By Riva Preil
Before vulvodynia was referred to by the title of this blog in an episode of Sex in the City, vulvodynia, a vulvar condition associated with chronic stinging, burning, irritation, and diffuse pain, received its name from doctors in 1983. Many believe that the pain and symptoms are due to irritation or injury to the pudendal nerve, the primary nerve supplier to the vulva, or any of its three branches. Injury to this nerve creates pain at rest, even without an additional trigger (ex. prolonged sitting, tight pants, cycling). The pudendal nerve can be damaged in many ways, several of which include a herniated disc, trauma related to pelvic surgery (ex. prolapse repairs that involve attaching the vagina to the sacrospinous ligament), orthopedic injury (ex. fracturing the coccyx, i.e. tailbone), stretching of the nerve during childbirth, or nerve damage due to the herpes zoster or simplex virus. Often, women who present with vulvodynia-like symptoms also reports increased vaginal discharge or vulvar secretions. This may be related to altered nerve mechanisms which cause the vulvar glands to produce abnormally high amounts of secretions.
Treatment of vulvodynia includes replacing vulvar irritants with vulvar friendly substitutes (ex. soft, white unscented toilet paper instead of products containing fragrance, sodium lauryl sulfate, or propylene glycol). Some doctors also recommend using a topical anesthetic, such as Xylocaine, to help relieve pain. In addition, doctors often recommend tricyclic antidepressants or anticonvulsant drugs to help control the pain symptoms. Any activity that aggravates the pain such as horseback riding, tight clothing, or working out should be avoided until the symptoms are controlled. Nerve blocks have helped relieve pain in some patients, and pelvic floor physical therapy is beneficial to help treat muscle tightness that may have resulted due to the pain and which may be continuing to contribute to it. Physical therapists can also help correct and musculoskeletal misalignment which may be further compressing and irritating the pudendal nerve, and they can perform nerve glides to mobilize the nervous system and decrease restrictions on the pudendal nerve.