Vestibulodynia:
o Severe pain and discomfort in the vestibule area of the vulva. The vestibule is where the vulva (area of the skin on the outside) meets with the vagina
o It is an extremely sensitive part of your body and contains the Bartholin's gland (which produces vaginal lubrication), the urethra (where you pass urine) and a few the small minor vestibule glands which also produce vaginal secretions.
o The vestibule is hypersensitive on touch, such as during intercourse and on insertion of tampons or tight clothes. Itching is not usually a feature of the condition. An excessive sensitivity of the nerve fibres and even, on occasions, overgrowth of the nerve fibres in the area are believed to be responsible for symptoms.
o Although the pain on light touch is the main symptom, tension in the lower pelvic floor muscles during attempted sex can lead to increased pain and subsequent avoidance of sex. If communication breaks down between a couple then this can lead to further disharmony.
Vulvodynia:
o Vulvodynia is the sensation of vulvar burning and soreness in the absence of any obvious skin condition or infection. The sensation of burning and soreness of the vulva can be continuous (unprovoked vulvodynia), or on light touch, e.g. from sexual intercourse or tampon use (provoked)
o The vulvar burning and soreness are usually the consequences of irritation or hypersensitivity of the nerve fibres in the vulvar skin. The abnormal nerve fibre signals from the skin are felt as a sensation of pain by the woman. This type of pain can occur even when the area is not touched. (Neuropathic pain)
o The pain described by women with unprovoked vulvodynia is often of a burning, aching nature. The intensity of pain can vary from mild discomfort to a severe constant pain which can even prevent you from sitting down comfortably.
o Vulvodynia is not only restricted to the vulva. It can be experienced in the inside of the thighs, upper legs and even around the anus (back passage) and urethra (where you pass urine). Some women also have pain when they empty their bowels. Unprovoked vulvodynia can influence sexual activity and is associated with pain during foreplay and penetration.
Treatment:
o Pain that originates from nerve fibres is best treated with drugs that alter the way in which the nerve fibres send their impulses to the spinal cord and give the sensation of pain e.g. tricyclic antidepressants. o Creams and lotion applied to the vulvar area which do act as soothing agents, but it is generally best to avoid all creams unless they have been prescribed by your doctor. o Vaginal lubricants can help during intercourse. o Aqueous cream is a very bland plain cream which may be used instead of soap when washing o
Causes:
o Infection e.g. candida
o Inflammation e.g. lichen sclerosis
o Neoplasms e.g. squamous cell carcinoma
o Neurological e.g. nerve injury
o Trauma e.g. obstetrical
o Hormonal deficiencies e.g. menopause
o Iatrogenic e.g. radiation
Lichen sclerosis:
Lichen sclerosis appears as white thin patchy skin around the vulva and anus. An overactive immune system or an imbalance of hormones may play a role. Previous skin damage at a site on your skin may increase the likelihood of lichen sclerosis at that location. Lichen sclerosis is not contagious and cannot be spread through sexual intercourse.
Anyone can get lichen sclerosis, but postmenopausal women have a higher risk.
Symptoms may include:
o Itching (pruritus), which can be severe
o Discomfort or pain
o Smooth white spots on your skin
o Blotchy, wrinkled patches
o Easy bruising or tearing
o In severe cases, bleeding, blistering (red or purple) or ulcerated lesions
o Painful intercourse Diagnosis can be made by a physical examination or a biopsy.
Treatment:
o Treatments help reduce itching, improve your skin's appearance and decrease further scarring e.g. corticosteroids, immune - modulating medications and physiotherapy for painful intercourse
o avoid washing with soap or bubble bath – use plain water or an emollient wash instead, such as aqueous cream (but avoid leaving aqueous cream on the skin after washing)
o avoid rubbing or scratching the area
o gently dab your genitals dry after urination, to stop your urine from irritating the skin
o apply a barrier cream or ointment, such as petroleum jelly, to affected areas after washing and before and after urinating
o avoid wearing tight or restrictive clothes and wear underwear made from natural materials such as cotton or silk – women may find it helps to wear stockings rather than tights
o for women who find sex painful, it may help to use a lubricant, a vaginal dilator and physiotherapy to release tight pelvic floor muscles.
