Vulvar vestibulitis, commonly known as Vestibulodynia, is defined as chronic pain in the opening of the vagina (vulva).
Aside from the pain this condition brings, inflammation and burning sensations can also follow which can be quite a traumatic experience for the patient.
Average tasks like, sitting, walking or indulging in sexual intercourse can become quite difficult due to the severity of the pain. Women of all ages can experience vulvodynia and vulvar vestibulitis.
Those who appear to be prone to these conditions are women with interstitial cystitis, endometriosis, and dysfunction of the pelvic floor’s high-pitched muscles, but it is unclear whether these conditions trigger vulvodynia and vulvar vestibulitis, or vice versa.
Menopause, stress, and changes in detergents, soaps or other hygiene products also seem to trigger vulvodynia and vulvar vestibulitis.
The exact causes of vestibulodynia have not been pinpointed as of yet. However, doctors have narrowed down some possibilities that may lead to this condition.
Irritation or damage to the nerves in the area surrounding the vulva has been cited as one of the leading factors of this condition.
Similarly, it has also been observed that past infections in the vulvar region, as well as the use of chemical substances that have detrimental effects on the skin, can also contribute to this.
Another theory suggests that the vestibulodynia may be a manifestation of the hormonal changes occurring in a female body.
It must be noted that vestibulodynia is not a sexually transmitted disease; however, women who have been associated with sexual abuse are most likely to get it.
Vulvar vestibulitis is a condition related to inflammation and redness in the opening of the vagina.
Vulvodynia is a condition associated with pain in the opening of the vagina. This includes deep burning and hypersensitivity. It is not understood a cause of these affections.
It is possible that the contributing factor, the sea sensitivity increased from the nerves on the surface of the skin.
Women of all ages may experience vulvar vestibulitis and vulvodynia.
Changes in detergents, stress, menopause, soaps or other hygiene products also appear to trigger vulvar vestibulitis and vulvodynia.
Women who seem to be most likely to suffer from these conditions are those with pelvic floor dysfunction, endometriosis, and interstitial cystitis, but it is unclear whether these conditions trigger vulvar vestibulitis and vulvodynia, or vice versa.
The severity of the symptoms can range from simple irritation to disabling pain in the vulva, which consists of subcutaneous tissue and skin at the opening of the breasts and around them.
The risk factors that can cause vulvar vestibulitis are:
- HPV (human papillomavirus).
- Chronic fungal infections, such as vaginal candidiasis.
- Bacterial infection.
- Repeated cystitis.
- Alterations of pH (acid-base balance of the vagina).
- Use for a long time of irritating chemicals, such as detergents, soaps, spermicides or lubricants.
- Lack of hydration or lubrication (vaginal dryness).
- Stress, anxiety, and diseases such as fibromyalgia.
- Microtrauma caused by sexual intercourse or by wearing tight clothing.
- Injuries or irritations of nerves and tissues around the vulvar area, for example during and after delivery.
- Allergy or hypersensitivity localized in the skin.
- Alterations of hormonal balance.
- Women who have suffered sexual abuse.
The most classic thing is to complain about:
- Burning when urinating
- Vaginal burning
- Chronic pain in the pelvis that is aggravated by the vulva with the use of tight clothing
- Inability to wear clothes
- Intolerance to hygiene wipes
- Painful sexual intercourse
The pain can become chronic due to:
- Hyperactivity of mast cells (cells involved in allergic reactions and acute inflammations),
- Decrease in pain threshold,
- Hyperactivity of nerve endings that transmit pain signals,
- Involuntary contraction of the pelvic muscles, especially the levator ani muscle (for example in the case of vaginismus).
There are some standout symptoms related and can be detected quite easily. Women may experience burning and soreness in their genitalia.
Patients also complain about itching and throbbing sensations. Intercourse can prove to be an excruciatingly painful experience.
The pain can be generalized to the entire vulvar area, or it can be narrowed down to some particular parts.
Some patients have claimed that the pain comes and goes, and there is no strict time duration. It can continue for days on without any relief and then suddenly it will vanish altogether.
It is necessary to apply pressure to the affected region before pain can be experienced.
This is in contrast to vulvodynia where patients will complain of pain without any specific triggers. Swelling of the infected area can also be a sign of this disease.
The severity can change from mere irritation to a disabling pain in the vulva, which is constituted by the skin and subcutaneous tissue at the opening of and around the pelvic organs.
Classical complaints include:
- Chronic pelvic pain that is aggravated by wearing tight clothing and contact with the vulva.
- Painful sexual intercourse.
- Burning when urinating.
- Vaginal burning.
- Inability to wear clothing, especially tight clothing.
- Intolerance to hygiene wipes.
Patients may also experience recurrent bladder infections, with symptoms such as burning during urination, frequent urination and a strong urge to urinate.
However, if there is vulvar or vulvar vestibulitis, a laboratory test will not show bacteria that causes infection in the urine.
They may also have pain, such as pelvic floor muscle dysfunction, interstitial cystitis, irritable bowel syndrome, endometriosis, and fibromyalgia.
Since patients with vulvodynia or vulvar vestibulitis experience many different conditions that present pain, they sometimes consult several physicians for treatment.
Doctors are trained to identify the various conditions and offer a variety of treatment options.
How are vulvodynia and vulvar vestibulitis diagnosed?
