vulvar/vaginal disease

by Gita Singh, MD

Vulvodynia and vulvar vestibulitis are descriptive terms for conditions that can cause female sexual dysfunction (FSD).

What is vulvodynia?

Vulvodynia is a condition which results in pain and tenderness throughout the vulvar area. It has no known cause.

What is vulvar vestibulitis?

Vulvar vestibulitis is a type of vulvodynia which causes redness and pain of the vestibule (ring-like portion at the opening of the vagina) extending from the labia minora inward. It may include all the area around the opening of the vagina, but most commonly is seen in the lower one-half. Vulvar vestibulitis involves the opening of mucous secreting glands (Bartholin's glands) and the surrounding skin.

Vulvodynia and vulvar vestibuilitis occur in women of all ages. Neither is likely to be sexually transmitted and both conditions may occur in women who have delivered babies and those who have not. The ability to transmit this condition to babies, young children, and sexual partners is unknown, but probably uncommon. It is seen in all types of relationships (short-term, long-term, and monogamous.)

Many women with this problem have suffered physically and emotionally for months or years, have seen a number of physicians, and have tried many unsuccessful treatments in search of relief.

What are the signs and symptoms of vulvodynia?

• Severe pain with pressure(for example: biking, exercise, tight fitting clothes, or attempted vaginal entry, such as tampon use or intercourse.)
  
• Burning, stinging, irritation or raw sensation within the vestibular area.
  
• Vestibular redness

How is vulvodynia diagnosed?

Your doctor or health care provider will examine the vulva and vestibule to identify the common skin changes. Pain is usually felt if the vestibule area is touched with a cotton-tipped applicator.  A sample of your discharge may be checked to rule out infection. A biopsy or small sample of skin may be taken to make a definite diagnosis. The biopsy allows for a closer examination of the skin cells using a microscope.

What is the cause of vulvodynia?

The exact cause of vulvodynia is unknown, but many studies are being conducted. The following factors have been associated with vulvar vestibulitis:

• HPV (Human Papilloma Virus)
• Chronic yeast infections
• Chronic bacterial infections
• Chronic changes of pH (acid-base balance in the vagina)
• Use of chemical (antiseptics and spermicides, for examples)
• Irritants (detergents and soaps)

What are the treatments for vulvodynia?

Treatment for vulvodynia may include any of the following:

1. Vulvar hygiene guidelines
   Avoid use of irritants -- Try fragrance-free soap and laundry detergent. Avoid douching and any feminine hygiene sprays.
   
   
2. Steroid Ointments
   How it is used: A thin layer is applied to the areas of discomfort.
   How it works: Decreases redness, irritation, and burning.
   Caution: Use only as prescribed by your doctor. Overuse may result in thinning of the skin, which will make your problem worse rather than helping it.
   
   
3. Surgery
   How it works: Removes involved skin areas.
   Caution: Use only as a last resort as symptoms may return after surgery.
   
   
4. Trichloroacetic Acid (TCA), Interferon, Fluorouracil may be used in some cases as determined by the severity of the symptoms you have.
   • TCA - used as a chemical to destroy small areas of the skin allowing new healthy skin to grow.
   • Interferon and fluorouracil - used to increase your body's response to infection.
     

Helpful Vulvodynia Treatment Hints

A & D Ointment
How it is used: Apply to the areas of discomfort.
How it works: Protects the skin, decreases irritation, heals and smoothes.

Lidocaine Gel may be prescribed as initial treatment.
How it is used: Apply to  the areas of discomfort.
How it works: Numbs areas before intercourse.
Caution: After applying, wait until area becomes less sensitive before intercourse. Burning may occur for a short time (5-10 minutes) after the gel is applied.

Witch Hazel Pads (TUCS pads)
How it is used: Apply to the areas of discomfort.
How it works: Decreases burning and irritation after intercourse and urinating.

Cleansing Bottle
Pour plain luke-warm water over the vulva after urinating to remove urine from irritated area.

References

Baker, PK. (1993) Musculoskeletal Origins of Chronic Pelvic Pain. Contemporary Management of Chronic Pelvic Pain, 20(4) December:719-742.05-227.

Duleba, A.J., Keltz, M.D., Olive, D.L. (1996) Evaluation and Management of Chronic Pelvic Pain. Journal American Association Gynecologic Laparoscopists, February 1996, 3 (2), 205-227.

Glazer,H.I.,Rodke,G.,Swencionis,C., Hertz,R.,Young,A.W.(2000) "Treatment of Vulvar Vestibulitis Syndrome with Electromyographic Biofeedback of Pelvic Floor Musculature". Journal of Reproductive Medicine, 40(4),11 pp.

Metts, J.F. (1999) Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management. American Family Physician, 59(6),1547-1556.

Newman, DK. (2000) "Pelvic Disorders in Women: Chronic Pelvic Pain and Vulvodynia". OstomyWound Management: December 46(12): 48-54.

Paavonen, J. (1995) "Vulvodynia - a complex syndrome of vulvar pain". Acta Obstet Gynecol Scand. 74,243-247.

Steege,J.F. (1997) Office Assessment of Chronic Pelvic Pain. Clinical Obstetrics and Gynecology, Vol.40(3),554-563.

Steege,J.F.,Metzger,D.A.,Levy, B.S. (1998) Chronic Pelvic Pain: An Integrated Approach. W.B.Saunders,Philadelphia, PA.

Yount,J.J., Solomons, C.C.,Willems, J.J., St. Amand, R.P. (1997) "Effective Nonsurgical Treatments for Vulvar Pain". Women's Health Digest, 3(2),88-93.

Posted June 2002
Updated December 2009

  See also: Pelvic Health in Women