Dr. Judith Reichman
'Today' show contributor
Q: I’ve had extreme vulvar burning and my doctor says it’s vulvodynia. Why did I get it and how can I treat it?
A: This disorder is still poorly understood, both by doctors and by the women who suffer from it. As one result of this common frustration — as with many chronic problems — an association has been created to try to help those who are suffering: the National Vulvodynia Association.
There are multiple proposed causes for vulvodynia (which usually means that we’re not sure what the true cause is), and these include changes in immune factors, possible genetic predisposition, chronic inflammation, hormonal factors, abnormalities of nerve conduction, and an increase in irritants in the urine (known as oxalates).
The condition is basically diagnosed through the history given by the patient. Most report a burning pain, especially with intercourse, and discomfort when wearing tight underwear or with attempt at tampon insertion.
Often, the pain is localized near the bottom third of the vulva and opening of the vagina (called the intraoitus). A doctor can test for areas of pain by touching the tissue with a cotton swab.
Just as there is no single established cause for vulvodynia, there is also no single therapy that works for those who suffer from it. Some of the treatments now being used include:
- Wear cotton underwear during the day.
- Avoid irritants such as perfumes, douches, bubble baths, and toilet articles containing dyes.
- Use mild soap and avoid using the soap directly on the vulvar area.
- Apply vegetable oil or petroleum jelly after you wash to keep moisture in.
- Use menstrual pads made of cotton.
- If the area feels hot and irritated, you might also try lying down and applying an icepack. (I recommend a small package of frozen peas wrapped in a cotton cloth.)
- Anesthetic ointments such as lidocaine 5 percent can be used, and I often suggest patients use it prior to sexual activity.
- Tricyclic antidepressants (including Elavil, Pamelor and Norpramin) can help by decreasing the sensitivity of the nerves in the irritated area.
- Anticonvulsants (anti-epileptic medications) also seem to help: Neurontin and Tegretol have been prescribed with some success.
- There has been some positive feedback on biofeedback and physical therapy, especially in those women who are in pain and suffer from vaginismus (uncontrolled spasm of the vagina, preventing intercourse). Trigger point pressure, electric stimulation, intravaginal stimulation of the pelvic floor muscles, exercises and pelvic floor training are all part of this therapy.
- Trigger point injections and “blocks” of the pudendal nerve (it receives sensory signals from the lower pelvic area) can be particularly effective. In these methods, steroids and a local anesthetic are injected into the painful area in order to “shut off” the nerve that receives signals from the vulva.
- This is a last-course option in which the most tender area of the vulva is removed. Some studies show success rates as high as 80 percent for surgery.
- A low-oxalate diet may be helpful. Oxalates are found in tea and some foods such as spinach and rhubarb, and can be an irritant. For some women, vulvar burning may be associated with elevated oxalate levels in the urine. To diminish these effects, stay away from high oxalate foods and take calcium citrate (1500 mg).
Dr. Reichman's Bottom Line: Vulvodynia is complex, and its treatment can be frustratingly slow. Improvements may take weeks to months, and require both your and your doctor’s patience.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.