Vulvodynia  

WHAT IS VULVODYNIA?

Vulvodynia is defined as chronic pain in the vulva. The pain can range from mild to extreme, sometimes resulting in sores or bumps - large or small - beneath the surface of the skin. The pain can feel like a stabbing pain, or a burning pain. Many women who suffer from vulvodynia also have a syndrome known as vulvar vestibulitis, which pain occurs at specific points in the vulvar vestibule, which is the area surrounding the entrance to the vagina.

Women who suffer from vulvodynia and vulvar vestibulitis usually have very dry skin around the vulva which can tear easily. These tiny tears are known as fissures. In some cases, the pain, bumps, and sores can travel to the opening around the urethra, which can cause burning after urination.

Vulvodynia is not a disease. It is a condition, much like getting a headache, or feeling nauseated. There is no infection of the skin, etc. associated with vulvodynia. The basic types of vulvodynia:

• Generalized Vulvodynia (also known as Dysesthetic) - pain may be in more than one area at different times, and can be a constant, steady pain, or it may ebb and flow.
• Vulvar Vestibulitis Syndrome - pain is only in the area surrounding the entrance to the vagina, and occurs upon touch or pressure being applied to the area.

Conditions that cause chronic vulvar pain and may occur simultaneously with vulvodynia:

• Cyclic Vulvovaginitis - recurrent burning and itching during the menstrual cycle.  Yeast infections are common.
• Vulvar Dermatoses - allergies that cause itching and burning.

The causes of vulvodynia are not entirely known, but contributing factors include:

• Injury to nerves within the vulva

• Infection or some type of trauma to the vulva

• Genetics

• Yeast infections

• Muscle spasms in the pelvic area

• Proliferation of nerves

• Increased sensitivity of areas of brain

There is no cure for vulvodynia. There are many ways to treat it, which include:

• Local anesthetics

• Injections

• Nerve blockades

• Topical creams

• Discontinuation of all topical medications, douches, soaps, etc. that
   can cause irritation

• Oral medications

• Phyical therapy

• Pelvic Floor Therapy

• Surgery

There are many acute and chronic dermatologic diseases that affect vulva. The appearance of these diseases in this intertriginous area is often different than their appearance on the trunk and extremities. There are several infectious diseases that have a presentation that is unique to this area. The vulva is an area of the body that is not well understood either by women or by many healthcare professionals.

A complete history and physical are required for diagnosis and treatment of vulvar disease. The cause can vary greatly and needs to be assessed case by case.

Infections

• Herpes simplex virus (HSV)
• Human Papilloma Virus (HPV)
• Candidiasis

Dermatosis

• Contact dermatitis
• Lichen simplex chronicus
• Lichen sclerosus
• Lichen planus (LP)
• Psoriasis
• Intertrigo
• Hidradenitis

Tumors

• Squamous Cell Cancer
• Extramammary Paget's Disease
• Basal Cell Cancer