Vulvodynia

Vulvodynia is defined as discomfort in the vulvar area for at least 3 months; it is therefore considered a form of chronic pelvic pain. According to studies, it can affect up to 16% of women.

Its origin is still unknown, although it is considered to be multi-factorial: embryonic origin, chronic inflammatory process, genetic immune factors, environmental factors (infections, use of irritating substances, trauma),
use of irritants, trauma), hormonal changes and human papillomavirus infections.

It manifests with pain in the vulvar area that can be in the form of burning, swelling, throbbing, itching, stinging and pain during sexual intercourse (dyspareunia). 

Diagnosis is made by clinical history, gynecological examination and by exclusion of other causes. A thorough evaluation of the history of pain, sexual history, clinical situation and physical examination are basic elements to make a good diagnosis. It is important to identify and treat specific disorders that may be causing the pain before labeling it as vulvodynia. 

The main goal of treatment is to reduce pain, improve quality of life and regain sexual function if it is impaired.
There are a number of general measures that can be taken into account in all cases:

• Do not use non-cotton pads.
• Use cotton underwear and wash very well to avoid traces of detergents or softeners.
• Use lubricants for sexual intercourse.
• Do not use genital douches or soaps in the genital area, only water and dry using a soft cloth.
• Use mild soaps for general bathing.
• Avoid wearing pantyhose or tight pants in the genital area.

Proper treatment requires a multidisciplinary approach, including preventive measures, psychological treatment, pelvic floor physiotherapy and medical therapy (local anesthetics, anti-inflammatories or antidepressants). In selected cases, surgery of the perineal area, a vulvar vestibulectomy, may be considered.