Vulvodynia, or the silent nuisance of women

Vulvodynia - it is the silent heroine of the trouble of every 10th woman in the world. It appears unexpectedly, can manifest itself in the form of various ailments on the vulva, which last at least 3 months, are defined as: discomfort, burning, stinging, hypersensitivity, dryness, burning of the urethra or anus. It happens that years pass before it is properly diagnosed, most women visit a whole range of specialists from gynecologists, gastroenterologists, urologists, endocrinologists, dermatologists to psychologists, often ultimately helplessly seeking help from a psychiatrist who will help explain the cause of the "fictitious pain" for which no one has found a logical explanation. Treatment can be long and pointless, usually begins with the use of all kinds of suppositories and antibiotics for recurrent intimate infections, women also reach for ointments, creams, infusions or herbal sitz baths, which will help locally suppress persistent ailments. In their search for help, they undergo invasive procedures such as cystoscopy with biopsy, pudendal nerve blockade, laser vaginal revitalization, and even vulvectomy, which involves partial or complete removal of the vulva. None of these procedures are supported by clinical studies, they only cause more damage to the vulva and make it more difficult to properly treat vulvodynia.

What is vulvodynia and why is it so difficult to diagnose?

Vulvodynia is a disease that affects 5 to 16% of women worldwide. In the US, over 40% of women suffer from pain, discomfort and unpleasant symptoms in the perineal area. It is estimated that vulvodynia affects one in ten women at some point in their lives. Most patients are between 27 and 34 years old, but mature women and those after menopause also suffer from vulvodynia. Gynecologists also refer little girls for vulvodynia treatment, the youngest of the patients are only 3 years old, although they are unable to determine what exactly is bothering them, they describe their symptoms in their own language as squirming bubbles in their butts or worms, which is why they avoid wearing underwear and pants. This pattern repeats itself later in adulthood, and it is only during a gynecological interview that patients remember that the first minor episodes appeared in childhood.

It is usually difficult to define the point in time when the first signs of vulvodynia and the harbingers of the disease appear. Sometimes the first signals are very subtle, for example, when we visit a gynecologist every few months due to recurring yeast infections or we feel a constant, urgent need to urinate and urge to urinate, or we avoid intercourse due to discomfort, burning and pain. Over time, we undertake further treatment with antibiotics, but the actual causes of the disease are still unknown, and the treatment itself is often simply inappropriate. When the symptoms worsen, we start looking for an effective treatment method, a method that will help us deal with the discomforts of everyday life once and for all... Sometimes women visit 6 to 8 gynecologists before they receive a specific diagnosis, information about the disease and available methods of therapy and treatment of vulvodynia. There are still few specialists who deal with vulvar diseases, which is why early diagnosis is quite rare.

Vulva doesn't like stress

There is no direct cause that causes vulvodynia. However, it has been proven that the risk of its occurrence is four times higher in women suffering from depression and anxiety disorders. A greater predisposition to the disease is observed among women who can be described as highly sensitive, more empathetic, over-analyzing past events, gestures and words. And also in the environment of so-called business women , professionally active, determined to achieve a set goal, functioning in constant stress under the pressure of time and increasing obligations. It is therefore not surprising that in times of increasing demands and corporate activity, the frequency of vulvodynia is increasing.

When it hurts and the cause is still unknown...

Vulvodynia has no organic or inflammatory cause for pain, which is why it is referred to as a disease of exclusion. This means that other common diseases that may require treatment and cause vulvar pain, such as fungal or herpes infections , inflammatory conditions, dermatoses, e.g. lichen planus, or neurological conditions, e.g. spinal nerve compression, must be eliminated to diagnose it. Diagnosis of vulvodynia involves collecting a focused interview, a gynecological examination, and assessing the pelvic floor muscles. Vulvodynia is most often caused by dysfunction of the pelvic floor muscles and fascia, which can occur for two reasons: weakened pelvic floor muscles or excessive pelvic floor muscle tension. Pain that occurs due to vulvodynia is usually felt by women in the area of ​​the vulva , clitoris , urethral meatus, and perineum. It also happens that the treatment of vulvodynia may include the anus, pubic symphysis and inner thighs. Due to the nature of the occurrence of vulvodynia, it is divided into three types:

• Spontaneous vulvodynia - you may notice symptoms in the vulva regardless of other factors, e.g. tight jeans, underwear or using tampons.
• provoked vulvodynia - discomfort occurs in response to touch, e.g. intercourse, gynaecological examination, inserting tampons.
• mixed vulvodynia - the above types may appear alternately or coexist with each other.

