Vulvodynia is a chronic condition characterized by pain in the vulva (external female genital organs). The exact cause of pain is usually unknown, but it can be caused by damage to nerve tissue, abnormal cell reactions, hereditary factors, infection, allergies, irritation, hormonal changes, antibiotics, or muscle cramps. With vulvodynia, the treatment process can be quite difficult: doctors can look for a variety of diseases, and then come to the conclusion that you have a physiological disorder. In addition, the specific symptoms can be very different and the same treatment does not work for everyone, so there is often a lot of trial and error involved.
Method 1 of 4: Making a diagnosis
Step 1. Make an appointment with your doctor
It is necessary to discuss the symptoms with a therapist or gynecologist. Do not be shy and elaborate on the pain you are experiencing. Before starting treatment, you should make sure that the pain is not caused by any other medical condition.
- Vulvodynia has only one primary symptom - pain in the vulva. Pain is described by patients in different ways. It can be itching, burning, aching, throbbing, tingling, or tingling in the labia, clitoris, and vaginal opening. The pain may increase and decrease, or change with touch or pressure.
- Some women diagnosed with vulvodynia experience painful sensations during certain activities, such as during sports or sexual intercourse.
Step 2. Get a medical examination
If your doctor suspects you have vulvodynia, they will examine the vaginal area. In addition, the doctor may prescribe certain procedures and tests. This will help him identify the cause of your symptoms.
- Doctors often order blood tests to check levels of hormones such as estrogen, progesterone, and testosterone.
- The doctor may touch different areas of the vulva with a cotton swab. At the same time, he will apply a little pressure and ask you where you feel pain and how strong it is.
- If you have severe pain in certain areas, or if the skin is inflamed and looks suspicious, your doctor may take tissue samples for biopsies.
Step 3. Eliminate other possible causes
Vulvodynia is diagnosed only after the doctor has ruled out other diseases and disorders that can cause pain in the vulva. Your doctor can check to see if you have a sexually transmitted disease, your skin is okay, a fungal infection, hormonal imbalances, and other disorders that can lead to similar symptoms. In the absence of such diseases, the doctor may diagnose vulvodynia.
Step 4. Get a specific diagnosis
There are two types of vulvodynia: vulvar vestibulitis and vulvodynia itself (or dysesthetic vulvodynia). Depending on the symptoms, the doctor will make one of the diagnoses. Try to describe your condition to the doctor in as much detail as possible.
- Vestibulitis of the external genital organs is characterized by painful sensations when touching the vestibule of the vagina between the labia. Women with this diagnosis usually experience pain during sexual intercourse, during the insertion of a tampon, during a pelvic examination, or pressure on the area near the entrance to the vagina.
- Dysesthetic vulvodynia is characterized by general and not provoked painful sensations in the external genital area. Pain can be felt in the labia minora, labia majora, clitoris, perineum, anus, urethra, or inner thighs. An attack of such vulvodynia can come suddenly and be accompanied by either intensifying or fading pain. Usually, touching the vulva area does not cause pain, but it can worsen symptoms.
Step 5. Consult with another professional
If you think your doctor is not taking your symptoms seriously, see another doctor. Some doctors do not take vulvodynia seriously and consider it a contrived problem. Find a doctor who will listen carefully, support you and find an effective treatment. Be persistent and try to get the correct diagnosis.
Method 2 of 4: Medication
Step 1. Try topical products
Local pain relievers can help temporarily relieve pain. You can use an ointment with 5% lidocaine. Apply a thin layer, if necessary, several times a day. Emla's cream, which contains 2.5% lidocaine and 2.5% prilocaine, is usually applied in a thin layer 15-20 minutes before sexual intercourse to prevent pain.
- Do not apply topical to damaged or irritated skin.
- Topical pain relievers increase the risk of a condom breaking because they contain alcohol, which tends to break latex. You and your sex partner should get tested for sexually transmitted diseases and use an additional method of contraception.
- For prolonged vulvodynia, when topical pain relievers do not help, pain can be relieved with local anesthesia. Discuss this type of anesthesia with your doctor, and if he recommends it, consult a professional anesthesiologist.
Step 2. Ask your doctor about hormone therapy
Sometimes an estrogen pill or cream is helpful for vulvodynia. Preparations containing estrogen can reduce pain, itching, dryness and redness, normalize urination and relieve pain during sexual intercourse.
