Generalised Unprovoked Vulvodynia

What is generalised unprovoked vulvodynia?

The pain occurs spontaneously without any trigger. Women with this condition often describe the pain as a constant burning but it is present regardless of whether the area is touched or not. Generalised unprovoked vulvodynia occurs in women of all ages. It is unclear how often it occurs in the general population. Often the term used for this condition is just vulvodynia.

What causes generalised unprovoked vulvodynia?

The cause of generalised unprovoked vulvodynia is unknown. Many believe it is a chronic disorder of the nerves that supply the vulva. Nerves of the vulva transmit a message of pain when they normally should indicate touch, pressure, heat or stretch. Normal sensations are perceived by the brain as abnormal which results in heightened sensitivity. Hormonal changes (menopause or post-partum) usually have little influence on the pain.

What are the symptoms?

Women typically describe this condition as a burning, aching, stinging soreness, or rawness-type of pain. Occasionally it is described as itching or irritation. Pain may be searing or stabbing. The painful area may include all of the vulva, one side or one area only. The area may vary from one episode to the next. Some women report constant pain, others report the discomfort may disappear for hours, days or weeks at a time. The discomfort may prevent sexual activity for some patients, but in other patients it may have little effect on their sexual activity.

What is visible?

The appearance of the vulva varies with each woman but in this condition no abnormality is seen.

How is generalised unprovoked vulvodynia diagnosed?

Generalised unprovoked vulvodynia is a clinical condition which means that there are no laboratory tests or imaging studies that are done to confirm the diagnosis. However it is most important that you see a health care provider who is experienced in the diagnosis and management of vulval conditions. By taking your medical history and performing a physical examination Dr Kliman can rule out other reasons for your pain. Dr Kliman may feel that other tests are necessary and these could include a swab to rule out infection or a biopsy to exclude other skin conditions. Dr Kliman will gently test sensation to the vulva using a Q-tip (cotton bud).

How can I help myself?

It is important to minimise irritation to the vulva and vagina, avoiding soaps, detergents and scented products. Bland, unscented lubricants, especially oil based ones such as olive oil or coconut oil are best used as a lubricant during sexual activity. Cotton underwear is best, avoid G-strings, synthetic fabrics and tight clothing against the vulva. Whilst these suggestions can help they generally will not cure the pain or discomfort.

What is the treatment for generalised unprovoked vulvodynia?

For many women finding a diagnosis will provide a great sense of relief. Since many health care providers think this is a chronic pain condition most of the treatment options target the nervous system. Some success in treating generalised provoked vulvodynia comes from a group of medications that work on these nerves to influence their messages. A wide variety of antidepressants, anticonvulsants and muscle relaxants can help. These medications are called neuromodulators, or chronic pain medicines. Examples of these include the oral tricyclic medications such as Amitriptyline. This medication is used to reduce the hypersensitivity of the nerve endings. Other medications used for this condition include Gabapentin and similar drugs. These medications can be made into creams by compounding pharmacies. There is also evidence that women with vulval pain often suffer from sexual problems. This can include poor libido, difficulty with arousal and lack of orgasm. Engaging in sexual counselling has been shown to not only help couples with intimacy but often reduces pain. Finding ways to have sexual activity with the least amount of pain is vital.

Things to remember about this condition.

1. In spite of not fully understanding the condition called generalised provoked vulvodynia most women with vulval pain improve with treatment.
2. Improvement can often take some time.
3. Pain can often come and go, often reflecting the poorly understood nature of this condition. This does not mean that a previous effective treatment is no longer working.
4. Chronic pain can be both exhausting and demoralising.
5. Those who are in an intimate relationship have two affected parties. Sexual counselling can be extremely helpful.
6. Relaxation physiotherapy by an appropriately qualified practitioner can also be useful in some patients.

Dr Len Kliman is a member of both the Australian and International Society of the Study of Vulval and Vaginal Skin Conditions.