Vulvodynia is a chronic vulvar discomfort or pain, characterized by burning, stinging, irritation or rawness of the female genitalia in cases in which there is no infection or skin disease. The causes of vulvodynia are largely unkown. Some theories regarding the cause of vulvodynia include:

• An injury or irritation to the nerves of the vulva
• An abnormal response to trauma or injury to the vulva
• Genetic factors
• Hypersensitivity to yeast/allergies
• Spasm of the pelvic floor muscles
• Changing estrogen levels

There is no definitive test to diagnose vulvodynia. Instead ruling out other causes of vulvar pain is very important. Also, a careful medical history and physical exam which may include vaginal cultures, biopsy, Q-tip test, and/or colposcopy of the vulva is critical. Most women with vulvodynia have normal appearing vulvas/vaginas. However, pressure to the area may cause more pain than is normal.

There is no cure for vulvodynia so treatments are meant to relieve symptoms. It usually takes time to find a treatment or combination of treatments that will decrease of alleviate the pain. Current treatment options include:

• Local anesthetic ointment (xylocaine jelly)
• Tricyclic antidepressants (amitryptyline, nortriptyline, desipramine)
• Anticonvulsants (tegretol, neurontin)
• Antihistamines (hydroxyzine)
• Topical estrogen cream (premarin or estrace cream)
• Nerve blockades
• Diet modification (low oxalate diet, calcium citrate)
• Pelvic floor therapy/Physical therapy
• Accupuncture
• Surgery (localized removal of painful area)

If you think you may have vulvodynia, consult your doctor for further information, workup, and treatment.

More information is available at the following sites:
National Vulvodynia Association www.nva.org
Vulvar Pain Society www.vulvalpainsociety.org
Vulvar Pain Foundation www.vulvarpainfoundation.org