Number of Women Afflicted by Vulvar Pain Underestimated

Jennifer Wider, M.D.
Society for Women’s Health Research
August 26, 2004

The number of women suffering from vulvodynia, an incapacitating and chronic vulvovaginal pain disorder, has been drastically underestimated according to research from Brigham and Women’s Hospital in Boston, Mass. Roughly 16 percent of the women aged 18 through 64 who were surveyed had experienced chronic vulvar pain for at least three months or more.

"Up until recently all genital pain has been considered psychosexual," said Elizabeth Gunther Stewart, M.D., director of the vulvovaginal service at Harvard Vanguard Medical Associates in Boston. "There has been little study or research into vulvar conditions; and in medical schools and nursing schools there is minimal instruction about vulvovaginal problems."

Sharp, stabbing or burning pain in the vaginal area is not a topic that most women will freely discuss. And it seems that many women with vulvodynia are either suffering in silence or receiving incorrect diagnoses. According to the study, 40 percent of the women decided not to seek help for their vulvar pain and 60 percent who wanted treatment visited three or more doctors before receiving a proper diagnosis.

The vulva is the external part of the female genitalia and includes: the inner and outer labia, clitoris and external vagina. Women with vulvodynia experience pain in the genital area. Women usually come into their doctor’s office and complain of "burning or stinging without signs of infection or other vaginal disease," said Karen Berkley, Ph.D, a professor of neuroscience at Florida State University in Tallahassee.

Many women suffer from vulvodynia for several months at a time and the pain can be constant or sporadic. Sometimes the tissue looks swollen, but most often it appears normal. Activities such as walking, sitting and exercising tend to make the pain worse.

"Another group of women have no spontaneous complaint except marked pain with sexual relations," Stewart said. "Often women complain that they have a yeast infection that will not go away or urinary symptoms even though cultures are negative."

The cause of vulvodynia is unknown but some sufferers have a history of recurrent yeast infections and sexual abuse. Vulvodynia is not caused by sexual intercourse and cannot be transmitted through contact.

New research from the University of Michigan in Ann Arbor suggests that women with vulvodynia may have heightened sensitivity to pain in other regions. The study, led by Jutta Gieseke, M.D., a fellow at Michigan’s Chronic Pain and Fatigue Research Center, found that the women experienced increased pressure pain sensitivity in peripheral body regions including the shin, thumb and deltoid. The deltoid is a large triangular muscle that covers the shoulder joint and serves to raise the arm laterally. This suggests that vulvodynia most likely involves nerves that are more sensitive in the vaginal region and in other areas as well.

Women with vulvodynia are also more likely to suffer from other pain syndromes. "The few studies carried out so far suggest that such co-occurrence seems quite common: with endometriosis, irritable bowel syndrome, interstitial cystitis, and fibromyalgia," Berkley said. But more studies are needed to establish the link.

Current treatment for vulvodynia concentrates on symptom relief. The choices include anti-depressants, biofeedback, lidocaine (an anesthetic), topical creams (low-dose hormones or steroids) and sitz baths. Treatment is tailored for each patient because a cure-all has not yet been discovered.

© August 5, 2004 Society for Women's Health Research