Co-authored by Lida Abdulrahman and Kat Merwin
This blog is a summary of our published article: Corsini-Munt, S., Rancourt, K., Dubé, J., Rossi, M., & Rosen, N. O. (2017). Vulvodynia: A consideration of clinical and methodological research challenges and recommended solutions. The Journal of Pain Research, 10, 2425-2436. doi: 10.2147/JPR.S126259
What is vulvodynia?
Vulvodynia is chronic pain around the opening of the vagina (the vulva) [1]. Studies suggest that approximately 8%-28% of women suffer from vulvodynia throughout their lifetime [2-6]. The most common subtype of vulvodynia in premenopausal women is provoked vestibulodynia (PVD) – this is characterized by acute pain near the vulvar vestibule. For more information regarding PVD, take a look at some of our other blog posts (1, 2, 3)!
Although many women suffer from vulvodynia, studies estimate that only 60% of affected women will seek treatment. Additionally, only 50% of these women will receive a diagnosis of vulvodynia, let alone be referred to appropriate treatment options. Why is this? Well, there are multiple potential causes for vulvodynia (i.e., biological, psychological, interpersonal factors), making it difficult to find a widely accepted treatment [7-8]. This suggests that there is still so much more that we need to learn about this condition—and in the meantime, many women lack access to evidence-based treatment options [5].
Vulvodynia is by no means something fun to live with; it disrupts sexual, relational, and psychological well-being not just for the affected women but also their partners [7].
Women with Vulvodynia often experience distress due to:
1) Feeling as if they are an inadequate partner (i.e., many women endorse fears of losing their partner, feeling emotionally distant, and a sense of shame when they cannot please their partner sexually) [6]2) Stigma they may encounter from health providers [6]3) Economic burden due to missing work or school [9]4) Difficulties with arousal, orgasm, and satisfaction during sex [10-12]
These are just a few examples of ways women suffer from vulvodynia in their social and romantic lives.
The purpose of this paper was to explore the various underlying causes and treatments available for women with vulvodynia.
As previously mentioned, there isn’t a widely accepted treatment available yet, but there are still some effective treatments available to reduce the pain these women suffer from. These range from psychological, physical, and medical-based treatments [13].
Treatments currently available:
Psychologically based treatments may work on (and are not limited to) managing the pain, relationship problems, and overall sexual desire. One effective psychological treatment available is Cognitive-Behavioural Therapy (CBT) – this focuses on challenging thought-processes towards pain and women’s general perception toward their disorder.
Pelvic floor physical therapy involves strengthening the muscles so that you are able to experience less pain during sexual intercourse. To put it into perspective, the pelvic floor is made up of muscles and nerves that make up your core muscles [17]. These core muscles are what allow us to sexually function (and perform many more functions)! What happens in this type of treatment? There are electrical stimulation and physical therapy; these focus on reducing pain and increasing quality of life. Electrical stimulation involves the placement of a small electrode inside the vagina, where an electrical current is passed through to allow the pelvic muscles to shrink. This can be done in different strengths, as well [17].
Surgical interventions have reduced approximately 70% of pain experienced during sexual intercourse [15]. Surgical interventions include removing areas of the skin between the lower vagina and within the vulva.
There are also nonsurgical interventions available that include local anesthetics and anti-inflammatory medication. There are still studies being conducted on these medications to evaluate the efficacy due to a lack of consistency supporting their use. Hormonal treatments and certain anti-inflammatory agents are a little more promising.
Medication options can help with the pain which women with vulvodynia often experience [14]. These medications include antidepressants, anticonvulsants, hormonal treatments, and anti-inflammatory agents.
Which one is better?
CBT has resulted in the greatest improvements in the pain and sexual functioning compared to medication [16]. It is important, however, to be aware of alternative treatment options before deciding. Typically, treatment starts off with non-surgical options, such as psychotherapy or physical therapy (pelvic floor therapy). If those are unsuccessful, medication is considered next (e.g., topical creams, oral medication). Finally, surgical intervention is considered as the last line of treatment.
It is important to note that each woman that suffers from vulvodynia will have a range of different symptoms and different factors to take into account.
This means that what might be useful for one patient may not be adequate for another patient.
The good news is that there are a variety of treatments available that can be tailored for people suffering from vulvodynia!
REFERENCES:
[1] Bornstein, J., Goldstein, A.T., Stockdale, C.K., Bergeron, S., Pukall, C., & Coady, D. (2016). 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Journal of Sexual Medicine, 13, 607–612. doi: 10.1016/j.jsxm.2016.02.167
[2] Reed, B.D., Harlow, S.D., Sen, A., Legocki, L.J., Edwards, R.M., Arato, N., & Haefner, H.K. (2012). Prevalence and demographic characteristics of vulvodynia in a population-based sample. American Journal of Obstetrics & Gynecology, 206, 170. e1–e9. doi: 10.1016/j.ajog.2011.08.012.
