Expert Answers to Your Vulvodynia Questions

Facts about Vulvodynia.

Vulvodynia is something that I, in one form or another, frequently get asked about. So, I spoke with Phyllis Mate, executive director of the National Vulvodynia Association to get expert answers to your questions.

Q. What is vulvodynia? Do we know what causes it?

A. Vulvodynia, in the simplest of terms, means "pain of the vulva."* It is defined by the International Society for the Study of Vulvovaginal Disease as chronic vulvar discomfort or pain, characterized by burning, stinging, irritation or rawness of the female genitalia.

The cause of vulvodynia remains unknown. It may be the result of multiple factors. Physicians speculate that it may be caused by an injury to or irritation of the nerves that supply and receive input from the vulva; a localized hypersensitivity to yeast; an allergic response to environmental irritants; high levels of oxalate crystals in the urine; or spasm and/or irritation of the pelvic floor muscles.

There is no evidence that vulvodynia is caused by infection or that it is a sexually transmitted disease.

*Also defined as existing for at least 3 to 6 months.

Q. What are the symptoms of vulvodynia?

A. Burning sensations are most common, however, the type and severity of symptoms experienced are highly individualized. Some women describe their pain as stinging irritation or rawness. Vulvodynia may be constant or intermittent, [concentrated on one area or spread out]. The two major subsets of the condition, dysesthetic vulvodynia and vulvar vestibulitis syndrome (VVS), are quite different.

Dysesthetic vulvodynia is characterized by pain that is [spread out] throughout the vulvar region. It can be present in the labia majora and/or labia minora. Sometimes it affects the clitoris, perineum, mons pubis and/or inner thighs. The pain may be constant or intermittent, and it is not necessarily initiated by touch or pressure to the vulva.

The vulvar tissue may appear inflamed, but in most cases, there are no visible findings.

Women with VVS have pain when touch or pressure is applied to the vestibule (area surrounding the opening of the vagina). Women may experience pain with intercourse, tampon insertion, gynecologic exam, bicycle riding, horseback or motorcycle riding and wearing tight clothing, such as jeans. Most often, the vestibule of women with VVS is inflamed and red.

Regardless of the type of vulvodynia a woman has, the disorder imposes serious limitations on a woman's ability to function and engage in normal daily activities. The pain can be so severe and unremitting that it forces women to resign from career positions, abstain from sexual relations, and limit physical activities. Not surprisingly, these limitations negatively affect a woman's self-image; many women become depressed because of the physical pain itself and the associated psychological and social implications.

Q. What is involved in diagnosing vulvodynia?

A. The diagnosis of vulvodynia is made by ruling out other conditions that can cause vulvar pain, such as sexually transmitted diseases, infections, skin disorders, and human papillomavirus. A patient's medical history needs to be reviewed carefully, and a complete vulvar and vaginal examination is necessary.

A culture is [often] taken from the vagina to rule out [things like] sexually transmitted diseases and infections. A "q-tip" test is often administered during the exam. During this test, different areas of the vulva and vestibule are touched with a [cotton swab] to determine the location and severity of a woman's pain. If the doctor sees areas of skin that look suspicious during the exam, a biopsy of the skin may be required. Additionally, physicians may recommend a colposcopy, a procedure that uses a specialized instrument to examine the vulva more closely.

The National Vulvodynia Association (NVA) was founded by Mate and three other vulvodynia patients.

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