Vulvodynia – Bladder Pain Syndrome/Interstitial Cystitis

What is Vulvodynia?

Vulvodynia is a form of persistent vulvar pain of at least 3 months’ duration, without clear identifiable cause. Women with vulvodynia often speak of vulval burning, soreness, stinging, itching and stabbing pain in the genital area. Simple activities such as wearing jeans, inserting tampons, having a pap smear, or attempting intercourse can be painful and distressing. Most times there are no identifiable medical causes to explain the severity of pain or of some of the associated symptoms. This condition can affect women of all ages, be they single, partnered, with or without children.

Diagnosis is made on the basis of reported symptoms, a q-tip examination of the vulva and exclusion of possible medical causes that could account for the pain. If medical causes are identified they are treated with standard medical protocols. In vulvodynia there is generally no pathology to explain the pain.

Patients Description of Pain

© Marek Jantos

For some women the pain can be widespread, affecting the whole perineal, labial and pubic area, or it can be very localised and confined to either the vestibule (vestibulodynia), clitoral area (clitorodynia), or affecting one side of the vulva (hemivulvodynia).

Location of Pain

© Marek Jantos

The pain can be constant or intermittent, or experienced only when provoked by pressure application to the vulva as during tampon insertion, medical examination, sexual activity, sitting for long periods of time or wearing tight clothing. The severity and presentation of pain can vary over time and can be significantly different for each individual. In most instances vulvar pain is difficult to localise and there is considerable evidence showing that some of the pain can be referred from other pelvic locations, hence much of the research work that we have undertaken to identify the origins of pain.

As a regional pain syndrome it is more common than most people realize. Based on current evidence the estimated lifetime prevalence of these conditions has been reported to be between 8 – 15 per cent. Vulvodynia affects women of all ages but studies show that prevalence peaks at around age 24, and to a lesser degree, later in life around menopause. Our own research profiling women with vulvodynia shows that onset can occur early in life, even in childhood, but becomes most prevalent in early adulthood.

Age Specifics Age of Symptoms Onset

© Marek Jantos

Women who have been affected by this disorder are often reluctant to speak about the problem or discuss it with their health practitioner. It would appear that only about half of those suffering vulvodynia will seek help. Privacy and potential personal embarrassment prevent a more open discussion of these problems. Some women assume that experiencing pain with intercourse is normal and feel obliged to put up with it. For various reasons, women suffer in silence and seek help only if circumstances force them to do so. Due to the established link between increased pelvic muscle tone and chronic vulvar pain, myofascial therapy with biofeedback assisted pelvic muscle retraining, relaxation techniques and sexual counseling are common strategies in the management chronic vulvar pain.