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Vulvodynia 

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Home > Pain Conditions > Vulvodynia

About Vulvodynia

The vulva is the outer region of the female genitals, vulvodynia refers to discomfort and pain in this region for at least three months. This condition affects all female age groups by causing sensitivity, irritation or pain, it disrupts daily functions and decreases one’s quality of life. It is also known to affect up to 16% of women. It is not due to aging. There are patients as young as 16 years old to elderly such as 70 years old.

What Causes Vulvodynia?

Information about the causes of vulvodynia is very limited. There are many suspected causes of vulvodynia including inflammation, nerve injuries (neuropathic problems), hormonal alterations, musculoskeletal problems, and genetic factors. Certain approaches such as hormonal creams to be applied to the vulva have been attempted with limited success. Vulvodynia is not uncommon amongst menopausal women.

What Causes Vulvodynia?

Information about the causes of vulvodynia is very limited. There are many suspected causes of vulvodynia including inflammation, nerve injuries (neuropathic problems), hormonal alterations, musculoskeletal problems, and genetic factors. Certain approaches such as hormonal creams to be applied to the vulva have been attempted with limited success. Vulvodynia is not uncommon amongst menopausal women.

Symptoms Of Vulvodynia

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Pain
Vulvodynia is felt gradually. It begins with mild vaginal pain during sexual intercourse and may develop into a constant discomfort, interfering with everyday life. The pain can be a constant “burning” pain, soreness, stinging, throbbing or a rawness of the affected area. Many cases of vulvodynia are not related to sexual intercourse and simple activities of daily living such as sitting, walking can elicit significant pain.
Redness or Swelling
Some symptoms are obvious upon physical examination, such as redness or swelling in the vulva region. In many cases, there are no obvious physical signs associated with the painful area of the genitalia.
Other Symptoms
Other signs of vulvodynia include pain in a specific location, pain that occurs when an area is touched or pain during intercourse.

A Message About Vulvodynia 

Vulvodynia is a painful condition ignored by many female patients. After physical examination and investigations with MRI or CT scan, they may all yield normal findings with no abnormality. Doctors may even attribute the patient as a hypochondriac or attention-seeking. Often vulvodynia is recognised as a neuropathic pain condition. It is hypersensitivity of the nerves due to various causes ranging from hormonal derangement to nerve impingement or muscle spasm. A similar model may be a sensitive tooth causing toothache without any tooth decay or crack or gingivitis.

The primary approach is to desensitise the painful nerves to control the pain and rehabilitate the pain threshold of the vulva to become less sensitive. This can be done through pulsed radiofrequency of the nerve plexus supplying the vulva.

Diagnosing Vulvodynia

Here at Singapore Paincare, our team of experienced primary care doctors and pain care specialists, together with the gynaecologist will conduct a thorough diagnosis. This includes a physical exam, questions about your symptoms and an evaluation of your medical history.

What Treatments Are Available for Vulvodynia?

In many instances, non-surgical treatment methods can provide excellent outcomes. At Singapore Paincare, we strive to treat your pain with the least invasive option possible after accurately identifying the cause. Our pain resolution approach focuses on removing pain generators via specialised injection and minimally invasive procedures. Combined with pharmacological treatments, cognitive and physical rehabilitative therapies. We help patients to improve functions and prevent pain from recurring.

Non-Surgical Treatments for Vulvodynia

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Pelvic Floor Therapy
Pelvic Floor therapy releases the tension in the muscles of the pelvic floor, which supports the uterus, bladder and bowel. This method includes physical manoeuvres such as Kegel’s manoeuvre and superficial perineal massage – these methods help to reduce the pain from vulvodynia.
Anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs may be effective in eliminating the pain caused by nociceptive vaginal pain. In many vulvodynia conditions, NSAIDs do not improve the pain relief as there is not inflammatory component in the pain generator.
Pharmacotherapy
Apart from NSAIDS, our physicians and specialists offer medications to improve vaginal pain such as anticonvulsants, antidepressants, antivirals and antifungals. Alpha-blockers and anti-biotics may also be introduced to eliminate the infection from the body, especially if the cause is likely to be bacterial. Antihistamines or lidocaine ointments are also offered to reduce sensitivity.
Estrogen Replacement Therapy
Specific drugs that will replenish the estrogen levels may be used for perimenopausal and postmenopausal women with vulvodynia. The effects of the therapy are a short-term relief of the symptoms of menopause, and improved treatment against vulvodynia.
Biofeedback Psychotherapy
This procedure may involve electric leads to immerse patients into a relaxed state, through repeated processes and guidance from our doctors, you will be able to manage the condition by association with these relaxation methods. Augmented by Psychotherapy, reduced attention to pain sensitivity in the vulva may be achieved.
Desensitisation of Pelvic Nerve Plexus Injection
The use of pulsed Radiofrequency desensitization of the pelvic nerves from the Sacral plexus (S2 – S4) has provided good relief. The related respective nerves are injected and are “blocked off” and made less sensitive to the transmission of the pain signal. Once the pain cycle has been broken, the pain is less intense and less amplification of central sensitization of pain.

Surgical Treatment for Vulvodynia 

In the case that all methods are exhausted, surgery may be recommended only if you are a suitable candidate. As surgery always comes with associated risks, complications and downtime, it may not be suitable for everyone. You should carefully weigh the decision before deciding to go under the knife by considering the pros and cons of both non-surgical methods and surgical reconstruction.

Vestibulectomy
Patients with localized vulvodynia who have not been significantly helped by other treatments may benefit from this procedure to remove the tissue around the area where they feel pain. This is to be weighed carefully for the risk-benefit ratio.

How Can I Prevent Vulvodynia? 

There is no known way to prevent vulvodynia since there is little information on its cause. However, you can lessen your pain from vulvodynia by:

  • Avoid wearing tight clothes and using a pantyhose
  • Using a 100% cotton underwear
  • Avoiding exercises that put pressure on the vulva, such as cycling and horseback riding
  • Reducing your stress levels
  • Getting enough sleep
  • Using plain water to wash the area

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