffective. Also remember that it only leads to positive results in women with vulvar vestibulitis.
- Hear the opinion of several gynecologists. Many doctors are not competent about all the treatments available for your ailment. Go to a second and maybe even a third gynecologist before accepting the surgery.
- Consider a vestibulectomy. If you have tried every possible remedy and treatment, you have obtained more than one medical opinion, but you have not solved the problem yet, then you can consider this operation. The procedure involves removing the painful tissue from the vestibule that is around the vaginal opening. The surgery is performed under general or epidural anesthesia.
Part 3 of 4: Try Alternative Therapies
Step 1. Find a physical therapist
Ask your family doctor or gynecologist for the name of a physiotherapist with experience in vulvodynia. A professional can perform manipulations to strengthen the pelvic floor muscles to manage tension and pain.
Some patients have found that physiotherapy alone can reduce or eliminate symptoms. In any case, you can combine it with taking medications or other treatments
Step 2. Try biofeedback
This therapeutic technique teaches the patient to control and manipulate physical processes that generally occur involuntarily. Thanks to biofeedback, women with vulvodynia can learn to consciously contract and relax the pelvic floor muscles. This allows for greater control over how the body responds to pain signals.
Some women benefit from even this technique alone, but no one forbids it from combining it with medications or other treatments
Step 3. Give acupuncture a try
This traditional medicine practice involves inserting fine needles into specific points on the body. There is some evidence that it can relieve acute and chronic pain. It is used to treat migraines, muscle problems, neurological, reproductive and rheumatic diseases. Some women with vulvodynia claim that acupuncture relieves symptoms.
Step 4. Find a psychotherapist
A psychologist is of great help and support because it allows you to increase knowledge of the problem, to develop mechanisms for dealing with pain and offers the opportunity to express feelings about the disease. Vulvodynia is a stressful and traumatizing disease that interferes with the quality of life, because it limits activities and complicates sexual and romantic relationships. A psychologist will help you manage this.
Remember that psychological counseling usually does not provide direct solutions. The therapist will listen to you and help you make decisions, but will not give you direct advice or suggestions regarding treatment for the condition
Step 5. Undergo cognitive-behavioral therapy
This is a specific form of psychotherapy that focuses on practical techniques for managing the problem. The therapist helps you understand the way you think, feel and act. It also offers you strategies to change behaviors. In patients with vulvoldinia it is an effective tool for symptom management.
There is some evidence that cognitive-behavioral therapy, when adapted to women with vulvodynia, can help the patient to control pain. This "self-management" therapy allows us to recognize the connection between feelings, emotions and behaviors that revolve around pain, sexuality and emotionality
Step 6. Get support
In this tutorial we have already mentioned how stressful and upsetting vulvodynia is. In addition to helping your therapist, you need to consider other forms of support, such as both "physical" and online mutual aid groups. Finding someone who has the same experiences as you could be of great help. Look for information about this at the hospital or family counseling center.
Part 4 of 4: Making Lifestyle Changes
Step 1. Follow a low oxalate diet
Oxalates are compounds found in plant foods that bind to minerals reducing their absorption. Foods rich in it make urine irritating and this phenomenon seems to be the element that correlates vulvodynia with high levels of oxalate. Talk to your doctor about the concentration of these compounds in your urine and consider changing your diet accordingly.
- Foods rich in oxalate include chocolate, berries, spinach and dried fruit.
- You can also take calcium citrate supplements. This mineral inhibits the development of oxalate crystals thus reducing pain and itching. Take about 200-250 mg of calcium citrate three times a day.
Step 2. Follow a diet rich in probiotics
When taken daily, they can defeat infections of the digestive and genital tract. They support the natural bacterial flora and help regulate digestion. Patients with vulvodynia benefit from a diet rich in probiotics that fight inflammation and infections.
- Foods that contain these nutrients are yogurt, kefir, and sour cream. Choose a yogurt that says "with live lactic ferments" on the label. Alternatively, you can take supplements.
- You should also consume foods with a lot of pectin. This substance supports the function of probiotics by making the digestive process smoother. Apples and citrus fruits are the best sources of pectin, but berries, peaches, apricots, cherries and grapes also contain it.
Step 3. Drink the herbal teas
Those prepared with anise and cloves are perfect for reducing symptoms. Try to drink two cups of anise tea (sugar-free) and / or two cups of clove tea (sugar-free) every day. These drinks not only taste great, they are also great for relieving symptoms.
Step 4. Maintain good personal hygiene habits
Wash your vulva with a mild, fragrance-free soap and rinse it well. If after urinating you feel your symptoms are getting worse, rinse the area with cold water.
Avoid irritants. Replace all scented cleansers, sprays, and lotions with other fragrance-free products and irritating chemical ingredients. Likewise, don't use underwear made of synthetic fabric (which traps moisture and irritates the skin), but choose 100% cotton panties
Step 5. Reduce all activities that put pressure on the vulva
Cycling and horseback riding are two of the classic activities that trigger vulvar pain. Pay attention to any other exercises that seem to be connected with your problem. When you find that a particular action triggers or worsens symptoms, try to avoid it as much as possible.
Step 6. Try cold packs
Cold slows down blood flow and circulation. This way you find relief from pain and inflammation. Make a compress by wrapping ice in a cloth or towel and then apply it to your vulva.
Never place ice directly on the skin
Step 7. Choose your lubricants very carefully
If you can have sex, use a water-soluble lubricant instead of an oily one. The latter, in fact, contain chemical agents that can aggravate symptoms. Avoid all lubricants that contain sugar or glycerin as they can irritate the skin.
Step 8. Take a bath with oats or baking soda
Oats contain an anti-inflammatory substance called avenantramide. It is able to reduce pain, irritation and itching. You can also give baking soda a try, an alkaline compound that can regulate vaginal pH. Baking soda corrects excess acidity, helping to soothe itching and burning.
- If you want to take an oatmeal bath, dissolve a bag of powdered oats in the bath water and soak for 20 minutes.
- If you prefer to use baking soda, mix 4-5 tablespoons into the water and soak for 15-20 minutes.
Step 9. Apply Indian tea bags
This tea contains tannic acids which work as a local anesthetic. These are substances that soothe the burning sensation in the vulva. Just place a tea bag soaked in hot or cold water on top of a sanitary pad and then keep it in contact with your genitals.
Step 10. Use marigold
It is a remedy with an anti-inflammatory effect that soothes inflamed skin and relieves the vulva. Apply the cream to the area to be treated a few times a day.
