What is dyaesthetic vulvodynia?
Dyaesthetic vulvodynia has been the name used to describe one of the most common types of vulvodynia or vulval pain of unknown cause. It can occur in women of any age.
The International Society for the Study of Vulvovaginal Diseases (ISSVD) in 2004 has reclassified the condition and it should now be referred to as ‘generalised vulvodynia’ (unprovoked, provoked or mixed), to distinguish it from ‘localised provoked vulvodynia’ or vestibulodynia (previously known as vulvar vestibulitis).
Dysaesthetic or generalised vulvodynia describes widespread pain throughout the vulvar region where there is no physical explanation for it. Pain may be present in the labia, clitoris, vestibule, perineum, mon pubis, and inner thighs. Pain may be constant or unprovoked by touch or pressure to the vulva. However activities such as intercourse, bicycle riding, and horse riding may make symptoms worse.
Many patients with dysaesthetic vulvodynia have pudendal nerve entrapment syndrome and/or a more generalised neuropathic chronic pain syndrome. This is a condition in which pain pathways through the spinal cord to the brain behave abnormally, so that normal sensations in the skin or other organs are felt as pain. It is also called central sensitisation.
What are the symptoms of generalised vulvodynia?
Patients with generalised vulvodynia may describe intermittent or continuous symptoms, including:
- Widespread, generalised vulvar discomfort and pain, not altered by position or activity (vulvar burning only when sitting suggests pudendal nerve entrapment)
- Burning, raw feeling, irritation, throbbing, stinging sensation in the vulva
- Poking, as if needle stuck in the vulva, vagina and/or anus
- Pain may be initiated by light touch or pressure (this is called allodynia), but it often occurs spontaneously
- Pain and discomfort sometimes experienced in the urethra or rectum
- Sexual intercourse may be unpleasant, difficult or impossible due to discomfort
- Associated stress-related and chronic pain conditions such as headaches, face, tongue amd mouth pain, fibromyalgia, irritable bowel syndrome, bloating, fatigue, sleep problems and eating disorders.
What causes generalised vulvodynia?
By definition, the cause of generalised vulvodynia is unknown. Current theories consider generalised vulvodynia is a chronic pain syndrome related to hypersensitive nerves. One or more of the following may have a role to play in the development of this condition.
- Stretched, inflamed nerves in the vulvar area (pudendal nerve entrapment or pudendal neuralgia), spine or related structures
- Trigger points where there are proliferating or sensitised nerve endings in the skin itself
- Previous vulvar skin condition, surgery or childbirth resulting in scarring or other injury
- Hormonal changes causing vulvar dryness, especially during menopause
- Herpes simplex (similar to post herpetic neuralgia from herpes zoster/shingles infection)
- Emotional stress
Management of generalised vulvodynia
Women who suffer from generalised vulvodynia require a range of treatments to help overcome their cycle of endless pain. A combination of therapies should be used and may include:
- Regular sleep, daily exercise and resolution of stressful issues.
- Physical therapy and pelvic floor exercises to relieve muscle spasms and generalised vulvar pain. These may also help associated urethral and bowel problems.
- Small doses of a tricyclic antidepressant such as amitriptyline (5 to 30 mg), desipramine or nortriptyline. They are prescribed for at least several weeks to months and if successful may need to be continued long term. Side effects such as drowsiness, weight gain, and dry mouth occur in up to 50% of patients, especially when they first start on the medication.
- Anticonvulsants such as carbamazepine, gabapentin or pregabalin may control chronic pain. Referral to a pain specialist may be helpful.
- Support and education: both the patient and their partner and families need to understand and learn how to cope with the stresses that the condition can place on relationships.
- The V Book: A Doctor's Guide to Complete Vulvovaginal Health
- The Vulvodynia Survival Guide: How to Overcome Painful Vaginal Symptoms & Enjoy an Active Lifestyle
On DermNet NZ:
- Pudendal nerve entrapment syndrome
- Cyclic vulvovaginitis
- Pruritus vulvae
- Vulval/vaginal problems in prepubertal females
- Genital skin problems
- Menopause and the skin