[3] Harlow, B.L, & Stewart, E.G. (1972). A population-based assessment of chronic unexplained vulvar pain: Have we underestimated the prevalence of vulvodynia? Journal of the American Medical Womens Association, 2003, 58, 82–88. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12744420
[4] Reed, B.D., Haefner, H.K., Sen, A., & Gorenflo, D. (2008). Vulvodynia incidence and remission rates among adult women: A 2-year follow-up study. Obstetrics and Gynecology, 112, 231–237. doi: 10.1097/AOG.0b013e318180965b.
[5] Harlow, B.L., Kunitz, C.G., Nguyen, R.H., Rydell, S.A., Turner, R.M., & MacLehose, R.F. (2014). Prevalence of symptoms consistent with a diagnosis of vulvodynia: Population-based estimates from 2 geographic regions. American Journal of Obstetrics & Gynecology, 210, 40.e1–e8. doi: 10.1016/j.ajog.2013.09.033
[6] Arnold, L.D., Bachmann, G.A., Rosen, R., & Rhoads, G.G. (2007). Assessment of vulvodynia symptoms in a sample of US women: A prevalence survey with a nested case control study. American Journal of Obstetrics & Gynecology, 196, 128.e1–e6. doi: 10.1016/j.ajog.2006.07.047
[7] Pukall, C.F., Goldstein, A.T., Bergeron, S., Foster, D., Stein, A., Kellogg-Spadt, S., & Bachmann, G. (2016). Vulvodynia: Definition, prevalence, impact, and pathophysiological factors. Journal of Sexual Medicine, 13, 291–304. doi: 10.1016/j.jsxm.2015.12.021.
[8] Bergeron, S., Rosen, N.O., & Morin, M. (2011). Genital pain in women: Beyond interference with intercourse. Pain, 152, 1223–1225. doi: 10.1016/j.pain.2011.01.035
[9] Arnold, L.D., Bachmann, G.A., Rosen, R., Kelly, S., & Rhoads, G.G. (2006). Vulvodynia: Characteristics and associations with comorbidities and quality of life. Obstetrics and Gynecology, 107, 617–624. doi: 10.1097/01.AOG.0000199951.26822.27
[10] Brauer, M., ter Kuile, M.M., Laan, E., & Trimbos, B. (2009). Cognitive-affective correlates and predictors of superficial dyspareunia. Journal of Sex & Marital Therapy, 35, 1–24. doi: 10.1080/00926230802525604.
[11] Masheb, R.M., Lozano-Blanco, C., Kohorn, E.I., Minkin, M.J., & Kerns, R.D. (2004). Assessing sexual function and dyspareunia with the Female Sexual Function Index (FSFI) in women with vulvodynia. Journal of Sex & Marital Therapy, 30, 315–324. doi: 10.1111/j.1743-6109.2007.00604.x
[12] Sutton, K.S., Pukall, C.F., & Chamberlain, S. (2009). Pain ratings, sensory thresholds, and psychosocial functioning in women with provoked vestibulodynia. Journal of Sex & Marital Therapy, 35, 262–281. doi: 10.1080/00926230902851256.
[13] Lua, L.L., Hollette, Y., Parm, P., Allenback, G., & Dandolu, V. (2017). Current practice patterns for management of vulvodynia in the United States. Archives of Gynecology and Obstetrics, 295, 669–674. doi: 10.1007/s00404-016-4272-x.
[14] Goldstein, A.T., Pukall, C.F., Brown, C., Bergeron, S., Stein, A., & Kellogg-Spadt, S. (2016). Vulvodynia: Assessment and treatment. Journal of Sexual Medicine, 13, 572–590. doi: 10.1016/j.jsxm.2016.01.020
[15] Tommola, P., Unkila-Kallio, L., & Paavonen, J. (2010). Surgical treatment of vulvar vestibulitis: A review. Acta Obstetricia et Gynecologica Scandinavica, 89, 1385–1395. doi: 10.3109/00016349.2010.512071.
[16] Bergeron, S., Khalifé, S., Dupuis, M.J., & McDuff, P. (2016). A randomized clinical trial comparing group cognitive-behavioral therapy and a topical steroid for women with dyspareunia. Journal of Consulting and Clinical Psychology, 84, 259–268. doi: 10.1037/ccp0000072
[17] Harvard Health Publishing. (2009). More on strengthening the pelvic floor. Retrieved from https://www.health.harvard.edu/newsletter_article/more-on-strengthening-the-pelvic-floor
