Monday, July 11, 2011

Sexual Health 101: Vulvodynia

The first topic I want to mention is Vulvodynia. It's something not a lot of people are aware of, unfortunately, despite the fact that "Estimates of women with vulvodynia range from 200,000 to 6 million." (women.webmd.com/vulvodynia). That's an awful lot of women to be suffering pain that most peole don't know about. Luckily though, there are more and more resources popping up.


Vulvodynia is pain of the vulva. There are two different forms of it: Generalized Vulvodynia and Vulvar Vestibulitis Syndrome (Provoked Vulvodynia). I myself have the Generalized version, which is the one that is a bit more frustrating. That is pain with every part of the vaginal area--the labia, the opening to the canal, the clitoral area, etc. Compared to Provoked, which is just pain in the area of the opening of the vagina (the vestibule).
Generalized Vulvodynia
Vulvar Vestibulitis (Provoked)

Because the knowledge of it is so low, diagnosis can take a long time, sometimes years, unfortunately. Many people are told that the pain is just in their heads and that it's all about just relaxing yourself and trying to ignore the pain. But that's not what this pain is. Yes, relaxation techniques can help for things like intercourse, and can make it a little bit more bearable. But the pain is definitely there. There is no specific cause of vulvodynia, but there is a lot of speculation. One is that there are oversensitive nerves. I was told that while most women have a certain amount of nerves in that area, I have double. Nerve endings allow us to feel pleasure when touched, but an overabundance of them can actually cause pain. The symptoms can start out of nowhere. One day you could have a completely normal sex life, and the next you could not be able to have one at all. Doctors still aren't sure why this happens. Abuse or injury to the vaginal area, along with the overabundance to nerves, are all things that can bring on vulvodynia.

Symptoms of Vulvodynia: 

--Raw, burning skin that stings with touch or without touch.
--Itching of the vulvar area, usually fairly severe.
--Achey pains in the vagina.
--Redness and open sores can be caused by itching, or swelling can occur. 

Lots of women find inserting tampons, having sexual intercourse, and receiving pelvic exams to be extremely uncomfortable and painful. If you have any of these symptoms, talk to your doctor. The symptoms can often times speak for themselves, but the real test is the 'Cotton Swab Test.' What your doctor will do is use a large cotton swab and gently push on certain areas of your vulva, asking you to rate the pain/stinging associated with that touch. For women with vulvodynia, this test is very painful. The cotton swab will not feel like soft material--it will feel like a knife. It is a terrible thing for women to have, and even more awful that there's not more information about it and how to help it.

If it is found that you have vulvodynia, your doctor may suggest a few things. Birth control pills tend to be pushed on women all the time, but sometimes that isn't good. The first thing my doctor did was take me off the pills. Birth control can cause a thinning of the vaginal canal lining, and for some women with vulvodynia, this can complicate things further, as it did for me. Estrogen creams (such as Estrace) will most likely be prescribed. The cream is a white cream that is applied to the outer and inner vulva, which gives the skin more estrogen, thickening the skin. Numbing agents may also be applied in attempts to block the pain and deaden some nerve endings. Surgery is often a very last resort. I won't post pictures because a lot of people may find them pretty gruesome, but what happens is they go into the vaginal canal and do some work with your skin, placing a new layer of skin over the painful thin layer. It is very painful and has a long recovery process.

One thing that can work is Pelvic Floor Therapy or Biofeedback Therapy. The vulvodynia in itself is painful and causes complications, but a lot of women with it tend to tense up when they are touched. This causes the pelvic floor to tighten, and a lot of women do not have the control over their bodies to know how to loosen back up, especially when suffering with something like this. Biofeedback Therapy teaches you how to control your pelvic floor. If you reach up inside your vagina, you hit a point where it's like the bottom of a bowl. That point is painful to get past for women with Pelvic Floor Dysfunction. If you press lightly on that area, most women will find that theirs is sponge-y or soft. Women with vulvodynia--or me when I first went in--will hear that there's most likely feels like a rock. The muscles are tightened to an extreme. At physical therapy, my doctor showed me tons of information about the vulvar area, including diagrams and books. She did a massage on the outside muscles, lightly pushing on certain parts of my thigh/vulva and gently, but deeply, stretching them. They can insert a tiny probe a "perineometer" into the vagina or rectum, which tells you how your pelvic floor usually sits. They will go through relaxation techniques with you, to teach how to tighten and loosen the muscles. They may even suggest a dilator--a small vibrator type object that you slowly insert into the vagina, teaching yourself how to relax the muscles. The vibrations can even help the nerves. 

If you suspect you have vulvodynia, make an appointment with your OB-GYN. In the meantime, take precautions. If sex hurts, try not to have it, or not as often. Pain is our bodies way of telling us something is wrong. Lots of women think that the more sex they have, the better they will get. This is not true, and it can actually make it worse by overstimulating the skin and causing severe irritation. Wear cotton underwear and loose clothing in the area. Do NOT use scented feminine products, and use water-based lubricants. Make sure the vaginal area stays clean and dry, but do not use body wash in the area. Use water and rinse it. Wet, sweaty places breed bacteria, and the last thing any women wants is a yeast infection. If you itch, avoid scratching it. Scratching it usually just causes the skin to itch more, and it will become unbearable, leading to open sores. If you have severe itching, try ice packs or a vaginal itching cream. Above all, don't give up hope. If you have symptoms, print out information and bring it to your doctor. If they don't know about it, maybe they know someone who will. There may not be an exact cure, but remember that professionals have figured out tons of ways to relieve the pain (medications, anti-anxiety pills, creams, physical therapy) or even take it away completely (surgery). Also keep in mind that sometimes, women just wake up one day with their symptoms completely gone. If you have any questions about Vulvodynia, check out nva.org, the National Vulvodynia Association, or email me at askarlette@hotmail.com








Resources:

National Vulvodynia Association n. pag. Web. 11 Jul 2011.

"Vulvodynia Overview." Web MD n. pag. Web. 11 Jul 2011. .  

"Pelvic Floor Dysfunction." ICA n. pag. Web. 11 Jul 2011. .

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