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Vulvodynia

Do Not Suffer in Silence: Free advice – ask me today!

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By Dr Helen Webberley MBChB MRCGP MFSRH | GMC no. 3657058

I am an NHS GP and a sexual health and hormone specialist. I can give advice on any medical matter, and I offer safe access to medical advice, prescription medication, blood tests and x-rays, and specialist referrals to your local private hospital as needed.

Vulvodynia

 

Vulvodynia is pain in, or around the female genital area (the vulva) and is largely unexplained in most women. The vulva usually looks entirely normal but vulvodynia can give rise to burning and deep-seated pain that can range in severity from mild to excruciating. So much so, that it can interfere with sexual intercourse, sleep and even sitting down. Often there is no obvious cause, although there is an association with vaginismus, lumbar back problems and irritable bowel syndrome.

It can be brought on by touch (such as sexual intercourse, use of tampons and tight underwear) but more often than not occurs for no reason at all and for that reason, there are probably very many women who ‘suffer in silence’.

Treatment options are diverse, from creams, to conventional pain killers, to ‘nerve tablets’, to cognitive behavioural therapy and even hypnotherapy.

Frequently Asked Questions

Why do I have vulvodynia?

Nobody can really explain why vulvodynia occurs and although in a minority it may be associated with localised or lumbar spine damage or trauma, the vast majority of women have no ‘risk factors’ and the vulva looks entirely normal. Instead, the nerves supplying the vulval area seem to be creating the pain themselves.

Can I pass it on?

Vulvodynia is not a disease or infection that can be transmitted to another person and therefore sexual intercourse is perfectly safe for both parties. There doesn’t seem to be a hereditary component either, with no evidence to suggest that the offspring of an affected mother will also suffer from the same problem.

How is vulvodynia diagnosed?

There are no specific tests to diagnose vulvodynia and the vulva looks entirely normal. Several studies looking at biopsies from the affected area as well as body scans, have shown no abnormality. It is therefore regarded as ‘idiopathic’ which means we don’t know what causes it.

Where does vulvodynia affect?

Vulvodynia mainly affects the immediate vulval area including the labia and clitoris. It can occasionally also affect the inner thighs as well as the buttocks and in some women, the entrance to the vagina. If the entrance to the vagina is affected, women often also experience vaginismus, where the vaginal muscles tighten very painfully during intercourse and insertion of tampons. Rarely it can affect the anus and even the urethra giving symptoms of proctalgia (painful rectum) and cystitis.

How common is vulvodynia?

Because the majority of women who have vulvodynia experience pain without the affected area having been touched, then it is very likely that many women experience symptoms without even telling anybody and in particular the medical profession, because it is too embarrassing to talk about. Therefore we don’t really know how common it is but we believe that it is much more common than originally thought.

Can vulvodynia be treated?

Although we don’t know of a physical ‘cure’ for vulvodynia, there are numerous treatment options that can make the lives of sufferers much more bearable. Conventional painkillers and the use of Tens machines applied to the affected area have been shown to be helpful. Use of emollient and emulsifying creams applied to the affected areas and ‘barrier creams’ when swimming can be of great help and also aid lubrication during sexual intercourse. Tricyclic antidepressants such as amitryptiline taken at night to avoid drowsiness can also be very helpful. Cognitive behavioural therapy, acupuncture, hypnotherapy have all been shown to help some women.

Medication

Tricyclic antidepressants

The most commonly used are amitryptiline and nortryptiline. They are often used very effectively in other types of ‘nerve pain’ such as post-herpetic neuralgia and trigeminal neuralgia and are used in much smaller doses than those used to treat depression. They seem to affect the way that nerves transmit pain signals and are very safe. The biggest problem with them is dry mouth and drowsiness and so they are usually taken at night. Symptoms usually start to improve after a few days and so does the drowsiness, so they are worth persisting with.

Creams

In general terms only very bland creams should be used and certainly none containing any scented chemicals. Emollients, emulsifying creams and barrier creams can all be prescribed for you and in general it is advised not to buy these over the counter, as some may make your symptoms worse. Seek your doctor’s advice on these.

Cognitive behavioural therapy, hypnotherapy, acupuncture and tens machines

These have all been shown to help some women but not all, help all women so you may need to chop and change to find the right treatment that suits you. We can advise you about this and refer you in the right direction to suit you.

Safe, real prescriptions to help you

Whether you know what treatment works for you or you need advice on what you should take,

ask me here about safe prescriptions to help with your condition.

Tests and Investigations

There are no specific tests or investigations necessary to diagnose vulvodynia as the symptoms are usually diagnostic in their own right. However it may be necessary to exclude other potential causes of vulval pain such as infections, STIs and pelvic or spinal conditions.

STI Screen

These can be performed on urine specimens or swabs of the vulva and vagina, performed in your own home. These are then sent away to a laboratory for analysis and we can then send your report back to you with medical advice.

Ultrasound of vulva and pelvis

These can be arranged by us, to be performed at your local private hospital. We would make the referral and then advise you on the result.

MRI lower spine

These can be arranged by us to be performed at your local private hospital. We would make the referral and then advise you on the result.

Contact me now for advice, prescriptions, blood tests and referrals.

Please note that this service does not aim to replace advice given to you by your own doctor, it is meant to supplement your health knowledge and awareness.

It is never to be used in the case of a medical emergency.

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