Vulvodynia: a Poorly Understood Female Pain Disorder

Vulvodynia, a chronic pain disorder characterized by consistent, diffuse, burning pain anywhere on the vulva, is estimated by experts to occur in 10 percent to 20 percent of women in the United States.

The pain experienced with vulvodynia appears to be out of proportion to the stimulus, with vulvar soreness, irritation, and chronic aching characterizing the syndrome.

In spite of the fairly high prevalence of this condition, I have not seen many definitive or comprehensive studies of vulvodynia, and our understanding of the condition remains incomplete. There are no comprehensive, agreed-upon diagnostic criteria for vulvodynia and, of the treatment approaches that proliferate, none has been rigorously evaluated in randomized clinical trials.

Some experts believe that the cause of this condition resides in injury to genital tissues from a host of causes, including candida and other infections, insufficient estrogen during and after menopause or while using oral contraceptives, very frequent intercourse, and other factors.

According to this hypothesis, too frequent or nonstop genital irritation leads to continuous stimulation of nerve endings, which results in heightened local sensitization followed by increased central sensitization, causing the chronic genital pain.

Another theory is that the injury causing vulvodynia is one to the sensory branch of the nervous system, not to the genital tissue per se. In this neuropathic theory, the pain of vulvodynia is secondary to nerve damage, which could result from surgery, childbirth, joint abnormalities, or spinal disc pathology.

Whenever possible, treatment of vulvodynia should involve education, counseling, and physical therapy to strengthen the muscles of the pelvic floor.

Pharmaceutical approaches to treatment include amitriptyline and gabapentin, used sometimes individually, sometimes in combination. Often, it takes a number of interventions before this bothersome condition is effectively treated.