Vulvodynia: what is it?

By Cristiano Antonino Last updated Jun 20, 2023

For a long time excluded from medical research because it was classified as a merely “psychosomatic” or even “psychogenic” disorder – therefore erroneously classified as an essentially trivial and negligible female problem – vulvodynia is the manifestation of a chronic painful state affecting the vulvar area , causing in the patient who complains of the disorder an intense burning sensation, irritation, swelling and redness

These symptoms have only rarely been observed in conjunction with obvious physical trauma

Despite the growing interest in this pathology, its still unknown origin causes sleepless nights to doctors, sexologists and gynecologists from all over the world, who rack their brains tirelessly to find an explanation – and a resolution – unequivocal to the problem.

Problem disorder starting from the nomenclature

It is no secret that vulvodynia has long been thought to be “a female whim”.

Nor is it a secret that studies on this pathology have long been scarce, superficial and fragmentary.

Witness of this, also the difficulty in giving the pathology a definitive nomenclature.

Vulvodynia, vulvar vestibulitis and vestibulodynia have long been used synonymously, when instead the three medical terms differ from each other in minimal but fundamental facets.

Vulvar vestibulitis indicates – as the suffix -itis suggests – an inflammatory condition of the vulvar area, not triggered by defined causes and not accompanied by pain.

Vulvodynia indicates – as the suffix -dynia suggests – a painful state

A physical condition in which a probable inflammatory state is accompanied by pain and/or burning.

The same goes for vestibulodynia, which likewise identifies a probable inflammatory state accompanied by pain and/or burning.

However, there is a profound difference between the two terms: vestibulodynia indicates pain that remains confined to a very specific area – that of the vulvar vestibule -, while vulvodynia indicates inflammation and pain that cannot be located but is more widespread.

To precisely identify a state of disorder or pathology, the first step should be to give it a correct and specific name.

Symptoms by which vulvodynia manifests itself

The symptoms with which vulvodynia manifests itself – vulvodynia, vulvar vestibulitis and vestibulodynia – are not the same for all patients.

This helps to make even more complicated not only the diagnosis, which often remains unacknowledged for a long time, but also the study of such a complex pathology full of changing facets.

In general, the symptoms most frequently complained of by women declared clinically affected by vulvodynia are:

Vulvar pain and burning, spontaneous or resulting from contact with clothing (slips, trousers).
Hypersensitization of the vestibular tissue.
Possible dyspareunia (pain during sexual intercourse). We want to underline the word possible because, in women suffering from vulvodynia, some report the absolute impossibility of having sexual intercourse, while others do not find any problem in the act.
Numbness and swelling of the affected anatomical area.
Sensation of needle pricks, stinging, electric shocks on the pubis, vulva, or near the perineal area.
Typical symptomatology of cystitis or vaginitis despite vaginal swab and urine culture being negative.
Feeling of abrasion without obvious physical abrasions.
Difficulty urinating or burning when urinating.

This symptomatology, evidently very complex, is often associated with anxiety, depression and a very strong sense of unease, mainly caused by not being able to lead a normal life, because most of the time it is conditioned by a constant painful sensation that also prevents daily gestures, such as walk, sit, cross your legs.

Vulvodynia: what are the causes?

As a disease that is still highly enigmatic and complex, the causes that lead to the development of vulvodynia have for a long time been considered to be of “psychological origin”, which is why patients who complained of these symptoms at the gynecological visit, without however having objective physical findings, a psychological visit was often recommended.

Fortunately, this misleading approach is now considered outdated in favor of a more conscious approach to the problem.

Studies, still under construction, have for now identified the causes of vulvodynia in a series of factors and events that act in symbiosis with each other.

Among the main causes are vaginal and bladder bacterial infections, often accompanied by a genetic predisposition to contract inflammation.

Even the hypercontractility of the muscles of the vulvar and perineal area seems to play a significant role in the development of vulvodynia.

Together with these specifically physical causes, psychological and sexual aspects also play a very important role: many women with vulvodynia have a history of harassment, trauma, abuse and relationship difficulties in their past, factors that risk worsening the causes of physical nature, leading to the development of a psycho-biological disease.

Vulvodynia: a difficult diagnosis

Given the extreme variability and the – unfortunately still scarce – studies on the subject, making a correct diagnosis of vulvodynia is rather complicated.

Generally, this diagnosis is reached by exclusion, after having followed all possible paths, with consequent frustration of doctor and patient.

Fortunately, the knowledge of this pathology progresses more and more every day, making it easier to identify and consequently cure it.

To make a diagnosis of vulvodynia we rely on specific tests.

Swab test

The swab test takes place with the help of a cotton swab with which the gynecologist specialist applies slight pressure on some specific points of the vestibular area.

If the patient overreacts even to a simple touch, it is likely that it is vulvodynia and the patient will be invited to perform further checks and investigations.

Examination with the vulvagesiometer

The vulvagesiometer is an instrument used to evaluate pain in the vulvar area.

Electromyography

Electromyography is used to verify the reactivity – which in the case of vulvodynia would be excessive – of the levator muscle.

Pain mapping

Pain mapping, associated with the investigation on the quantification of the intensity of the pain experienced, are the main diagnostic factors useful for the identification of the pathology in question.

These tests are carried out through a questionnaire delivered to the patient, who will have to associate values to some parameters.

How to cure vulvodynia: the most appropriate therapy

Having finally been classified as a psycho-biological disorder – that is, involving both the physical and psychological spheres of the patient – the treatments that have found greater effectiveness are those that address both interested fronts.

Psychotherapy always gives valuable help in the treatment of vulvodynia, helping the patient to overcome any past traumas and to accept with awareness even the most disabling aspects of her current – and hopefully fleeting – disease.

While contributing to the improvement of the clinical picture, psychotherapy alone is not enough.

This must be accompanied by pharmacological therapies, which generally involve the use of painkillers taken orally or applied topically; the use of local anesthetics in topical formulations; in selected cases, the use of antidepressants and anticonvulsants for short courses.

Important results that contribute, if not to healing, at least to the alleviation of symptoms, have been found in the treatment of nutrition: foods rich in oxalates (spinach, rhubarb, whole grains, cabbage, etc.) risk aggravating the clinical picture of the patient; avoiding them significantly reduces the symptoms.

Surgical therapy is the last resort of treatment, and should generally be avoided in clinical practice.

The surgery consists in cutting a part of the vulvar mucosa, physically eliminating the nerve endings responsible for the pain, but, unfortunately, also for the sensitivity of the area, incurring the risk of creating long-term sensitivity deficits.

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