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Vulvodynia: how to make the correct diagnosis? How to Treat Vulvodynia - wikiHow.

Women with this disease experience pain when opening the vagina during sexual intercourse, and sometimes a constant burning sensation and pain; irritation and redness are observed. There is acute sensitivity when touching the ring of Bartholin's glands located in the vestibule of the vagina. This can permanently prevent a woman from having sexual intercourse. Patients with vulvodynia usually visit many doctors without finding real reason diseases and an adequate treatment method, they deserve great sympathy.

What is vulvodynia?

Currently, the syndromes of pain in the vulva and vaginal vestibule, previously called “vulvodynia” and “vestibulitis”, are united by the International Society for the Study of Diseases of the Vulva under the term “vulvodynia”. Depending on the prevalence, vulvodynia can be local or general. Further classification is determined external influence: provoked, unprovoked or mixed vulvodynia.

Symptoms and signs of vulvodynia

The pain may be burning, stinging or shooting, or it may be something unpleasant or painful sensations in the absence of clinical and laboratory signs disease that could explain these complaints. Itching is not typical for vulvodynia.

The diagnosis of vulvodynia is not familiar to all doctors general practice and not even all gynecologists. Many patients for a long time go from doctor to doctor, often thinking that they have thrush.

What causes vulvodynia? Reasons

Numerous studies have failed to identify the cause of vulvar vestibulitis, but some believe it is triggered by a vaginal yeast infection, gynecological surgical operations or childbirth. Some included sexual harassment. Research data has not been able to show that allergies, human papillomavirus, or bacterial overgrowth are causes of vulvodynia. Under a microscope, signs are most often visible nonspecific inflammation Bartholin gland. But even surgical procedures, such as laser vulvectomy or removal of Bartholin's gland, often do not help stop the pain, although some achieve good results. Interestingly, scientists have discovered that the a glands in this area are associated with nerve structures containing neurotransmitters (substances that transmit nerve impulse) serotonin and chromogranin. This explains why treatment aimed at supporting nervous system, and treatment for mood disorders sometimes helps with vulvodynia. Anything that affects the levels of neurotransmitters in our cells can affect your health. Serotonin levels have been shown to be affected by wide range substances - from bioregulators to antidepressants.

Treatment of vulvodynia

Used to treat vulvodynia a whole series measures, but all of them are not optimal in terms of effectiveness and long-term prognosis. It is believed that this is due to the lack of a CNS component in treatment, an incomplete understanding of the pathogenesis of this condition, and a failure to take into account the psychosocial aspect. It is probably best to consider chronic vulvar pain as one of the systemic pain syndromes.

Treatment algorithm for vulvodynia

  • Non-specific but necessary measures:
    • educating the patient about vulvodynia;
    • consulting;
    • avoiding the use of irritating substances and unnecessary topical medications;
    • lidocaine (2% gel or 5% ointment);
  • Amitriptyline/gabapentin/venlafaxine/dul oxetine/pregalbin.
  • Treatment of diseases of the pelvic organs.
  • Surgical treatment.

Diet issues for vulvodynia

Some studies indicate that vulvodynia is somehow related to calcium oxalate in the urine. Calcium oxalate is believed to be a strong irritant to the genital skin. Not all researchers have confirmed these data. But whether the genital irritation is caused by calcium oxalate in the urine or simply increased sensitivity to it, the fact is that many women benefit from a low-oxalate diet and daily intake of calcium citrate. Dr. Herzl Melmed, a gynecologist specializing in this area, reports that 70% of his patients experienced significant improvement with such measures. A low oxalate diet should be followed for approximately six months. Rhubarb, celery, chocolate, strawberries and spinach contain a lot of oxalates.

Calcium citrate also reduces oxalate levels. Look for products without vitamin D on the label; you don't want excess amounts of this substance. The drug Citracal contains 200 mg of calcium and 750 mg of citrate in one tablet. You can take another drug with approximately the same dose, two tablets before meals three times a day. Sometimes this is enough for a Woman to get rid of pain in the genital area and return to normal life.

