Try out PMC Labs and tell us what you think. Learn More. The pathological underpinnings of localized provoked vulvodynia LPV , the most prevalent cause of vulvar pain that is frequently comorbid with other variants of chronic pelvic pain, have evaded clinicians and scientists for decades. This commentary describes the background and implications of the findings presented by Foster et al. An emphasis is on reasons why the vulvar vestibule—an embryologically distinct band of tissue demarcating the internal female reproductive tract and external vulva—should exhibit a propensity for fibroblast-mediated proinflammatory responses to commonly encountered yeast in healthy women, as well as women with LPV. The reproductive machinery is evolutionarily precious. As a result, physiological mechanisms evolved to protect reproductive organs from common environmental threats.
Does inflammation trigger nerve pain?
Considering how successful surgery is, how do you tell a young woman who's unable to have intercourse that she needs to learn to live with her pain? Even so, a surgical approach is only for carefully selected women--usually those with primary vestibulitis who have exhausted other treatment options. A woman with vulvar vestibulitis VVS can't have normal sexual relations because it's just too painful. Sex hurts. We do know there are three clear-cut categories of vulvar pain. VVS, the leading cause of dyspareunia in women under 50, can be primary or secondary. On the other hand, secondary VVS develops after a period of comfortable sexual relations. My goal here is to outline the criteria for diagnosing this condition and to discuss the basic pain management principles for VVS. I'll then discuss the often controversial surgical options available when medical therapy fails.
See related patient information handout on vulvodynia , written by the author and Elizabeth S. Smoots, M. Vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The patient's vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation.
In the past ten years, the problem of vestibulitis has been increasingly recognized as a cause of painful sexual intercourse. In more severe cases, the pain is present during normal daily activities, as well as during sex. Careful examination reveals redness and unusual sensitivity of the tissue at the opening of the vagina. This means that inflammation starts for any one of a long list of reasons, such as vaginal infection which causes pain; the nerves involved in sensing the pain then release chemicals that promote inflammation, and this inflammation causes further pain. Although this problem is not caused by any single factor, it can be aggravated by acid foods in the diet, by low levels of estrogen hormone, and by any infections that happen to occur while it is there. At the same time, it seems that many treatments bring about at least some relief in some women. The regimen we use now is one we have arrived at as the result of over 10 years of experience in treating this disorder, having tried many different treatment methods. Our most successful treatment has been a combination of estradiol estrogen hormone and lidocaine local anesthetic compounded in a special preparation. Applied three times daily over 6 to 8 weeks, many women note considerable improvement. When pelvic muscles have become abnormally tight as a result of the pain, we find pelvic muscle exercises helpful, sometimes assisted by pelvic floor biofeedback done by a physical therapist.