Vulvodynia and vulvar vestibulitis are diagnosed primarily through a review of the family medical history and physical examination.
To perform the test, the doctor must touch different parts of the vulva with a swab to identify where the pain triggers.
Vulvar vestibulitis is diagnosed when a patient has a positive result of a touch and redness test on the opening of the vagina.
If the symptoms appear, you should go to the gynecologist, who examines them based on the Friedrich criteria, that is:
- Intense pain and burning sensation in the vulvar vestibule, or when trying vaginal penetration
- Pain and feeling of slight pressure inside the vulvar vestibule
- Vulvar erythema (inflammation and redness)
To make the diagnosis, the doctor uses a swab to exert light pressure in the vulval vestibule.
If the patient suffers from vulvar vestibulitis, the test with the swab causes extreme pain and discomfort.
Vestibulitis can cause vaginismus or worsen it, although the two conditions can coexist.
For this reason, some women must undergo treatment of the two diseases at the same time to be able to have sexual intercourse again without pain.
The most suitable specialist doctor to treat this type of disease is the gynecologist.
The treatment for vulvar vestibulitis is mainly focused on alleviating the patients from some of the symptoms. There is no fixed road to recovery, and the treatment is also a time-consuming process.
Days or even weeks may elapse before the patient starts to experience some relief. Doctors often prescribe oral medicine as the first stage of treatment.
There are many treatment options, and often combined treatment is necessary. Options include:
Medicines. Many medications are available, including oral and topical creams. Some treat specific conditions such as inflammation and atrophy.
In some cases, drugs are combined into particular formulas to treat various symptoms.
Sometimes, changing simple things can control the symptoms. This could include the use of hypoallergenic detergents and soaps, wearing cotton underwear and other breathable clothing, and avoiding tight clothing.
Strengthening of pelvic floor muscles. A physiotherapist specialized in these conditions can teach techniques to improve the symptoms.
The therapy includes techniques to help to relax and to restore healthy body posture and mechanisms. The patient may need to perform a variety of exercises, but the results are excellent.
Modification of the diet. Minimizing the consumption of bladder irritants in the diet can improve symptoms. The most common are alcohol, caffeine, and artificial sweeteners.
Changes in diet can be adjusted to particular needs, but they are essential for the control of these conditions.
Treatment of related conditions. Treatment of other medical problems that occur with vulvodynia and vulvar vestibulitis may improve the recovery.
Steroids and tricyclic antidepressants are used to reduce the pain. Similarly, antihistamines are prescribed to relieve the patients from itching sensations.
Some doctors also suggest specific exercises that will help the patient to work on the pelvic muscles. This will help lessen the discomfort and fight against other symptoms.
For patients suffering from severe pains, local anesthetics and nerve blocking agents can be administered.
These substances help in numbing the ends of the nerves in the affected area that will help reduce the pain, and the patient is relieved.
In extreme cases, a process called vestibulectomy is also sometimes employed by the doctors. Here, the affected part of the skin and the surrounding tissue are removed surgically.
However, this has its consequences and is only opted under certain circumstances.
Diet and feeding for vulvar vestibulitis
When talking about food, most people think that food can only cause digestive problems.
In fact, the experience of hygienists, naturopaths, and patients demonstrates that a natural diet (if necessary, also fasting) can cure the diseases of almost all organs, except for:
- Some degenerative neurological disorders (Parkinson’s disease, Alzheimer’s disease, and others),
- Bone tumors,
- Advanced stage cancer
- Polka dots and vitiligo,
- Medical emergencies (infarction) and severe trauma.
It is a free therapy that does not intoxicate the body as do the medicines and integrators.
The types of feeding that have provided the best results in patients are:
- A vegan diet with at least 50% of raw foods, based on:
- Fruit, mainly citrus, in the morning
- Fresh vegetables, especially green leaf
- Fruit of shell (almonds, hazelnuts, nuts, etc.) in regular quantities
- Legumes in small amounts
Blood group diet, in which each person eats the foods allowed according to their blood group, although all must eliminate from their diet:
- Milk and milk products
- Pork and deli products
- Cereals with gluten, although it is recommended to avoid all grains
- Fried, smoked and processed foods
Medications for vulvodynia and vulvar vestibulitis
The treatment for vulvar vestibulitis includes:
Aliamide (Adelmidrol): drugs that regulate the activity of mast cells.
Antidepressants, anxiolytics, antiepileptics: these medications, including amitriptyline (Deprelio), can relieve the pain of nervous origin caused by vulvar vestibulitis or interrupt the abnormal sensitivity of the nerves.
It has been shown that these drugs are very effective against “neuropathic” pain (of the nerves).
It is recommended not to take antibiotics (except if the doctor thinks they are necessary) since they alter the balance of the intestinal flora and favor genital infections, especially those that originate in fungi such as candida.
Surgical intervention for vulvar vestibulitis
If the pain persists even after a few months of treatment, surgery should be considered (vulvar vestibuloplasty).
In any case, before undergoing an operation, it is necessary to try to solve the problem through non-surgical treatments, as the patient can be cured without the need for an intervention.
The intervention involves ten days of rest at home. After the period of rest, treatment should be carried out on the sensitive vaginal tissue for a few months before being able to have sexual intercourse without pain.
Some treatments are not helpful, such as:
- Laser treatment,
- Interferon injections,
- TENS on the vulva, which in many cases makes the problem worse