It is recommended that women suffering from vulvodynia change their diet and start taking a good vitamin and mineral complex in doses recommended by their doctor. Add proanthocyanadins (antioxidants found in grape seeds and the skin of grapes, these can be bought in health food stores) initially at a dose of 2 mg per 1 kg of body weight, this dose should be divided into two to four doses and taken daily for two weeks. Then reduce the dose to maintenance, 20-60 mg per day. Taking vitamins minerals, antioxidants improves performance immune system and helps repair and regenerate cells throughout the body. This is probably why this regimen helps cure vulvodynia.

Psychological aspects of vulvodynia

Like all diseases, vulvodynia has physical, emotional and rational aspects. All of them need to be dealt with at the same time, otherwise we will achieve only temporary improvement, and our inner voice will look for an opportunity to convey information and attract attention. Studies of the emotional aspects of Bartholin's gland inflammation, in which these patients were compared with a control group of women with other vulvar diseases, found that women with vulvodynia were more psychologically depressed, had a greater tendency towards sexual dysfunction, and were more preoccupied with their body's reactions, which were generally completely normal. But instead of realizing that these tests are normal, they believe that they have symptoms of serious illnesses. For example, they feel that their stomach is bloated after eating, and they are afraid that this is a sign of a serious illness. Small pink spots and others normal changes on the skin make them believe it is cancer, or they think their heart is beating in their ears at night, which is a sign of a brain tumor.

As already mentioned, patients with inflammation of the Bartholin gland are more likely to have a history of sexual or physical abuse than women with other vulvar problems. It is well documented that women who have suffered sexual or physical violence often have difficulty establishing normal relationships afterwards. sexual relations, therefore, it is not surprising that trouble occurs in the genital area, to which the woman’s inner voice wants to draw attention in order to cure it. One way to change the nervous system signal in this area is to activate a biological feedback mechanism. Vaginal biofeedback involves knowing how to relax and re-tighten your pelvic floor muscles, and the exercise has been shown to relieve pain in 83% of women who did it for 16 weeks. Most of these women were able to have sexual intercourse after treatment. Kegel exercises work according to the same mechanism; women can perform them at home. Many therapists have been trained and are able to provide rehabilitation after injuries pelvic floor. Those dealing with stress incontinence can also benefit from this.

Other treatments

Treatment of depression. Tricyclic antidepressants, such as amitriptyline or desipramine, help some women because of their ability to block the reuptake of the neurotransmitters serotonin and norepinephrine, which can affect the function of the Bartholin glands themselves. Some doctors consider it correct to use antidepressants “to give the nerves a rest.” Newest antidepressants, such as Prozac, have not yet been studied in these settings.

Treatment was started with the lowest dose, which was increased if necessary and if there was no side effects. Amitriptyline was started at 10 mg every evening for a week, then the dose was increased to 20 mg every evening for another week, then 30 mg for the third week. You will need to work with your doctor to find a dose, but women most often achieve benefits with doses ranging from 30 to 75 mg per day.

Allergy therapy using the Nambudripad (TLAN) method. Despite the fact that there is still no data on the connection between vulvulitis and allergies, it is known for sure that it is associated with impaired immune response. It may be treatable using the TLAN method described earlier.

Interferon. Interferon is an antiviral agent that stimulates cells - natural killer cells of the immune system. It may help treat many cases of vulvodynia, although we do not yet understand what mechanism is at work. It is clear that in women with vulvodynia, something is abnormal in the mucosal immune response. Therefore, it is logical to assume that a substance that affects the immunity of the mucous membrane will help treatment. Some researchers believe that interferon only works in women with herpes virus infection. Others believe that He works in all cases.

Interferon is given as an injection into the Bartholin glands three times a week for four to six weeks. Improvements are reported in 40-80% of cases, depending on the selection of patient groups. Although the herpes virus is not known to be the cause of vulvar pain, the success of this treatment is an interesting paradox that has not yet been explained. Interferon has no effect in women who are not infected with the herpes virus.

Surgical methods of treatment. Surgical excision of the Bartholin glands is successful in some women, but not in all.

After studying all the scientific data and clinical observations it becomes clear that best method treatment for vulvodynia should combine physical, emotional and psychological aspects. The symptom of constant and chronic genital pain requires a lot of faith in your inner wisdom, a lot of empathy and patience.

Today, the problem of treating diseases of the vulva is topical, since it presents great difficulties in achieving therapeutic effect and is chronic.

