Pelvic Pain

Vulvar Pain

Vulvodynia

Vulvodynia is classified as chronic pain or discomfort, which includes burning, stinging, irritation or rawness of the female genitalia, specifically of the vulva. The word "vulvodynia" actually means "painful vulva." This condition can severely impact the quality of life for affected women and may prohibit participation in sexual activity, physical exercise and even social activities. The condition is believed to be underreported because of its lack of visible symptoms and often a woman's reluctance to talk about her symptoms. As many as one in six women may be affected by vulvodynia at some point in their life.

Variations of Vulvodynia

There are several different types of vulvodynia. Some are as follows:

  • Clitorodynia is a form of vulvodynia in which the pain is concentrated in and around the clitoris. The area may feel sore and uncomfortable much of the time or mainly while exercising, wearing tight clothing or having sexual intercourse. In some patients, sitting for long periods of time and dealing with stress can worsen the symptoms.This condition may be a result of trauma to the clitoral area or certain systemic illnesses, but in many cases, a cause is not found for clitorodynia. Lifestyle changes such as wearing loose-fitting clothing, physical therapy and over-the-counter pain medication may help some patients. For those with severe or persistent symptoms, prescription medication, topical pain relievers and nerve block injections can be effective treatment methods for reducing pain.
  • Vulvar vestibulitis is a form of vulvodynia in which a patient’s pain occurs in the vestibule, or the area around the opening of the vagina. This condition can produce a burning sensation that may be persistent or arise mainly when pressure is placed on the vestibule, such as during sexual activity. The cause of vulvar vestibulitis is unknown, but inflammation, past infections, nerve injury and hormonal changes are all believed to be contributing factors.There are a number of methods available to effectively treat vulvar vestibulitis. These include the use of estrogen hormones, topical anesthetics, prescription medications that disrupt some nerve impulses and physical therapy focused on the pelvic muscles. In more severe cases that do not respond to conservative treatments, vestibulectomy surgery may be recommended. This procedure involves removing some of the tissue of the vestibule to relieve symptoms.
  • Dysesthetic vulvodynia , or generalized vulvodynia, where symptoms occur throughout the vulvar anatomy and can occur constantly or intermittently. Patients have reported pain in the labia majora, labia minora, vestibule, clitoris and/or inner thighs. Pressure to the vulva can trigger these symptoms but is not the only cause
  • Vulvovaginitis, or cyclic vulvodynia, occurs at the same stage of the menstrual cycle.
  • Vulvar dermatoses, caused by dermatologic conditions and often present in the form of itching and burning, are also conditions associated with chronic vulvar pain. These conditions can coexist with vulvodynia.

Causes of Vulvodynia

Vulvodynia does not have one set cause, but several factors can contribute to the development of chronic vulvar pain. A history of recurring vaginitis or vaginal yeast infections, as well as allergies, lupus, eczema or injury can be the cause of this condition. It can be tested by a "touch test," touching the tiny gland openings at the entrance to the vagina with a cotton-tipped applicator. If the patient suffers from vulvodynia, the area will be extremely sensitive.

Treatment for Vulvodynia

Treatment for vulvodynia does not cure the condition, but it does help to relieve symptoms.

  • Trigger point injections can be used to insert a steroid medication as well as a numbing agent into the exact points where pain is felt.
  • Topical agents, such as estrogen, can be applied daily to reduce pain.
  • Physical therapy or biofeedback treatments teach muscle control and allow patients to counteract pelvic muscle spasms.
  • Pelvic nerve block may be inserted to numb the nerves in the pelvic area.
  • Botox injections may be used to relax spastic muscles and reduce tension pain in the region.

Careful care of the vulva, avoiding toxins, and the use of cotton underwear, toilet tissue free of bleach, lubricants free of preservatives and chemicals, and non-perfumed soaps and creams can help mitigate symptoms and prevent flare-ups. Some helpful web sites to obtain hypoallergenic products are:

Vulvodynia Education Links

Rectal Pain

Coccydynia refers to pain and inflammation affecting the coccyx, or tailbone, which is located between the buttocks. Patients suffering from coccydynia may experience pain and/or tenderness on the tailbone that is especially pronounced when sitting. Coccydynia is usually diagnosed through a physical examination, and in some cases, imaging scans to rule out other conditions. Treatment for coccydynia includes sitting in seats with sufficient padding and over-the-counter pain medication. Persistent cases of coccydynia may require cortisone injections, or in rare instances, surgery.

 

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