Vulvodynia – A Special Kind of Pain

‘Vulvodynia’ is a medical term (derived from the Greek word dynos = pain), coined to describe chronic vulva discomfort or pain of uncertain origin. In that almost 90% of women with this syndrome have a fair complexion and very sun-sensitive skin, it seems likely that the basic disease process is hypersensitivity/susceptibility to painful inflammation, because of individual’s genetic makeup. Some doctors suspect that the trigger is a low grade yeast infection or a virus. It often feels like a yeast infection but the medication prescribed by the doctor either doesn’t help at all or helps only for a short time. It is not sexually transmitted.

It is also unclear how many women suffer from vulvodynia but the majority of patients are young women in the 20-40 age group.

Pain can interfere with the wearing of jeans and pantyhose or even sitting in a normal posture. Any mechanical pressure can amplify the symptoms from a simple discomfort to a sharp pain. This pain is often severe enough to prevent or interrupt vaginal intercourse. Even when intercourse is possible, the vulva may become very red and sore for days afterwards.

It needs to be emphasized that vulvodynia is not ‘all in the women’s head’ Many women with vulvodynia display evidence of psychological distress but such emotional problems represent a secondary reaction to the illness. The pain is real and there is constant feeling of ‘rawness’. However inspection with a hand mirror frequently fails to display any visible abnormality. At most, the area will look a little dry and a little swollen and perhaps show small splits that look like ‘paper cuts’.

Normally the fine blood vessels located beneath the vulva’s skin are not readily visible. However in vulvodynia the chronic inflammation of the vulva’s skin produces a self-perpetuating overgrowth of the small blood vessels lying in the underlying connective tissues. To the unaided eye the entire vulva often appears red.

In patients with severe or longstanding vulvodynia the mucous secreting glands around the vaginal opening can become intensely inflamed, usually providing an identifiable physical reason for it. Even though the causes for vulvodynia remains unknown, diagnostic features are relatively constant from person to person and include an irritated dry change to the skin of the vulva and exquisitely painful, sometimes ulcerated red spots at the vaginal entrance.

About 10% of women with vulvodynia develop contracture of the vulva and lower vagina, probably as a result of longstanding inflammation in these tissues. Such scarring adds another layer of difficulty to the problems of being able to have vaginal intercourse without pain.