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.
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:
|Candida / Yeast||99%||Confirm|
|Herpes Simplex Type II||15%||Unlikely|
|Vaginitis/Vaginal Infection||3%||Ruled out|
|Chronic Fatigue-Fibromyalgia||3%||Ruled out|
|Interstitial Cystitis||2%||Ruled out|
|Human Papilloma Virus||1%||Ruled out|
Do you experience any discomfort in the vulvar area (labia and opening to the vagina)?
Possible responses:→ Don't know
→ Mild irritation / burning - stinging
→ Moderate pain
→ Very painful / sensitive to any contact
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.
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:
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.
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]
Whether there is an association between vestibulitis and HPV infection is still being debated.
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.
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]