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.

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.

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

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]

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.

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]

Reducing the amount of oxalate in your diet may be helpful.  Things to avoid include tea, spinach, beer, berry juices, baked beans in tomato sauce, peanuts, peanut butter creams, pecans, soybean curd, concord grapes.  In addition, do not take more than 250mg of Vitamin C per day as it may contribute to oxalate formation.  Restrict or limit milk or dairy products to reduce the amount of calcium oxalate in the body.  Calcium citrate may prescribed to neutralize high blood or urine levels of oxalate.

If intercourse is painful, you can apply xylocaine jelly to numb the sore areas.

Vulvar pain that is due to infection e.g. ureaplasma, candida or strep will respond to the appropriate treatment.

Carefully avoid all potential irritants in your underwear, such as laundry soaps and bleaches.  You may use a mild non-perfumed soap such as Castile soap and run twice through the rinse cycle.  Perfumed or even plain soaps may aggravate the irritation.  Natural glycerin soap may be helpful as it has no residual drying effects.  A hand-held shower massager is preferable to an overhead nozzle as it makes it much easier to wash away any soap residue that remains after washing.  Washing the vulvar area with distilled water instead of tap water may help avoid irritation from chlorine.  Another way to help painful urination is to pour a cup of water on the area while urinating: this dilutes the urine and helps to wash away any irritating residue.

Topical estrogen creams may provide relief.  Estrogen thickens or toughens the skin and increases blood supply.  It may help you even if you have not reached menopause or do not have estrogen deficiency.  If you find vaginal creams painful (possibly from the additives such as alcohol or parabens), your physician may mix 5-10% solution in a petroleum gel base or mineral oil instead of using the standard base.

The iliolumbar ligament may be weakened and referring pain to the vulvar area.  Prolotherapy can strengthen that ligament.

Surgical treatment may include removal of painful areas such as the vulvar (bartholin's) glands, decompression surgery of the pudendal nerve to free the nerve and its branches up (from compressions due to blood vessels and veins, damaged tissue, and ligamental grip), and/or laser therapy to destroy underlying vulvar blood vessels.

Soothing relief may be obtained by applying warm soaked tea bags to the area.  This can be done by placing the tea bags on menstrual pads to hold them in place or you can take a sitz bath in which tea bags have been soaked.

To relieve pressure on the vulvar area when sitting you may use a pressure relief cushion.

Biofeedback and pelvic muscle exercises involving relaxation and muscle strengthening may be helpful.