Painful intercourse, or dyspareunia and vulvodynia

Vulvodynia can take various forms. In some patients, the pain manifests itself ambiguously, e.g. as abundant vaginal discharge, burning and/or discomfort of the vulva, in others it occurs in the urethra as a constant pressure on the bladder, in still others the dominant pain symptoms are in the area of ​​the vaginal entrance , which makes intercourse difficult or completely impossible. Pain symptoms that appear during or after intercourse are also vulvodynia. They occur as a variant of delayed pain. Sometimes it is felt immediately after intercourse, sometimes a few hours after. The discomfort can last from a few hours to a few days. It is worth knowing that dyspareunia is often confused with another disease: vaginismus. It is worth knowing that there is a significant difference between them. Vaginismus is a type of phobia and is most often accompanied by a fear of intercourse, in its case the pain itself can also appear, but it is not the leading symptom. It should also be noted that in the case of dyspareunia due to the inability to have sex, the couple struggles with difficult personal and emotional problems in the relationship. Although there are also cases in which women keep their condition a secret for years, fearing betrayal and not wanting to disappoint their partner, they perform every intercourse in discreet suffering or the fear and fear of penetration are so strong that they increase the tendency to avoid intimate contact and make it difficult to show closeness.

Psychological discomfort that is better left unsaid

It is difficult for women to talk about vulvar pain even among their closest friends, when everyone complains fervently at a family dinner or during a quick chat while making coffee in the office about a sore head, leg or back, but a sore vulva? The vulva causes discomfort. The burden of the disease, with which women are often left to their own devices, affects their professional, emotional and sexual lives. When looking for the causes of unbearable symptoms and carefully analyzing your own results, many questions also arise that give rise to suspicions and doubts - after all, if I am healthy, it means that my partner is infecting me, but since I have visited so many gynecologists and there is no trace of infection, the cause must lie somewhere else, so he is certainly cheating on me. Although sexually transmitted diseases may have similar symptoms, they are most often not the cause of discomfort felt during intercourse, so they are not a consequence of the partners' infidelity either. The cause of burning or painful intercourse is not, as is generally assumed, the disproportion in the size of the intimate organs of the couple.

See what everyday life with vulvodynia looks like

Vulvodynia requires exceptional endurance and determination from women not only in treatment, but also in everyday routine. Everyday situations that are completely mundane for each of us, such as going to the cinema with friends, to the swimming pool, riding a bike, or meeting friends in a restaurant, are a source of frustration and greater stress for patients with vulvodynia. Due to vulvodynia and troublesome symptoms, they give up everything, which not only increases the pain, but also leads to awkward situations, such as using the toilet dozens of times during a meeting, nervously adjusting bothersome underwear or stopping the constant need to scratch and relieve the annoying itching. There are also extreme situations in which women do not move from bed for days with enormous pain resembling the urethral being squeezed in a vice or, wanting to avoid constant visits to the toilet, spend the night in the bathtub instead of in their own bedroom. Their life is adjusted to their state of well-being, the constant abandonment of opportunities that previously seemed natural, isolation and abandonment of activities that brought pleasure, leads to greater helplessness and loss of control over everyday life. In the process of treatment or better coping with vulvodynia, a doctor who knows and understands the problem of vulvodynia will also justify the need to include psychotherapy in the treatment.

Treating vulvodynia is a complex puzzle

There is no single, binding standard of diagnostic and therapeutic procedure for patients with persistent vulvar pain worldwide. Multidisciplinary therapy is considered the most effective method of treating vulvodynia, which brings the most health benefits to the patient. A modular approach is very important in the treatment of vulvodynia, i.e. cooperation between a gynecologist, urogynecological physiotherapist, pelvic floor muscle/fascia therapy and support from a psychologist/psychotherapist. A woman with vulvodynia is a patient with chronic pain, because the cause is myofascial dysfunction, so vulvodynia is chronic functional pain. Treatment is based on the principles of pain management, not gynecological or urological infection. This does not mean that patients with vulvodynia do not have inflammation, but it is not the cause of vulvar discomfort. This is a fact that is hardest to believe for a woman who itches, burns or constantly hurts. In the treatment, they would like to include an antidote that will stop all the symptoms once and for all and return them to their normal everyday life. Treating vulvodynia requires a lot of dedication, peace, reducing stress and tension, as well as mindfulness, which is why relaxation and breathing exercises and yoga are also recommended as aids in the treatment of vulvodynia. The gynecologist will recommend avoiding irritants that are in direct contact with the vulva, i.e. giving up artificial, colored underwear, intimate hygiene fluids with an unnatural composition or pads and tampons with dyes or chlorine (see our text on the compositions of popular brands of pads and tampons ).

A diagnosis that brings relief

Women suffering from vulvodynia spend years feeling ashamed, lonely, anxious, low mood and restless. After visiting a whole series of specialists, they themselves begin to doubt their symptoms. Feeling helpless and due to the lack of a logical explanation from the medical profession, they begin to suspect a mental illness. Although vulvar pain can be the cause or coexist with a clear deterioration in mood or depression, it is not caused by a mental illness. It is also not the result of sexual harassment, sexual immaturity, rape or violence. Nevertheless, living with chronic stress contributes to vulvodynia, while the correct diagnosis is often the moment when a woman, after many unsuccessful visits, regains hope for normal functioning despite the chronic nature of the disease. Many diagnosed patients believe that the very diagnosis, the understanding from the doctor and the belief that what they are saying is true bring them relief. Often, it is at this point that they begin to believe that the nightmare they are experiencing is not just in their head, but is confirmed by science and medicine based on clinical trials, and that there are thousands of women in the world who struggle with the same problems.