Vulvodynia
Something feels “off” but you are told there’s no infection? It might be Vulvodynia.
With other causes ruled out (yeast infection, BV, herpes, lichen planus or sclerosis, allergy, nerve issues, vulvar trauma, hormonal issues – the list goes on!) symptoms of pain or discomfort, itching, burning, redness, irritation might be diagnosed as vulvodynia. Symptoms can come and go, or be present all the time. For some, symptoms can impact using tampons, having sex, or even sitting or wearing tight clothes. To be diagnosed as vulvodynia, these symptoms have to be present for 3 months or longer.
But if those symptoms aren’t caused by an infection, what does cause them?
We don’t entirely know. Researchers continue to investigate what might contribute to this condition. Some thoughts include injury or irritation to the nerves that transmit pain from the vulva or an increase in the number and sensitivity of nerve fibers in the vulva; inflammation; previous infections – it’s possible vulvodynia may develop after recurrent yeast infections for example; environmental factors; genetic susceptibility; and pelvic floor dysfunction – either spasm, weakness or instability. There may even be some connection between hip pain – labral tears specifically – and vulvodynia.
Often vulvodynia occurs alongside other pain conditions including painful bladder, endometriosis, temporomandibular joint syndrome (TMJ), chronic headaches etc. Pain is so complex and often involves discussing our emotions, how we are sleeping, physical health and functioning – among other aspects of our health – to understand how to best support you.
There are some medications that might help but a holistic approach is often best when it comes to this condition. With vulvodynia, I approach with lifestyle (good vulvar care, sleep hygiene, eating enough etc), mindfulness and breathing, referral for therapy and massage, and then we discuss pelvic floor therapy.
From a pelvic perspective, this often involves pain education and exercises to down-regulate how our nervous system responds to pain. When we are in pain, we often contract muscles as a protective mechanism. The same happens when we are stressed – think about your traps or your jaw when stress and anxiety are present for you. Unfortunately, this often amplifies the pain and strengthens that pathway to the brain. When we work on relaxing the muscles of the pelvis, we can often decrease symptoms.
Things you can do at home
Avoid scented products that come in contact with your vulva (toilet paper, pads, tampons, wipes etc) as they can be irritating.
This extends to soaps - simple is best if you are going to use soap. That said, avoiding soap as much as possible and using just water to clean your vulva is ideal.
If you are able to/want to engage in penetrative sex, you may want to opt for a lubricant that is water-soluble and free of common irritants such as glycerine, parabens, propylene glycol, sulphates, and fragrance. You also want to choose a lubricant that is pH appropriate and free of spermicides.
Wear loose fitting underwear or no underwear to sleep.