Imagine living your life in constant pain, having to give up physical activity – including sex – for good. For women suffering from vulvodynia – this is their reality. Things like sitting for long periods of time or being intimate with their partners become unthinkable because of the pain and embarrassment they suffer.
Dr. Manny sat down with Dr. Philippa Cheetham, a urologist at Columbia University Medical Center in New York to talk about how doctors are diagnosing and treating this often “depressing” condition.
Q: What is vulvodynia?
A: Interestingly, it actually got a mention on “Sex and the City” and the National Vulvodynia Association was pretty upset about it because it was portrayed as being a very fleeting condition, but actually it can be very chronic and last for many years.
Vulvodynia actually just means pain in the vulval area. It is a diagnosis of exclusion, it doesn't actually necessarily imply a diagnosis. So we have this term, but it really just means pain which can present with burning, stinging, stabbing pain. There's a whole range of different symptoms that people report.
It has a huge effect on quality of life. People often feel very depressed about it, and it affects their intimacy and their relationships. I think it's even more difficult when we can't tell them the cause, because if you don't know the cause, it can often be difficult to address the symptoms.
Q: What causes it?
A: Well there are many different causes. It may be infection, it may be inflammation, it may be a thrush-type picture, it may be related to urinary symptoms. It may be a urethral prolapse or a urethral caruncle. There are lots of different reasons, and that's the problem.
Q: How is it diagnosed?
A: First of all, I think the key is to examine the patient fully and see if you can identify any causes that you can exclude. So let's exclude a urinary tract infection, let's see if we can identify any pinpoint tenderness.
I think also, the key with managing these patients is to take a really good history. It's not a five minute consult. You need to sit down with the patient and find out what causes it in their mind, what triggers it. Is it related to stress, is it related to menstrual cycle? Sometimes I find that patients, if they have ongoing symptoms and it's really troublesome, examining them under anesthetic can also give you some extra information.
Q: How is it treated?
A: For some patients, you actually have to resort to giving them antidepressants, and as you know, it's a chronic problem. And there's a whole lot of pain medications that can affect the nerve supply down there that may help but it's not an easy thing to treat.
There are studies that have shown that education really can help manage patients symptoms.
Some patients may benefit from simple measures, lifestyle measures. Wearing cotton underwear, not using any perfumed bubble bath or body washes, making sure that they always void or empty their bladder after having sex. In addition, using plenty of lubrication during sexual intercourse can make a big difference. For many patients, just understanding that they don't have anything serious can make a huge difference.
We know that diet may help, low oxalate foods can certainly help. But it's a difficult problem to manage because no one treatment helps all, and it's different for different patients.
Q: Can women do anything to prevent vulvodynia?
A: I think usually there is a trigger, and the trigger is often unknown. So if patients get recurrent urinary infections, it may pre-dispose them, if they've had a difficult delivery that's resulted in suturing afterwards. So I think prevention is a difficult thing to address.
Again, some patients may benefit from simple lifestyle measures like wearing cotton underwear, not using any perfumed soaps, making sure that they always empty their bladder after intercourse.