Translated, “Vulvodynia” means “painful vulva.” Vulvodynia is a condition of discomfort experienced by women in groin area, which is permanent and accompanied by sharp pulsating pain, itching, burning and other unpleasant symptoms that intensify during sexual intercourse. Often the discomfort experienced by a woman can be so acute that it is impossible to sit, let alone have sexual intercourse. Over the past few years, the number of patients suffering from this complex and not fully understood anomaly has increased significantly. Reasons for the increase in cases of this disease steel frequent change sexual partners, presence bad habits such as alcohol and smoking, the prevalence of sexually transmitted infections, unprotected sex.

Vulvodynia in some cases can be a symptom of complex diseases of the vulva, which the patient is not even aware of. The pain can occur periodically or be constant (several months or even years), or it can also suddenly disappear as it appeared. Similar symptoms observed with vulvar vestibulitis, when slight pressure in the vestibule of the vagina can cause sharp pain. It is the appearance of such acute pain encourages a woman to turn to specialists. Based on statistical data, we can conclude that at least one episode of pain in the groin area lasting for at least three months (and this already indicates vulvodynia) occurred in one out of six women during their lifetime. Externally, this disease does not manifest itself in any way, but in rare cases the vulva area is swollen or slightly inflamed.

Causes of vulvodynia.
There are many reasons that could trigger the development of vulvodynia. They can be divided into small groups:

  • previous infectious and inflammatory diseases of the external genitalia (vulvovaginitis, vulvitis, vaginosis);
  • nerve damage in the vulva area;
  • presence of allergic reactions to hygiene products and synthetic underwear;
  • diseases of the vulva of a dystrophic nature (dermatoses);
  • chronic somatic diseases (kidney damage, diabetes mellitus etc);
  • muscle spasms of the vulva and vagina;
    • changes in estrogen levels during menopause.
In addition, some patients suffering from this disease have previously been prescribed treatment for vaginitis or fungal infections of the vagina. Vulvodynia is not a sexually transmitted disease, nor is it a symptom of cancer. If groin pain occurs, you should consult a gynecologist.

Treatment of vulvodynia.
Treatment for vulvodynia should only begin after a thorough examination. There is no single method of treating such a disease; it is individual for each patient and its effectiveness depends on the immediate cause that caused it. Before prescribing treatment, the doctor must exclude possible reasons pain, for example, the presence of bacterial or fungal infections, diabetes, various lesions skin. After a thorough analysis of the symptoms, the doctor will prescribe treatment and recommend ways to reduce pain. I will say right away that the effect of the prescribed treatment may not appear immediately; months may pass when the symptoms of the disease decrease.

Treatment of infectious processes is carried out by prescribing antibiotics, antiviral, antifungal and other agents. Corticosteroids are usually used to treat dystrophic diseases of the vulva. The treatment of vulvodynia caused by mental disorders requires a specialized approach, as well as the treatment somatic diseases. For the treatment of atrophic vulvovaginitis, systemic and local replacement drugs are used. hormone therapy(creams with estrogen to reduce pain, vaginal tablets with estrogen to eliminate dryness or atrophy, etc.).

To reduce chronic pain, tricyclic antidepressants (amitriptyline, desipramine (Petylyl) and nortriptyline (Aventil, Allegron)) can be prescribed. anticonvulsants carbamazepine (Finlepsin) and gabapentin (Gabagamma), as well as antihistamines to reduce itching (hydroxyzone). Lidocaine ointment is prescribed as a local anesthetic, which temporarily relieves pain symptoms.

Autogenic training (achieving a relaxed state) is also good remedy reducing pain. It is expressed in self-control of the reactions of the pelvic muscles, which can spasm in anticipation of pain, and thereby cause chronic pain.

Physiotherapeutic procedures can be used to treat vulvodynia, such as: massage, stimulation of nerve endings, exercises to strengthen the pelvic muscles, therapeutic ultrasound, as well as effects on trigger points steroid hormones in combination with an anesthetic, helping to relieve painful muscle tension.

How to help yourself?
To reduce pain and severe itching at home, you can apply cold compresses to the groin area.

