Vulvodynia is a chronic pain condition that affects the vulvar area and occurs without an identifiable cause.
Symptoms may include pain, hypersenstivity, hyposensitivity, difficulty with arousal, muted or absent orgasm.
Others include genetic predisposition to inflammation,[14] allergy or other sensitivity (for example: oxalates in the urine), an autoimmune disorder similar to lupus erythematosus or to eczema or to lichen sclerosus, infection (e.g., yeast infections, bacterial vaginosis, HPV, HSV), injury, and neuropathy—including an increased number of nerve endings in the vaginal area.
Initiation of hormonal contraceptives that contain low- dose estrogen before the age of 16 could predispose women to vulvar vestibulitis syndrome.
A significantly lower pain threshold, especially in the posterior vestibulum, has also been associated with the use of hormonal contraceptives in women without vulvar vestibulitis syndrome.
[16] Many co-morbidities are commonly associated with vulvodynia, including fibromyalgia, irritable bowel syndrome, interstitial cystitis, pelvic floor dysfunction, endometriosis, depression and anxiety disorders.
The vagina should be examined, and tests, including wet mount, vaginal pH, fungal culture, and Gram stain, should be performed as indicated.
[18] Surveys have estimated that only about half of the women who meet the criteria for vulvodynia will seek medical help.
Moreover, the absence of any visible symptoms means that before being successfully diagnosed many patients have been told that the pain is "in their head".
[20] The misattribution of women's vulvo-vaginal pain to a psychological origin rather than a medical one is traceable back to the influence of Freudian psychoanalysis.
[21] In recent years, diagnostic algorithms for the diagnosis of the various sub-types of and causes of vulvar pain have been developed and refined.
A number of lifestyle changes are often recommended such as using cotton underwear, not using substances that may irritate the area, and using lubricant during sex.
[2] Gynaecologist-led educational seminars delivered in a group format have a significant positive impact on psychological symptoms and sexual functioning in women who have provoked (caused by a stimulus such as touch or sexual activity) vestibulodynia (pain localized in the vulvar vestibule).
Given the difficulty of getting diagnosed and treated for vulvodynia,[5] patients have formed communities to help each other access healthcare and to advocate for better recognition of the disease.
Founded in 2019, Tight Lipped started as a story-telling podcast focused on ending the stigma and mystery surrounding vulvovaginal pain.
It has evolved into a grassroots, patient-led organization devoted to changing how chronic vulvovaginal pain conditions like vulvodynia are understood by the medical community and by society.