Vulvodynia

There are two types of vulvodynia:

• actually vulvodynia (pain is constantly present);
• Vulvar vestibulitis syndrome or vestibulodynia (pain occurs in response to pressure on the affected area).

Vulvodynia

• genital neuropathy;
• allergies or other sensitivities (e.g., to oxalates in urine);

Vulvar vestibulitis

Increased awareness of vulvar vestibulitis has led to exciting new research, and it has become apparent that vulvar vestibulitis is not just one disease, but only a symptom of several different diseases or conditions.

Doctors at the centers of vulvovaginal disorders have identified at least twelve different causes (diseases or conditions) that cause vulvar pain, redness, and pain during intercourse, i.e. vestibulitis. While many of these diseases look similar, subtle differences along with the patient’s history can be used to highlight the cause of the pain and thereby lead to a logical way of treatment. This also explains why no treatment approach works for every woman with vestibulitis, and why the vast majority of studies until today are not very useful. Here is a list of the most common of these reasons. ^[2]

Atrophic vestibulitis, or hormone-related vulvodynia

Often caused by oral contraceptives, surgical removal of the ovaries, chemotherapy for breast cancer, hormonal treatment for endometriosis, hormonal treatment for acne, menopause. It has been proven that the vulvar vestibule needs an adequate level of estrogen and testosterone, and these levels are often altered with the listed medications and conditions. A distinctive feature of the “atrophic vestibulitis” is that symptoms occur gradually and that the entire vestibule is affected. There are low values ​​of estrogen and free testosterone and an increased level of globulin that binds sex hormones in a blood test. Just stopping the pill does not eliminate the symptoms, just like using hormonal creams without stopping the pill. ^[2]

Several studies have shown that the use of combined oral contraceptives significantly increases the risk of vestibulodynia. There are several factors that may explain this observation. According to the fact that COCs interfere with the production of luteinizing hormone , the production of testosterone by the ovaries is reduced. In addition, synthetic estrogen - and progestin - COCs, which are metabolized in the liver, lead to increased production of sex hormone binding globulin (SHBG) by the liver. The coincidence of two factors - the production of less testosterone by the ovaries and the increased level of sex hormone-binding globulin - leads to a decrease in the level of circulating free testosterone.

The vulva is an embryonic analogue of the male urethra. Mucin-secreting, androgen-dependent bulbourethral glands (Cooper glands) and urethral glands (Littre glands) in men are embryonic analogues of the small vestibular (vestibule - vestibule of the vagina) glands in women. These vestibular glands are rich in androgen receptors. In addition to changes in the level of free testosterone and sex hormone binding globulin, COCs provoke changes in hormonal receptors and change the morphological structure of the mucous membrane . COCs also reduce the pain threshold in the vulvar vestibule. ^[3] The use of oral contraceptives at an early age increases the risk of developing vulvodynia by a factor of 900. ^[four]

Pelvic Dysfunction

Also known as muscle syndrome, lifting the anus; pelvic floor hypertonicity, vaginismus.

In this condition, the muscles surrounding the vestibule are tightly compressed and painful. This can cause soreness and redness of the vestibule without the presence of an internal problem of the vestibular tissue. Often the lower side of the vestibule (near the perineum) suffers more than the upper part (near the urethra). Pelvic floor dysfunction can be detected by a thorough examination of the muscle that raises the anus. Treatment includes intravaginal physiotherapy, warm baths, muscle relaxants such as Valium suppositories, biological feedback, Botox injections designed to enhance physiotherapy.

Neuron Proliferation

A condition when the density, density of nerve endings in the vestibular mucosa is increased. This group is divided into primary (pain from the first attempt at sexual intercourse) and secondary (acquired after painless times). There is reliable evidence. that primary proliferation of neurons is a congenital problem (that is, a birth defect), while secondary proliferation of neurons can be caused by an allergic reaction or reaction to an irritant (often to vaginal antifungal creams).

Treatment for secondary proliferation of neurons includes tricyclic antidepressants, lidocaine, capsacin, and surgical removal of the affected skin (vulvar vestibuloectomy with advancement into the vagina). According to doctors centers of vaginal dysfunctions, primary proliferation of neurons can only be cured by vestibuloectomy. However, there are specialists who do not agree with this opinion. .

Colpit

Sometimes the inflammation in the vagina is so strong that the white blood cells leave the vagina, cover the vestibule and cause secondary vestibulitis. There are two categories of colpitis: infectious and sterile (non-infectious). Organisms such as yeast and Trichomonas, but not bacterial colpitis (Gardnerella), are the cause of infectious colpitis. Sterile colpitis can be caused by the use of chemicals such as vaginal creams, spermicides, lubricants, latex in condoms. In addition, sterile colpitis can be caused by a lack of estrogen (see “atrophic vestibulitis”) and a condition called desquamative inflammatory vaginitis (DIV). The cause of the DIV is unknown, but it is characterized by copious yellowish discharge. Despite the fact that infectious colpitis is rarely the cause of vestibulitis, almost all women with vulvar pain were unjustifiably course of antibiotics and antifungal agents has been prescribed.

Vulvar Dermatoses

Several different dermatological conditions of the vulva can cause vulvar vestibulitis. The most common disease affecting approximately 1.3% of women is lichen sclerosis. The second most common condition is lichen planus. More rare diseases are plasma cell vulvitis and pemphigoid mucosa).

Allergy or Other Sensitivity

Women expose their vulva to many different chemicals every day. Even the most gentle soap contains various chemicals in the form of fragrances, paints and preservatives. Toilet paper, sanitary pads, tampons - all contain chemicals. Washing detergents and fabric softeners that are used to wash underwear and towels add to this chemical burden. A woman may be sensitive or allergic to any of these chemicals; this can cause inflammation and pain in the vestibule. ^[2]

The main and only symptom of vulvodynia is pain in the external genital area and vestibule. Sensations are characterized by a feeling of soreness, burning, sharp and burning pain.

The pain can be constant (vulvodynia) or occur with touch, pressure and, accordingly, during intercourse ( dyspareunia ) and with the introduction of a tampon (vulvar vestibulitis syndrome or vestibulodynia). With vulvodynia, pain can be given to the perineum , anus , urethra , inner thighs .

• Hormone treatment. With vestibulodynia, a complete rejection of the use of hormonal contraceptives is recommended. It is possible to treat external use of a combined cream of estradiol and testosterone. ^[3]
• Drug treatment . In case of vulvodynia, antidepressants are used, drugs for the treatment of neuropathies, topically anesthetic gels or sprays, novocaine blockades.
• Diet. An alkaline diet is recommended, as the cause of vulvodynia may be a reaction to oxalates.
• Injection into the affected area. Injections of a mixture of steroids and bupivacaine at trigger points are used; submucosal injections of methylprednisolone and lidocaine; Injections of Interferon A. ^[5]
• Physiotherapy . With vulvodynia, special manual techniques are used, electromyostimulation.
• Reflexotherapy Acupuncture is effective in some cases.
• Surgical treatment . In cases where there is no effect from other means, they resort to the removal of that part of the genital organs in which excessive pain is observed. This operation is called vestibuloectomy.

• Vulva
• The nerve