When choosing underwear, give preference to natural fabrics (cotton); avoid nylon underwear, since this kind of fabric does not allow air to pass into the groin area, which causes an increase in temperature and humidity, leading to irritation. During the night's sleep underwear It is recommended to remove it.

For vulvodynia, hot baths are contraindicated, as they can cause severe itching and burning.

Personal hygiene should not be neglected. Strong rubbing of the affected area further irritates it. You should wash yourself clean water, and wipe with soft wipes, after which be sure to apply pure cosmetic Vaseline to create some kind of protective barrier, and it will also retain skin moisture.

Women suffering from vulvodynia are advised to use special lubricants before sexual intercourse. In some cases, lidocaine ointment is prescribed to reduce discomfort during sexual intercourse.

Avoid irritating factors that trigger vulvar pain. These factors, as a rule, are different for all women. These include the use of soap, contraceptives, scented toilet paper, etc.

Lead an active lifestyle. Daily exercise has been proven to relieve chronic pain. Only from physical exercise, causing pressure on the vulva area (cycling), it is recommended to avoid.

Vulvodynia is a disease of a woman’s external genitalia, in which she experiences constant pain, itching and burning. Often these symptoms intensify during sexual intercourse. This condition causes a woman a lot of discomfort and interferes with her normal lifestyle. Vulvodynia is not independent disease, but rather a complex of symptoms that can occur with the development of several pathologies. In most cases, painful sensitivity of the vulva can be caused by infectious inflammation of the external genitalia.

For vulvodynia, treatment depends on the cause of the pathology, so it is important to undergo a high-quality diagnosis. Best used for therapy folk remedies. This treatment has a complex effect on the woman’s body: it counteracts the development pathogenic microorganism, promotes tissue regeneration and strengthens the girl’s immune system.

  • Symptoms of the disease

    Pain with vulvodynia can be constant or recurrent. This condition can last for several months or even several years. In some cases, spontaneous disappearance of the disease is noted.

    Vulvodynia is manifested by pain experienced by a woman in response to pressure on the external genitalia: the labia majora and minora, the vestibule of the vagina. The intensity of pain may vary. In addition to pain, a woman may experience itching, burning, and discomfort.

    In most cases no external changes vulva. In some cases, inflammation of the vulva develops: slight swelling and hyperemia of the mucous membrane occurs.

    Causes of pathology

    Vulvodynia is a fairly common pathology. To one degree or another, it affects every sixth woman at least once during her lifetime. The reasons for the development of this condition can be very diverse. Highlight the following groups factors:

    • infectious diseases of the external genitalia;
    • damage or inflammation nerve fibers vulva;
    • allergic reactions to personal hygiene products, synthetic fabric linen;
    • dystrophic diseases vulva, in particular, dermatoses;
    • spastic contractions of the vaginal muscles;
    • systemic diseases body: diabetes mellitus, and others.
    • hormonal imbalance, in particular, insufficient amounts of synthesized estrogens during menopause and menopause.

    If vulvodynia is not caused infectious diseases, then this disease is not sexually transmitted, and it is also impossible to get it from a partner. Also, vulvodynia is not a sign cancer.

    Diagnosis of the disease

    For accurate diagnosis A thorough history is important. It is necessary to find out how long the patient feels pain, if the connection of pain with the woman’s daily activity, her sex life, menstrual cycle. They also carry out a series diagnostic procedures:

    • gynecological examination women;
    • bacteriological and cytological examination of a vaginal smear;
    • ultrasound examination pelvic organs;
    • PCR reaction for determining the herpes virus and human papillomavirus;
    • determination of a woman’s hormonal balance;
    • neurological examination, determination of general psychological state.

    Treatment of pathology

    For vulvodynia, treatment depends on the cause of the disease. This pathological condition is a symptom that there are some disturbances in a woman’s body. It is very important to identify these disorders and target therapy to eliminate them. Treatment is carried out by means traditional medicine. This treatment is safer, it provides comprehensive positive action on the body and does not cause side effects.

    If the cause of vulvodynia is an infectious process, then treatment for this disease is carried out. To do this, use external antimicrobial agents that suppress the development of bacteria, reduce inflammation and promote tissue regeneration. In addition, it is useful to take general strengthening herbal infusions and folk medicines. This therapy will strengthen the immune system and improve general condition woman's health.

