It is a complex condition that requires careful assessment by a knowledgeable, patient-clinician in order to arrive at answers and resolutions.
There are three types of vulvodynia conditions:
- Infectious vulvodynia, including candida, cyclic vulvitis, chronic vaginitis, some herpes infections, etc.
- Vulvar dermatoses (formerly called vulvar dystrophies), including lichen sclerosis, lichen planus, lichen simplex chronicus, erosive vaginitis, steroid rebound dermatitis, etc.
- Dysesthetic (idiopathic) vulvodynia, including vulvar vestibulitis. (Dysesthesia = abnormal sensation)
Infectious vulvodynia and vulvar dermatoses are diagnosed by examination and/or laboratory tests and are managed by medication or other medical interventions, usually with good results.
In contrast, dysesthetic (idiopathic) vulvodynia is a condition without an apparent cause, which is the meaning of the term “idiopathic.” This is the most common type of vulvodynia and the content of the following discussion.
- Burning, throbbing, itching, stinging in the vulva (the female genitals that are within the outer lips, or labia majora)
- Poking, as if a needle is stuck in the vulva
- Diffused, generalized vulvar pain
- Urinary urgency and/or frequency
- Associated stress-related conditions, such as irritable bowel syndrome, headaches, fibromyalgia, chronic fatigue syndrome, sleep problems, eating disorders, TMJ problems, etc.
In our extensive work with dysesthetic vulvodynia, we have identified the following seven main causes for this distressing condition, each necessitating a careful evaluation and personalized intervention:
- Vulvar dryness
- Alteration of the vulvar ecosystem (the balance between the “good” and “bad” bacteria)
- Excessive vulvar friction irritation
- Substance sensitivity/allergy
- Poor vulvar hygiene
- Hormonal effect
- Emotional stress that is translated (“sent”) to the vulva
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However, not everyone can be helped by addressing these main causes, supporting the recent hypothesis (the research is ongoing) that there may be physiological factors, such as increased neural density in the vulva and/or immunologic changes that cause the pain and discomfort of vulvodynia.
Women who suffer from dysesthetic vulvodynia are often caught in a cycle of endless pain and suffering, which leads to depression, anger at the medical field for not being able to help, withdrawal from life’s activities, difficulties sustaining relationships, and avoidance of sexual intimacy. Read Monica’s testimonial.
The support system, which may include the partner, family, and friends, becomes frustrated, impatient, resentful, hopeless, angry, and withdrawn, further propelling the woman into a deeper sense of “I will never be able to live a normal life again.”
As with vulvar vestibulitis, the treatment process of dysesthetic vulvodynia must be that of a body-mind approach because both the body and the mind are affected!
Resolving dysesthetic vulvodynia requires finding the right clinician who will be patient enough and knowledgeable enough to spend the time it may take to get to the root of the problem and offer the intervention that will work best.