Pain In The Vulva / Vulvar Pain

What Causes Vulvar Pain?

Vulvar pain can have various causes, ranging in severity from 'worrying' to 'serious'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose vulvar pain, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "vulvar pain" as a symptom.  Here are eight possibilities:
  • Vaginitis/Vaginal Infection
  • Vulvodynia
  • Herpes Simplex Type II
  • Urethritis-Urethral Syndrome
  • Interstitial Cystitis
  • Chronic Fatigue-Fibromyalgia
  • Candida / Yeast
  • Human Papilloma Virus

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
discomfort caused by mold/mustiness
history of deformed toenails
short-term memory failure
refined sugar consumption
poor recovery from exertion
sugar/sweet craving
vaginal burning
poor tolerance of sugars
temple-based headaches
non-vaginal candidiasis
major joint pain/swelling/stiffness
regular morning stiffness
... and more than 90 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of vulvar pain:
Cause Probability Status
Candida / Yeast 99% Confirm
Urethritis-Urethral Syndrome 21% Unlikely
Herpes Simplex Type II 15% Unlikely
Vaginitis/Vaginal Infection 3% Ruled out
Chronic Fatigue-Fibromyalgia 3% Ruled out
Interstitial Cystitis 2% Ruled out
Vulvodynia 1% Ruled out
Human Papilloma Virus 1% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate vaginal problems, The Analyst™ will ask further questions including this one:
Do you experience any discomfort in the vulvar area (labia and opening to the vagina)?
Possible responses:
→ Don't know
→ No
→ Mild irritation / burning - stinging
→ Moderate pain
→ Very painful / sensitive to any contact
Based on your response to this question, which may indicate no vulvar pain, vulvar pain or severe vulvar pain, The Analyst™ will consider possibilities such as:
Interstitial Cystitis

Vestibulitis may sometimes be part of bladder and/or urethral inflammation as seen in the interstitial cystitis or urethral syndrome.  The lining of both vagina and bladder arise from the same tissue during fetal development and thus when one becomes inflamed, the inflammation may spread to the adjoined areas.

Vulvodynia / Vestibulitis

Symptoms of vulvodynia or vestibulitis can range in severity from mild to severe.  Burning, itching and pain are experienced in the skin of the vaginal entryway and sometimes the labia or clitoris.

Vulvodynia / Vestibulitis also suggests the following possibilities:

Chronic Fatigue / Fibromyalgia Syndrome

Dr. St.  Amand, MD, specializing in fibromyalgia and author of What Your Doctor May Not Tell You About Fibromyalgia believes that all women with chronic vulvodynia have a form of fibromyalgia.  He discovered that at least 11% of his female patients with fibromyalgia also have vulvodynia (painful genitals).  The guaifenesin therapy for chronic fatigue enhances oxalate crystal excretion which has been shown to be beneficial in vulvodynia also.

Herpes Simplex Type II

Some women seem to develop vulvodynia in response to infection with the herpes virus.  [Vulvodynia: A Perplexing Disorder; Questions and Answers With Stanley Marinoff, M.D.  NVA News, Vol. I, Issue 1; Winter, 1995]

HPV (Human Papilloma Virus)

Whether there is an association between vestibulitis and HPV infection is still being debated.

Urethritis / Urethral Syndrome

Vestibulitis may sometimes be part of bladder and/or urethral inflammation as seen in the interstitial cystitis or urethral syndrome.  The lining of both vagina and bladder arise from the same tissue during fetal development; thus when one becomes inflamed, the inflammation may spread to the adjoined areas.

Yeast / Candida Infection

Cyclic vulvovaginitis is probably the most common cause of vulvodynia and is believed to be caused by a hypersensitivity reaction to Candida.  While vaginal smears and cultures are not consistently positive, microbiologic proof should be sought by obtaining candidal or fungal cultures during a symptom-free phase.  The diagnosis of cyclic vulvitis is made based on the patient's report of cyclic symptomatic flare-ups (or, conversely, symptom-free days) and by the patient's report of symptomatic improvement after the administration of long-term topical or systemic anticandidal therapy.  [Autoimmunity as a factor in recurrent vaginal candidiasis and the minor vestibular gland syndrome.  J Reprod Med 1989;34: pp.264-6]

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