    If vulvodynia develops against the background of an allergic reaction, then it is important to determine what the allergy is developing to and exclude contact with the allergen. Hypersensitivity can develop to synthetic underwear or, more commonly, to personal care products. For women prone to allergies, it is recommended to exclude soaps and shower gels that are scented. toilet paper. It is best to wash yourself with herbal infusions. This practice will help reduce inflammation and restore the mucosa. Allergies often develop against the background of defects in the immune system, so girls prone to this condition are also recommended to take restorative and immunomodulating drugs.

    If the disease is caused by a hormonal imbalance in the body, herbal decoctions can be used for treatment, which normalize the cycle and stimulate the production of female sex hormones.

    In some cases, the disease is psychosomatic in nature, that is, vulvodynia develops against the background emotional disturbances, stress, depression. In the treatment of such conditions, it is useful to take soothing herbs and herbs. In addition, it is very important to identify factors that provoke psychological or mental disorders, and eliminate their effect.

    Sports activities, in particular yoga, frequent walks on the fresh air, communication with pleasant people and positive emotions, various auto-trainings. A relaxing massage is useful in treating illness. These procedures will strengthen the body and improve health. They will be useful in the treatment of any type of vulvodynia.

    External folk remedies for vulvodynia:

    1. Bath with chamomile. Sitz baths are very effective for vulvodynia. Decoctions are used for the procedure medicinal herbs that have antimicrobial and anti-inflammatory effects: chamomile, calendula, sage, plantain, oak bark and others. To prepare a bath, steam 4 tbsp in 2 liters of boiling water. l. dried herbs, leave for half an hour, then filter and use for baths. The procedure lasts 10–15 minutes.
    2. St. John's wort. An infusion of St. John's wort herbs and flowers is used to wash the external genitalia. To prepare the infusion, steam 2 tbsp in half a liter of boiling water. l. St. John's wort herbs, leave for an hour, then filter. The washing procedure is carried out twice a day.
    3. Wintergreen. An infusion is prepared from the stems of this plant. In 1 glass of boiling water, infuse 1 tbsp. l. dried wintergreen herb, leave for an hour and a half, then filter. The drug is used as a lotion for the external genitalia.
    4. Lungwort. Freshly squeezed juice of this plant is used in therapy. The juice is squeezed from the entire above-ground part of the plant during its flowering period. The juice is diluted with water twice and used for lotions on the external genitalia.
    5. Herbal collection No. 1. Mix 1 part at a time oak bark and chamomile color, 3 parts nettle leaves and 4 parts knotweed grass. Steam 5 tbsp in 1 liter of boiling water. l. such collection, leave for several hours and filter. Used for vaginal douching. Douching is carried out once a day before bedtime. Treatment lasts no more than 10 days, then take a break of two weeks.
    6. Herbal collection No. 2. I mix the colors of calendula, chamomile and tansy, the grass of cinquefoil, cucumber and celandine and plantain leaves. Steam 1 tbsp in 400 ml of boiling water. l. such collection, leave in a thermos for 3 hours, then filter. The infusion is used for vaginal douching. The procedure is carried out once a day for 10 days.

    Drugs for oral administration:

    Prevention

    Preventive measures serve to prevent diseases of the female reproductive system that can cause vulvodynia. Prevention measures:

    1. Wear cotton underwear. Natural fabrics do not cause allergies and also ensure normal air exchange. If you constantly wear underwear made of synthetic fabrics, then the breathing of the skin is difficult, the temperature and humidity in the groin area increases, which can cause the development of infection or inflammatory process.
    2. It is important to observe the rules of personal hygiene. It is recommended to wash your genitals twice a day. Best used for washing clean water or decoctions medicinal plants: chamomile, calendula, sage and others. The external genitalia should be wiped with soft wipes.
    3. Women prone to vulvodynia are better off avoiding hot baths, as they can cause an exacerbation of the disease.
    4. For vulvodynia, it is better to use lubricants before sexual intercourse.
    5. It is recommended to practice only protected sex.

    An active lifestyle and regular exercise strengthen the body. They also promote blood flow to the pelvic organs, including the genitals. Painful sensations are reduced. However, women prone to this disease should avoid exercises that place pressure on the perineum, such as cycling and some gymnastic exercises.

