Vulvodynia (or vestibulodynia) is pain felt in the vulva, without lesions. Definition, list of symptoms, causes (menopause, stress, childbirth) and treatment: insight from Dr Véronique Julien, gynecologist, vulva specialist.
Definition: what is vulvodynia?
Vulvodynia is persistent pain, located in the vulva, with no identifiable cause. “When we talk about vulvodynia, we are more generally talking about vestibulodyniapain in the vulva vestibulewhich is expressed in contact, for sex but also when setting upa sanitary pad ora menstrual cup for example, and which will become part of everyday life”, says Dr Véronique Julien. There is two types of vulvodynia :
► Primary vulvodynia : the pain is present from the first intercourse and it will settle down.
► Secondary vulvodynia is characterized by the onset of pain after a triggering episode, when before everything was fine.
What are the symptoms of vulvodynia?
Vulvodynia is mainly characterized by pain in the vulva and its vestibule. Of the burns and warming sensations can also be felt by the patient. A simple contact with the vulvaits orifice or areas of the vestibule causes this pain.
What causes vulvodynia?
Vulvodynia results fromdysfunction of the pain modulation system. Normally, pain is a warning signal that there is tissue damage. But, in this context, there are no lesions but only pain on contact with the vulva. Among the causes:
► Recurrent fungal infections are the most common cause of vulvodynia or vestibulodynia. “It is observed in patients who have had repeated fungal infections, who even after their treatment still have painful sexual intercourse.“, notes Dr. Julien.
► Menopause is also a period conducive to the development of vulvodynia due to hormonal imbalance (lack of estrogen).
► The aftermath of childbirth
► The aftermath of surgery
► A stressful or bad gynecological examination.
To note that “primary vestibulodynia is more complex to manage because the patient has always had pain and this established pain is often linked to childhood stress Or a disturbing view of sexuality“she adds.
Which doctor to consult in case of vulvodynia?
It is recommended to consult a gynecologist or dermatologist specializing in the vulva Or a midwife sensitized to vulvar pathologies to avoid diagnostic wandering. Directories of health professionals specializing in the management of this pathology are available on various websites: the MAG (the anogenital diseases group), the Clés de Vénus or Périnée Bien-Aimé.
The diagnosis of vulvodynia is made whena clinical examination. There are no additional examinations (biopsy, vaginal samples, etc.). Questioning the patient will therefore be fundamental for the management. “One can during the clinical examination make a cotton swab test and observe the sensitive areas of the vestibule. The patient is generally surprised to observe that the areas tested by the specialist are those which are painful to her. She is very often happy to feel understood“, explains Dr. Julien.
What treatment to treat vulvodynia?
Treatment will depend on the cause of vulvodynia.
► If you observe recurrent fungal infections, antifungal treatment orally will be prescribed. “We will adapt the treatment against fungal infections over the long term: once a week for 6 months, then once a month for 6 months, so that the fungal infections and successive inflammations of the vulva disappear and thus regain comfort..
► If the patient is postmenopausal and that she does not want to take hormone treatment, local estrogen therapy may be offered (an estrogenic cream) to reduce atrophy, nourish the mucosa and restore balance.
► Multidisciplinary care. “After years of taking care of and sharing experiences around vulvar pathologies, I have developed a treatment protocol in collaboration with other teams: I thus offer a masterful preparation for based on anesthetics and fatty substances to create a desensitization of the area (2 to 3 local applications per day), accompanied by a work of relaxation and massages which involves sophrology and sexology with a midwife or a specialized physiotherapist”, emphasizes Dr. Julien. This multidisciplinary care will allow the recovery of the patient in 90% of cases.
► Laroxyl®. The longer treatment for vulvodynia is delayed, the longer recovery will take. In order to disconnect the brain from this pain which has become chronic, a short treatment based on Laroxyl® can also be prescribed in small doses. “The principle is to put in place as many solutions as possible at the same time so that the patient progresses quickly and heals quickly. By explaining her pathology and encouraging her to participate in the management of care, the patient is thus integrated into a real dynamic of healing.“.
What are the natural treatments for vulvodynia?
THE natural oilscoconut, jojoba or aloe vera for example, can provide a solution, both in terms of hydration and lubrication of the mucous membranes. hypnosis can also have a complementary interest when there is a psychological blockage and the treatment does not change the vestibulodynia, primary in particular. One can also consider consult a psychologist Or a sex therapist to better consider the impact of the pathology and, for example, the resumption of sexuality.
Thanks to Dr Véronique Julien, gynecologist specializing in the vulva, in Les Vans (Ardèche)