Vulvodynia refers to vulvar discomfort, most often described as burning pain, which occurs without visible clinical findings, such as an infection or a disease. Vulvodynia affects an estimated 16% of women in the general population. There are two major types of vulvodynia. The first more common type is provoked vestibulodynia (PVD), formally known as vulvar vestibulitis syndrome, in which pain is restricted to the vestibule (VVS). The second is generalized vulvodynia (GVD), in which the pain is more diffuse, involving the whole vulva.
PVD is a syndrome in which there is increased sensitivity to touch, to the point of pain and burning at the vaginal entry with sexual intercourse. In addition to causing pain with sex, PVD can interfere with tampon insertion and gynecological examinations.PVD is the most common cause of painful intercourse in women of child-bearing age affecting 12% of pre-menopausal women in the general population. Approximately 50% of women who suffer from PVD have what is called primary PVD, indicating that the pain has been present since their first intercourse attempt. The other half has secondary or acquired PVD, which develops after a period of pain-free intercourse, and in many cases, after an aggravating factor such as repeated vaginal infections or a sexually transmitted disease. Little is known about the causes of PVD, however, most health professionals agree that it is caused by a combination of factors.
Generalized vulvodynia (GVD) is a common form of vulvar pain, affecting 6-7% of women in the general population, with a higher prevalence in women over the age of 30. In GVD, the pain is present on a constant or almost constant basis and affects the entire vulvar region. Like PVD, the pain of GVD is described predominantly as burning. GVD not only affects sexual functioning in most women, it also affects daily activities (e.g., sitting for long periods of time at work, bicycle riding) due to the constant nature of the pain.
The treatment for PVD as well as generalized vulvodynia is multi-disciplinary and generally involves a physican, a sex therapist and a physiotherapist. A physician with expertise in sexual pain disorders first makes the diagnosis and provides the appropriate medical treatment.
A woman who experiences vulvar pain and repeated episodes of painful intercourse may develop a habit of contracting her pelvic floor muscles in anticipation of pain. Her ability to concentrate on the pleasurable sensations of sex may be affected, and often her sex drive will decline.This will perpetuate her pain, as decreased sexual excitement may lead to less vaginal lubrication and tight, contracted muscles, all of which may increase unpleasant friction in the vagina during sex. Emotional anxiety, which often results from painful sex and the resultant effects of this on the sexual relationship, will likely increase a woman’s perception of pain as well. Obviously, sexual pain creates a vicious cycle which needs to be addressed from multiple perspectives in order to be resolved.
Having vulvodynia is distressing both personally and in relationships. Sex therapy, either individually or as a couple which combines psychotherapy with cognitive behavioral techniques for pain management is an important intervention. Physiotherapy of the pelvic floor is part of the treatment of PVD as well. Physiotherapy focuses on decreasing pain through desensitization techniques, manual therapy, biofeedback, and use of vaginal dilators.