    • Vulvodynia is persistent painful sensations observed in the area of ​​the female genital organs. Similar pathology differs in that it has not yet been possible to establish any relationship between vulvodynia and other diseases or malfunctions of the body.

    Risk group

    Typically, this diagnosis is made to women whose age ranges from 20 to 60 years. Treatment of vulvodynia can take many years, but it is extremely rare to achieve a therapeutic effect.

    During the diagnosis process, it is impossible to determine the presence of tumors, autoimmune processes, allergic reactions or injuries, which complicates the development of tactics for subsequent medical or surgical intervention.

    There is an opinion among doctors that vulvodynia is the result of irritation peripheral nerves or the body's response to certain substances chemical origin. All these processes cause irritation and negative reaction tissues, as well as hormonal imbalances.

    Classification of the disease

    In modern medical practice fall under the definition of “vulvodonia” immediately following states female body:

    • Vulvovaginitis is a cyclic type, which means high susceptibility female body to the Candida fungus. The latter refers to the conditionally pathological microscopic flora of the mucous membranes and skin. In normal quantities, the fungus does not cause significant discomfort or pain, but if the body demonstrates extreme sensitivity to its presence, then the appearance of vulvodonia is quite possible;
    • Vulvar vestibulitis, the symptoms of which manifest themselves in the form of pain at the very beginning of sexual intercourse, when a man penetrates a woman’s vagina. Similar sensations arise during the insertion of a tampon. The cause of this condition cannot be diagnosed. Sometimes it is associated with papillomavirus, discovered as a result of laboratory examination of the patient’s biomaterials;
    • Dyesthetic vulvodynia is typical for women who have entered the postmenopausal period of their lives.

    Along with this, there is a provoked and unprovoked form of the disease. The first is characterized by the fact that the sensation of pain becomes the result of external circumstances, such as pressure exerted on the vulva, injury, the onset of sexual activity, or carelessness during sexual play.

    The second option arises regardless specific factors, and does not have any indirect companions, except for acute pain.

    Signs of illness

    The main symptoms of persistent vulvodynia are expressed in the form of pain at the very entrance to the vagina. They usually appear at the moments when a woman begins to have sex, sits down suddenly, or inserts a tampon. Moreover, pain can have the most different character, be itchy, throbbing, rapid or growing during intercourse.

    Pain can become a constant companion of a woman, or it can arise at the most unexpected moments, be located exclusively in the vulva area, or radiate to the urethra, anus, inner surface hips Patients begin to complain of redness and swelling of the vagina, dryness of its mucous membranes and painful swelling of the external genital organs.

    Each variation of vulvodonia is accompanied by its own manifestations:


    • With cyclic type vulvovaginitis, pain usually comes with the onset of menstruation or before it, and sometimes it occurs only the next day after sexual intercourse. This disease has a cyclical nature, during which a woman has to experience deterioration and improvement of her well-being;
    • Vulvar vestibulitis announces its presence by local or large-scale redness of the anterior parts of the vagina and mucous membranes of the vulva, pain when inserting and using a tampon, at the beginning of sex and during such;
    • Burning, dryness and discomfort in the vagina, as well as unexpressed pain in the area where the external genitalia are located are signs of dysesthetic vulvodynia.

    What can trigger the disease

    To date, there are no specific causes of this disease. All assumptions boil down to the fact that the receptive nerve located on the external genitalia is irritated.

    Along with this opinion, the following possible causes of vulvodynia are common among doctors:

    • Diseases inflammatory in nature, which previously affected the vaginal mucosa or its vestibule. These include colpitis, fungal infections and vaginitis;
    • Dystrophic condition of the vulva;
    • Allergic reactions to substances of chemical origin that are used in the production of products intimate hygiene or underwear;
    • Pain that is of a purely mental nature and is not accompanied by any visible disturbances in the functioning of the body;
    • Atrophy of the vagina and vulva caused by menopause or menstrual irregularities;
    • Heredity.

    Is there a chance for a cure?

    Diagnosis and treatment of this condition are carried out only after excluding the presence of other pathologies of a urological, gynecological, infectious, endocrine, neurological or dermatological nature. In this regard, the woman will have to go through many visits to the gynecologist’s office, and be examined by a neurologist, psychiatrist and other specialists.

