Vulvodynia: Diagnosis and Management

“The diagnosis of vulvodynia is made after taking a careful history, ruling out infectious or dermatologic abnormalities, & eliciting pain in response. Treatments recommended by Vulva Pain Doctors include oral medications that decrease nerve hypersensitivity (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants), pelvic floor biofeedback, cognitive behavioural therapy, local treatments, nerve blocks, & trigger injections. Most women experience substantial improvement when one or more treatments are used” [1]

What Can I Expect When I Consult a Vulva Specialist?

Correctly diagnosing vulvodynia necessitates that the Vulva Pain Doctor carefully reviews the patient’s medical history, and if necessary, conducts various tests and scans, as well as a confirmatory physical examination. The sufferer’s medical history should incorporate various factors, thee include:

• Details regarding the onset and characteristics of the pain
• Provoking factors (e.g., inserting tampons)
• Relieving factors (e.g., bathing in cool water)
• Up-to-date medical evaluations
• Previous treatment details, including their positive, negative, or neutral impact [1]

Of note: on some occasions, the sufferer may not be mindful that the sensitivity is in the introitus region, hence, they may describe the pain as deeper in the pelvis of vagina. However, once the Pain Doctor has undertaken an examination, this situation is likely to be clarified [1].

Vulvodynia Management

• Low-dose TCAs (tricyclic antidepressants) which assist in blocking the body’s pain receptors
• Pain relieving topical creams and ointments (e.g., Lidocaine)
• Anticonvulsants, which also assist in blocking the body’s pain receptors
• Nerve Blocks, which when administered by a Vulva Doctor, can often provide significant pain reduction within a week
• Trigger Point Injections that deliver local anaesthetic and steroids to an inflamed area, which when administered by a Vulva Doctor, have been shown to ameliorate patients’ localised pelvic pain symptoms (localised vulvodynia symptoms are a good example)
• Biofeedback, a treatment through which the machine’s sensors are placed within the vagina, for the purpose of transmitting impulses which empower the patient to help strengthen their pelvic floor muscles. In addition to this, biofeedback also trains patients to relax their pelvic floor muscles
• Physiotherapy (conducted by a vulvodynia physiotherapist) to relax contractions and tight muscles
• CBT (cognitive behaviour therapy), a proven form of psychological therapy, which enables vulvodynia patients to manage their long-term pain [2]

References

[1]. Reed BD. Vulvodynia: diagnosis and management. Am Fam Physician. 2006 Apr 1;73(7):1231-8

https://pubmed.ncbi.nlm.nih.gov/16623211/

[2]. Christiano, D. (2019). “Vulvar Pain: Symptoms, Causes, and More.”