Estrogen therapy is helpful when vulvar pain is caused by atrophy (tissue thinning and drying out). If other estrogen treatments are ineffective, your doctor may recommend a 1% estradiol cream. Be aware that some medications, such as oral contraceptives, can cause atrophic changes and increase pain
Step 3. Consider taking antidepressants
Sometimes antidepressants can help relieve pain of an unclear cause, as is the case with vulvodynia. Your doctor may recommend antidepressants to help relieve the pain of vulvodynia. Typically, these are tricyclic antidepressants (TCAs), which alter the transmission of pain signals by neurotransmitters in the brain.
- The tricyclic antidepressant Amitriptyline is one of the most common drugs prescribed for vulvodynia. Typically, patients start with a small dose of 10 milligrams taken at bedtime. Each week, the dose is increased by 10 milligrams until an effective dose is reached, which should not exceed 150 milligrams. Your doctor will most likely recommend that you take the effective dose for 3 months and then gradually reduce it. In some cases, this treatment can completely get rid of vulvodynia.
- Be aware of the side effects of antidepressants. Side effects of TCAs include drowsiness, weakness, fatigue, dry mouth, headache, and constipation. If you experience any of these symptoms for a long time (or they get worse), tell your doctor. Seek medical attention immediately if rash, itching, swelling, or shortness of breath occurs while taking the medication.
- For the treatment of vulvodynia, Effexor and Simbalta are also used, which belong to a separate class of drugs.
Step 4. Ask your doctor about anticonvulsants
Anticonvulsants can help reduce chronic pain, including vulvodynia. The most common medicines of this type are gabapentin. It alters the transmission of pain signals in the brain.
- The dosage of gabapentin can vary widely. Usually, gabapentin is taken orally 300 milligrams a day, and then gradually increased to an effective daily dose, which should not exceed 3,600 milligrams. Common side effects include drowsiness, dizziness, headache, fatigue, nausea, dry mouth, constipation, imbalance, and fever. In case of long-term side effects or their worsening, inform your doctor.
- You may also be prescribed pregabalin, which is similar to gabapentin. Pregabalin has been shown to be effective in treating postherpetic neuralgia and has recently been used to relieve vulvar pain. To begin with, your doctor may prescribe 50 milligrams of pregabalin three times a day. If you tolerate this drug well and it works for you, your doctor may gradually increase your daily dose up to 600 milligrams (200 milligrams three times a day).
Step 5. Take additional medications as needed
Your doctor may recommend corticosteroid or antihistamines to relieve itching, swelling, or inflammation. You may also be prescribed fluconazole to treat a fungal infection. Talk to your doctor about a safe dosage and route of medication.
Step 6. Discuss the option of surgery with your doctor
For vulvodynia, surgery is considered only if other possible diagnoses have been ruled out and all other treatments have failed. In addition, surgery can only help with vulvar vestibulitis.
- Get tested by several doctors. Many doctors are not well versed in certain treatments for vulvodynia. See a second (and even third) doctor before agreeing to surgery.
- Consider the possibility of a vestibulectomy. If you have tried all other methods to no avail and consulted several doctors, weigh the possibility of a surgical operation, the so-called vestibulectomy. This operation involves removing diseased tissue in the vestibule of the vagina (around the vaginal opening). It is usually performed under spinal or general anesthesia.
Method 3 of 4: Alternative Treatments
Step 1. Find the right physical therapist
Ask your doctor or gynecologist to recommend a physical therapist with experience in treating vulvodynia. A good physical therapist can use gentle manual therapy to help strengthen your pelvic floor muscles and deal with tension and pain.
In some cases, physical therapy alone is sufficient to alleviate or eliminate symptoms. However, it is best to combine physical therapy with medication and other treatments
Step 2. Try biofeedback
This technique consists in the fact that the patient learns to control and change those physical processes that usually occur involuntarily. With biofeedback, patients with vulvodynia can learn to contract and relax their pelvic floor muscles at will. This allows them to better control the response of a given body part to pain signals.
While biofeedback can sometimes help on its own, it can be combined with medication and other treatments
Step 3. Try acupuncture
This method consists in the impact on specific points of the body with very thin needles. There is some evidence that acupuncture can help relieve acute and chronic pain. It is used to treat migraines, muscle problems, neurological disorders, reproductive disorders, rheumatism. Sometimes acupuncture can help relieve symptoms of vulvodynia as well.