    In the process of production accurate diagnosis, you have to go through repeated instrumental and laboratory tests in the form:

    • Visual examination of the vaginal opening and walls, which is done using a specific instrument. During such an examination, a biopsy and smear are removed;
    • Ultrasound of the uterus;
    • General laboratory blood testing;
    • Analysis for bacteria and microbes, which is done by scraping biomaterial from the vaginal walls and urethra;
    • Establishing or refuting sexually transmitted infections;
    • Hormonal testing;
    • MRI, which reveals pinched nerves.

    Depending on what exactly provoked the disease and what its symptoms are, it will depend further treatment. Vulvodynia does not respond to one specific treatment strategy, and the list of medications must be selected on an individual basis. Often, it is possible to improve health only through a course of psychotherapy.

    Painful sensations in the area of ​​the vulva - a complex of female genital organs located outward from the entrance to the vagina. The pain is sharp, dull or itchy and long course, which leads to problems in intimate life women. Determining the cause of vulvodynia is not easy because routine gynecological examination(examination on a chair, palpation, smear tests for flora and oncocytology, ultrasound) often do not reveal pathology. Depending on the reason pain syndrome, vulvodynia is treated with painkillers, antihistamines, antimicrobials, anti-inflammatory drugs and antidepressants. In some cases it is required surgical treatment.

    General information

    Vulvodynia – discomfort or pain in the projection of the vulva, existing long time associated with an infectious process or other disease. The term “vulvodynia” is commonly understood as any discomfort in the vulva area, including those caused by fungal or herpetic infections, allergic reaction or physical force. Sometimes the cause of vulvodynia cannot be identified - in this case it is regarded as idiopathic and is presented as an exclusion diagnosis.

    Women suffer from this disorder childbearing age (middle age 25-35 years old). According to statistics, from 3 to 10% of women at least once in their lives have experienced pain in the vagina or vulva - symptoms of vulvodynia. Sometimes women are embarrassed to see a doctor because of the sensitivity of the problem. Constant pain in the genital area not only forces you to refuse sexual intercourse, but can also cause depression, rejection of your own femininity and sexuality.

    There are spontaneous and provoked vulvodynia. In the spontaneous form, discomfort and pain are present in complete rest - during rest, sleep. Most often, the cause of spontaneous vulvodynia is pathology of the pudendal nerve (neuropathy, neuritis). Provoked vulvodynia is associated with the appearance or intensification of discomfort during sexual intercourse, insertion of a tampon into the vagina, while playing sports, horse riding, walking, or simply sitting.

    From the point of view of etiology, there are following forms vulvodynia: infectious, dystrophic or atrophic, psychogenic, allergic and vulvodynia due to chronic somatic diseases (metabolic disorders, kidney disease).

    Causes of vulvodynia

    Vulvodynia is a symptom of many diseases of an infectious and non-infectious nature, occurring independently or as one of the manifestations of a systemic process. The cause of pain is always an increase in the number of impulses from sensitive nerve endings. Often the basis of vulvodynia is neuritis of the pudendal nerve or vestibulitis - inflammation of small glands located in the vestibule of the vagina. The cause of vestibulitis remains unclear to date. This could be vaginal candidiasis, genital herpes, papillomavirus infection.

    Sometimes the trigger for vulvodynia is childbirth, gynecological operations(including abortion), aggressive sexual intercourse (rape). In some cases, chronic pain in the genital area has psychogenic origin. This fact is confirmed by the fact that even after removal of the vestibular glands, the main source of inflammation, vulvodynia (so-called “phantom pain”) persists. In addition, there is some genetic predisposition to the development of vulvodynia.

    Symptoms of vulvodynia

    The main symptom of vulvodynia is pain. It is acute or constant, aching in nature, appears at rest or with physical activity. Most often the place of localization discomfort are the labia majora or minora, the clitoris and the entrance to the vagina. But sometimes a woman points out pain in the perineum, in the anus.

