Discourse About Intercourse: Vulvodynia 

Chronic, unexplained genital pain can be debilitating.

Defined by its mystery, vulvodynia is diagnosed when a clear cause of vulvar tissue hypersensitivity cannot be found. Clinicians agree that the burning pain must last for at least 3 months before putting a label on it.

The discomfort can originate from any number of vaginal tissue sites. Typically, patients experience raw, tingling sensations around the vestibular and clitoral areas that can be spontaneous, provoked, or a mix of the two.

Proper diagnosis and therapy can be challenging for medical professionals. Like many chronic pain states, vulvodynia’s impact can vary widely from person to person. A trial-and-error approach to the condition can leave women frustrated with their medical care.

What are the options?

Studies highlight the importance of knowing yourself and your own body. Recommended by the authors of “Vulvodynia: Real Condition, Real Pain,” using at home methods initially may help you take charge of your symptoms.

Lifestyle options:

• Educate your body and mind: The evidence behind cognitive behavioral therapy is strong. The goals are to help you decrease pain and strengthen their sexual function and intimate relationships. Take time to understand your personal experience with this sexual problem. Ask yourself: 

• What improves my symptoms? What makes my symptoms worse? 

• Are there certain thoughts or feelings impacting my pain? 

• Get on the floor (the pelvic floor): Addressing the physical aspect of vulvar pain with muscle strengthening and training exercises may help patients combat uncomfortable sensations. 

• Lay the groundwork for intimacy: Recognize vulvodynia doesn’t dictate every aspect of your intimate experience. Staying open to all forms of stimulation may allow you and your partner breathing room to overcome sexual challenges. 

Pharmaceutical options: 

• There is no easy fix, but oral medications targeting neuropathic pain offer meaningful support throughout the body. Anticonvulsant drugs, gabapentin or pregabalin, and antidepressants like amitriptyline and venlafaxine, have been investigated in vulvodynia with relative success. While these medications may help address symptoms, it’s always important to talk to your prescriber about potential side effects. 

• Topical and vaginal compounded creams offer localized relief. Coordinating application timing and frequency can feel like an obstacle at first but creating a routine will help. Limiting systemic side effects with local therapy at the pain source is a real benefit.  

How do I talk to my doctor about my vulvodynia?

Let’s pause for a moment: any hesitation you may be feeling is valid. Of the small percentage of women that speak up, only a handful are accurately diagnosed with chronic vulvar pain. Even then, relief is not immediate. The situation is complex and warrants a complete evaluation. Be patient with yourself. When you are ready, share what you know about your body and pain, using the “ask yourself” questions above as a guide.

How do I talk to my sexual partner about my intimacy concerns?

Vulvodynia’s impact on relationships has been studied. Research suggests the fear of losing or letting down partners can take a toll on emotional health. When the stakes feel that high, it’s no wonder these issues are hard to talk about.

If you are in a loving partnership, speak honestly. Take comfort in the trust you and your partner are building together. They need to hear that intimate moments can be challenging for you. You both will benefit from an open conversation.

References 

1. Gloria Bachmann, Janice McElhiney, Shillena Peters, Raymond Rosen. Vulvodynia: Real condition, real pain. Sexuality, Reproduction and Menopause. Volume 4, Issue 2, 2006, Pages 71-73, ISSN 1546-2501, https://doi.org/10.1016/j.sram.2006.08.013. (https://www.sciencedirect.com/science/article/pii/S1546250106000326) 

2. Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-Spadt S. Vulvodynia: Assessment and Treatment. J Sex Med. 2016 Apr;13(4):572-90. doi: 10.1016/j.jsxm.2016.01.020. Epub 2016 Mar 25. PMID: 27045258. 

3. Loflin BJ, Westmoreland K, Williams NT. Vulvodynia: A Review of the Literature. J Pharm Technol. 2019 Feb;35(1):11-24. doi: 10.1177/8755122518793256. Epub 2018 Aug 20. PMID: 34861006; PMCID: PMC6313270. 

4. Pukall CF, Goldstein AT, Bergeron S, Foster D, Stein A, Kellogg-Spadt S, Bachmann G. Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors. J Sex Med. 2016 Mar;13(3):291-304. doi: 10.1016/j.jsxm.2015.12.021. PMID: 26944461. 

5. Rosen NO, Bergeron S, Sadikaj G, Glowacka M, Baxter ML, Delisle I. Relationship satisfaction moderates the associations between male partner responses and depression in women with vulvodynia: a dyadic daily experience study. Pain. 2014 Jul;155(7):1374-1383. doi: 10.1016/j.pain.2014.04.017. Epub 2014 Apr 23. Erratum in: Pain. 2014 Nov;155(11):2438. PMID: 24769137. 

6. Torres-Cueco R, Nohales-Alfonso F. Vulvodynia-It Is Time to Accept a New Understanding from a Neurobiological Perspective. Int J Environ Res Public Health. 2021 Jun 21;18(12):6639. doi: 10.3390/ijerph18126639. PMID: 34205495; PMCID: PMC8296499.