Step 4. See a psychologist
You will find the support you need from a qualified psychologist who will listen to you carefully, help you learn more about your illness and make a plan to overcome it. Vulvodynia is often stressful and depressed, interferes with certain activities, and makes sex and romance difficult, which impairs the quality of life. Qualified psychological assistance will help you cope with this.
Please note that psychological help is usually indirect. The psychologist will listen to you and help you make independent decisions. As a rule, in such cases, psychologists do not give direct recommendations and do not offer specific methods of treatment
Step 5. Consider the option of cognitive behavioral therapy (CBT)
This is a special form of psychological help, in which attention is mainly paid to practical ways to overcome a particular state. A psychologist can help you better understand your thinking, feelings, and behavior. Then he will recommend a plan of action to change your behavior. For vulvodynia, this method may be effective in reducing symptoms.
There is evidence that CBT can help relieve pain, particularly in vulvodynia. This method of self-control allows you to identify connections between thoughts, feelings and behavior that relate to pain, sexual behavior and the emotional sphere
Step 6. Get support
In addition to helping a psychologist, consider other forms of support. For example, you can join a local support group or a related online community. This way you will meet other women who are experiencing the same problems. Check with your doctor or psychologist if they are aware of similar support groups in your area.
Method 4 of 4: Lifestyle Changes
Step 1. Eat more probiotics
Consuming probiotics daily has been shown to help fight many infections of the digestive tract and genital tract. This will help you maintain a healthy vaginal flora and prevent infection. A probiotic-rich diet can help fight inflammation and infection in vulvodynia.
- A large number of probiotics are found in yogurt, kefir and sour cream. Choose yoghurts with active live cultures of beneficial bacteria. You can also take a probiotic supplement.
- Also, try to eat foods rich in pectin. Such food enhances the effect of probiotics and improves digestion. A large amount of pectin is found in apples and citrus fruits, as well as in berries, peaches, apricots, cherries and grapes.
Step 2. Follow the rules of hygiene
Wash your external genitals with a mild, unscented soap and rinse thoroughly with clean water. If symptoms worsen with urination, rinse your external genitals with cool water after using the bathroom.
Avoid irritants. Ditch scented soaps, sprays and lotions and replace them with unflavored natural counterparts without any chemical additives. Also, wear 100% cotton underwear, not nylon, as nylon traps moisture and can irritate your skin
Step 3. Limit activities that involve increased pressure on the external genitals
For example, cycling or horseback riding can cause pain in the vulva area. Pay attention to the types of physical activity that may be associated with the symptoms you are experiencing. If you find that they make your symptoms worse, try to avoid them.
Step 4. Try applying cold compresses
Sometimes cold compresses are helpful for pain in the vulva. Cold slows down blood circulation, which helps reduce pain and inflammation. To make a cold compress, wrap an ice cube in a towel or other cloth and apply it to the affected area.
Never apply ice directly to your skin
Step 5. Choose your lubricants carefully
Lubricants help relieve vulvar pain during intercourse. If you are sexually active, try to use water-based lubricants rather than oil. Oil-based lubricants can contain chemicals that can worsen symptoms. Avoid lubricants with added sugar or glycerin as these can irritate your skin.
Step 6. Take a sitz bath
Take a local healing or cleansing bath in which the water covers only the pelvis and buttocks. Draw warm water and add oats or baking soda to it. Oats contain anti-inflammatory substances called avenanthramides. These substances help relieve pain, irritation, and itching. You can also add baking soda to the water, which is alkaline and helps regulate vaginal pH. The baking soda can help reduce excessive acidity in the vagina, which can make itching and burning sensations worse.
- For an oatmeal bath, dissolve one packet of oatmeal powder in water and sit in it for 20 minutes.
- Prepare a baking soda bath: Dissolve 4-5 tablespoons (80-100 grams) of baking soda in water and soak for 15-20 minutes.
Step 7. Consider switching to a low oxalate diet
Oxalates are substances found in plant foods. They bind to trace elements and slow down their absorption. Some doctors recommend a low oxalate diet for vulvodynia, as oxalate-rich foods promote urine production, which can increase irritation and pain in the vulva. Talk to your doctor about oxalate levels in your urine and talk to him about making appropriate dietary changes.
- High levels of oxalates are found in chocolate, berries, spinach and nuts.
- You can also take calcium citrate supplements. Calcium citrate inhibits the growth of oxalate crystals and thus relieves pain and itching. Consider taking 200-250 milligrams of calcium citrate three times a day.