    A typical symptom of vulvodynia is the appearance/intensification of discomfort when touching the vulvar ring, where numerous glands are located. Sometimes even a light touch with a piece of cotton can cause significant suffering. Redness, a feeling of heat, itching and dryness of the vagina do not always accompany vulvodynia, but often obsessive itching can be the equivalent of pain. The pain is always chronic - its duration without treatment can reach six months or more.

    Diagnosis of vulvodynia

    The diagnostic search begins with a thorough questioning of the woman. The nature of the pain, its duration, and its connection with sexual intercourse or physical activity are established. The characteristics of the patient’s menstruation (regularity, pain) are clarified. The number of pregnancies, childbirths, gynecological, general somatic and allergic diseases is specified.

    After questioning, the gynecologist examines the woman on the chair using mirrors. A smear of the cervix and posterior vaginal fornix is ​​necessarily taken for infectious agents and for cytological examination. For vulvodynia, according to indications, PCR analysis for HPV and herpes virus, pelvic ultrasound, consultation with an endocrinologist and therapist are prescribed. If during the examination no organic pathology was found, the woman usually continues treatment with a neurologist or psychiatrist.

    Treatment of vulvodynia

    During the period of treatment, it is recommended to maintain sexual rest and avoid any actions that contribute to the formation of vaginal microtraumas (insertion of tampons, active sports). It has been found that a diet limiting foods rich in calcium oxalate (chocolate, strawberries, rhubarb, celery) helps reduce vulvodynia. An increase in the content of calcium oxalate in the urine is one of the causes of irritation of the mucous membrane of the vagina and vulva, and, therefore, the appearance of discomfort and pain - symptoms of vulvodynia. If the pain is not acute, it is recommended to special exercises(can be done using the Kegel technique), aimed at strengthening weak pelvic floor muscles and relaxing spasmodic muscles. Physiotherapy, balneotherapy, and sitz baths often have a good pain-relieving effect for vulvodynia.

    To treat vulvodynia, it is important to consider the cause of its development. Infectious inflammation can be controlled with antibiotics and antifungal drugs. Medicines are usually applied topically - in the form vaginal suppositories and tablets (ternidazole, nystatin, neomycin, osarsol, natamycin). If the process is advanced or it is impossible to introduce the drug into the vagina, the oral or intramuscular route of administration is used. For herpetic or human papillomavirus infection, they are prescribed antivirals(acyclovir, inosine pranobex, interferon preparations). For dystrophic and atrophic processes in the vaginal mucosa it is used vaginal creams and suppositories that stimulate epithelial regeneration. If vulvodynia is associated with a deficiency female hormones during menopause, resort to hormonal therapy.

    For itching and pain in the vagina caused by allergies, treatment is necessary antihistamines(chloropyramine, clemastine, cetirizine). It is also necessary to identify and exclude the allergen. To do this, a consultation with an allergist and skin tests are carried out. Severe renal failure or destabilization of blood sugar levels can cause vaginal itching and vulvodynia. In this case, consultation with a nephrologist or endocrinologist is required. If the pain is psychogenic, treatment of vulvodynia is carried out jointly with a psychiatrist. The specialist not only prescribes antidepressant drugs (amitriptyline, hydroxyzine, desipramine), but also conducts courses of psychotherapy.

    For any cause of vulvodynia, anti-inflammatory and painkillers (diclofenac, indomethacin, naproxen) are used, as well as multivitamin therapy, herbal sedatives, immunotropic drugs, activating the body's own defenses. If everyone is ineffective therapeutic measures and a clearly limited area of ​​pain with vulvodynia, surgical treatment is prescribed. The surgeon removes the inflamed vaginal glands or areas hypersensitivity skin and mucous membranes. In some cases this gives good result, especially with the concomitant use of anti-inflammatory drugs and antidepressants.

    Forecast and prevention of vulvodynia

    Vulvodynia – unpleasant symptom many diseases; it is not dangerous in itself, but it significantly impairs the quality of life and is difficult to treat. To prevent vulvodynia, a woman should be selective in sexual intercourse, use barrier methods of protection (condom), observe personal hygiene rules, and undergo regular examinations by a gynecologist (at least once every six months). It is recommended to wear underwear made from natural hygroscopic fabrics (cotton, viscose, silk), use hypoallergenic personal hygiene products, be examined by a doctor for chronic diseases, monitor blood sugar levels, and avoid hypothermia and stress.