Vulvodynia is chronic, unexplained pain or discomfort, characterized by burning, stinging, irritation, or rawness in the area around the opening of the vagina (i.e., the vulva). This is a poorly understood and under-researched pain syndrome for which optimal treatment remains unclear. The pain, burning or irritation associated with vulvodynia can make women so uncomfortable that sitting for long periods of time is tortuous and sexual intimacy becomes unthinkable. The condition can go on for months or years.
Vulvodynia’s onset is most commonly between the ages of 18 and 25. Sadly, 60% of symptomatic women need to see an average of 3 different providers to receive the diagnosis of vulvodynia, and 40% of symptomatic women remain undiagnosed. Other causes of pelvic pain can include interstitial cystitis, endometriosis and urethral syndrome. It is important to work with health care providers who are experienced in the treatment of vulvodynia.
Some women experience pain in only one area of the vulva or genitalia, while others experience pain in multiple areas. If you have vulvodynia, don’t let the absence of visible signs or embarrassment about discussing the symptoms keep you from seeking help. Treatment options are available to lessen the pain and discomfort of vulvodynia, ranging from topical therapies to oral medications, physical therapy and biofeedback. A physical therapist trained in treating pelvic floor muscle dysfunction can provide strengthening exercises that can be very helpful.
Medications can be applied topically, directly on the vulva, taken orally or injected. Here are a few options:
- Topical anesthetics that contain lidocaine can be applied 30 minutes prior to the problematic activity to numb the affected area (avoid topical corticosteroids)
- Estradiol cream
- Antidepressant (topical amitriptyline) and anti-seizure medications that are known to have pain-reducing properties
- Trigger-point injections of steroids or Botox®
- Topical gabapentin 6% cream. Researchers evaluated the clinical efficacy and tolerability of topical gabapentin 6% cream, and found that after a minimum of 8 weeks of therapy, pain was significantly reduced and sexual function improved. Patients applied a small amount of cream (approximately 0.5 mL, equivalent to the size of a small pea) three times daily. Common adverse effects of oral gabapentin – including dizziness, somnolence, and peripheral edema – were not reported with topical therapy because the amount of active drug in topical preparations is significantly less than that administered orally, and the topical route of delivery reduces systemic absorption of the medication. The conclusion: “Topical gabapentin seems to be well-tolerated and associated with significant pain relief in women with vulvodynia.”
- Topical nitroglycerin 0.2%. At UCLA Medical Center, 34 women used a compounded low dose topical nitroglycerin 0.2%. The study concluded “Topical nitroglycerin is safe and effective in providing temporary relief of [painful intercourse] and vulvar pain in women with vulvodynia.” Side effects associated with commercially-available higher strength nitroglycerin ointment, such as headache, are much less common with the lower dose.