Vulvodynia is a broad category of pelvic pain that can be broken down into smaller subset diagnoses. They include:
Vestibulodynia (pain at the vestibule or “entrance” of the vagina)
Vulvodynia (pain in the superficial tissues of the vulva, particularly the labia majora and minora)
Clitordynia (pain at the clitoris)
These superficial tissues are innervated by the pudendal nerve, as well as the iliohypogastric nerve. These pain syndromes can be related to irritation of these nerves, superficial trigger points in the pelvic floor muscles (MSK Dysfunction in CPP, Pelvic Floor Tenderness in Pelvic Pain), connective tissue tightness. issues in the skin, hormonal changes (sometimes secondary to the birth control pill or menopausal changes), genetic factors and central sensitization. Central sensitization has been increasingly studied in relationship to Vulvodynia by many researchers; Dr. Caroline Pukall from Queen’s University (a fellow Canadian) has done a brilliant job of looking at central sensitization and its role in persistent pain of the vulvar tissues. An excellent fact sheet on central sensitization and vulvodynia can be found here; there is real hope since the nervous system is plastic, and what has changed, can be changed back again.
Pain will often be described as burning on the external skin as well as a burning and itching sensation within the vagina. When these tissues are touched there is usually an intense burning pain. Penile penetration or the insertion of a tampon will cause the patient to complain of a ripping or tearing pain associated with an intense burning sensation. Often with vestibulodynia, (however, this can also occur with the other subsets of vulvodynia) if the tissues are not being touched, the patient will not experience any pain.
These are more complex problems and need to have a multi-modal treatment approach. Often topical 5% lidocaine, or xylocaine is used directly on the skin or smeared on a mini-pad, or cotton ball, at night for eight weeks to decrease the sensitivity associated with painful touch. Connective Tissue Dysfunction must also be addressed, as well as superficial Myofascial Trigger Points in the pelvic floor. Lastly, neural tension in the pudendal nerve and iliohypogastric nerve must be addressed since there is usually a component of adverse neural tension in vulvodynia syndromes, as well. Hormonal compounds and creams can also be used to try to rebalance the hormonal drivers that might be present in these pain syndromes.
There is a wonderful organization, the National Vulvodynia Association, who works diligently to provide education materials, research support and dissemination of information for both patients and health care practitioners alike. Vulvodynia is not a condition that needs to be accepted as a chronic pain syndrome that cannot be changed. Vulvodynia, and all of its subsets, can become less sensitive, and the health of these tissues can be addressed, including the nervous system. Starting with understanding the pain system and how it works is a good start. Do not give up hope.