Vulvodynia, chronic vulvar pain

Diagnosis  

The diagnosis of vulvodynia often begins by ruling out other possible causes of the discomfort. This involves asking one’s medical, sexual, and surgical history, and inquiring about the symptoms including the location, type, and intensity of the symptoms.

To confirm the diagnosis, test and procedure may be performed:  

• Physical examination: To assess the vagina and cervix, the healthcare provider will inspect the vulva and do a pelvic exam with a speculum. Pelvic floor muscles are inspected to identify affected areas.  This procedure also involves visually inspecting the external genitals and vagina to identify signs of infection or other potential causes for the symptoms. 

• Cotton swab test: This exam is particularly useful for identifying localized pain in the vulvar vestibule. The healthcare provider will use a wet cotton swab to gently inspect the vulvar area for localized areas of pain. He or she will ask when or where the contact is unpleasant. 
• Swab test for infection: Even if there is no visible infection, the healthcare provider may take a sample of vaginal cells to test for an infection. Sexually transmitted infections (STIs), bacterial vaginosis, and yeast infections are all illnesses that can cause vulvar pain. 

Treatment  

Treatment for vulvodynia focuses on symptom relief.  However, treatment for vulvodynia requires time. Finding the right treatment or combination of treatments to relieve the pain requires trial and error and may not function right away. Good hygiene practices that keep the vulva and vagina healthy may also help with vulvar pain.

Several treatments are available to manage vulvodynia, such as:  

• Medications: Antihistamines may help with itching. Oral medications such as antidepressants and anticonvulsants can help relieve nerve discomfort. 
• Biofeedback therapy: By teaching a person how to relax the pelvic muscles and control how the body responds to the symptoms, this therapy can help reduce pain.  
• Local anesthetics: Topical treatments include lotions and ointments that numb the vulva or stabilize the nerves. Healthcare provider may prescribe topical creams containing estrogen or a combination of estrogen and progesterone. To alleviate the discomfort, the healthcare provider may advise to apply lidocaine 30 minutes before sexual intercourse. Temporary numbness may be felt my one’s partner after contact. 

• Nerve blocks: Local nerve block injections may be beneficial for women who have chronic pain that has not responded to other therapies. The medication blocks the pain signals from the nerves to reaching the brain. 
• Pelvic floor therapy: Vulvodynia is associated with muscle spasms. Physical therapy can help relax the muscles, ligaments, and connective tissue in the pelvic floor. Stretching, extending, and strengthening weak pelvic floor muscles may be used in treatment. Tension in the muscles is common in many women who have vulvodynia.
• Surgery: Vestibulectomy can help relieve pain among women with localized vulvodynia whose pain has not improved with more conservative therapy. During the procedure, tissue from the painful area of the vulva is removed.