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Q
Relieving Women's Genital Pain?
I have just been diagnosed with vulvodynia. What treatment do you recommend?
A
Answer (Published 9/16/2004)

Vulvodynia is a painful condition that affects the vulva, an area around the opening of the vagina. The pain can be so severe that women may be unable to have intercourse or even sit comfortably. It may feel like burning, itching, soreness, stinging, rawness or throbbing; it may come and go or remain constant. Sometimes, the pain disappears as suddenly and mysteriously as it began, or it can last for years.

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Vulvodynia is a nonspecific diagnosis that can have many causes, some serious, some minor. A thorough diagnostic work-up should be done to rule out treatable underlying diseases. New research from the University of Michigan suggests that affected women are abnormally sensitive to any type of pain. In a small study involving only 17 women with vulvodynia, the Michigan researchers found that all of the women were more sensitive to pain from pressure applied at unrelated body sites including the deltoid muscle, the shin and thumb. The findings were published in the July 2004 issue of Obstetrics and Gynecology.

In 2003, researchers at Boston's Brigham and Women's Hospital found that the prevalence of vulvodynia has been significantly underestimated. In a Boston-area survey, the researchers found that approximately 16 percent of the respondents reported a history of chronic vulvar pain lasting at least three months or longer and that nearly seven percent of the respondents were experiencing the pain at the time of the survey. Based on their results, the researchers estimated that approximately five percent of all women will experience vulvodynia before the age of 25 and that more than 14 million women may suffer from the problem during their lifetime. The survey results also suggested that women who experienced pain the first time they tried to use a tampon were seven to eight times more likely than other women to suffer from vulvodynia later in life.

If women with vulvodynia are more than normally sensitive to any type of pain as the Michigan study found, researchers there suggested that treatment with antidepressants known to reduce chronic pain (such as amitriptyline, aka "Elavil") might be more helpful than therapies aimed at the vulvar area such as topical anesthetics (e.g. viscous xylocaine or lidocaine). Other treatments that have been successfully used include biofeedback, which can help you to relax and lessen pain, and aerobic exercise, but avoid bicycling which can put pressure on the vulva. Recently, I have heard promising reports about eliminating oxalates from the diet while supplementing with calcium citrate. Oxalates are acidic crystals excreted in urine. They can be very irritating to the mucous membranes in the vulva. Common oxalate-containing foods include all beans, beer, beets, berries, celery, chard, chocolate, eggplant, some grapes, green peppers, peanuts, rutabaga, spinach, squash and tofu.

Unfortunately, no single treatment works for everyone so you may have to experiment before you find one that helps you. For more information on vulvodynia, log onto the Web site of the National Vulvodynia Association (www.nva.org). And definitely explore the mind/body connection by trying hypnotherapy or guided imagery.

Andrew Weil, M.D.

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