Ask the Pharmacist

Q. I have a lot of vaginal pain and I was told it could be vulvodynia. Can you explain what that is and what can be done about it?

A. Absolutely. Vulvodynia is a term that not many people would have heard of before. Simply put, it means pain in the vulva (the outer female genitals) that lasts longer than three months. It can be the cause of much pain and burning that can persist for many months or even years. It is difficult to say how common this is as many women are too shy to discuss this with any healthcare practitioners. Our hope is that this column will explain the condition well enough and give women the courage to seek help if they are finding they are suffering from this.

Vulvodynia pain is best described with any of the following.. burning, irritation, itching, stinging, rawness, throbbing, soreness, sharp stabbing pain, and/or swelling. Some women may find their symptoms are transient (the pain comes and goes) while others have a constant pain. Women who have these symptoms should consider seeing their healthcare provider. They will likely try to rule out other possible concerns such as a yeast or bacterial infection, a sexually transmitted infection or vulvar growths. Vulvodynia can be described as either localized (where the pain is isolated to one area of your vulva) or generalized (where the pain is felt throughout the entire vulva). Unfortunately, the cause of vulvodynia is still not clear.

There are thoughts that the following could be contributing;

It should come as no surprise that women who experience this pain continuously for many months may also find themselves suffering from anxiety and/or depression. Not too surprising if they are having extreme pain 24/7. Many women may be reluctant to participate in intimate experiences due to painful intercourse which can further exacerbate their inadequate feelings. If this describes you, we strongly urge you to visit your healthcare provider and/or a pelvic floor physiotherapist. They can perform a pelvic exam and run tests to rule out other possible infections mentioned above.

Once vulvodynia is confirmed, there are a variety of options to help relieve the discomfort. Unfortunately, there isn’t one medication that works best for everyone. Often, women will have to go through a trial and error process to find the best treatment. As well, women may find they need to adopt several treatment types to get relief. All of these trials take time and none of these options show improvement right away which can be discouraging for women.

Some of the options that might be tried are;

· Topical medications that can numb the area (anesthetics), help ease the nerve pain (gabapentin, amitriptyline) and/or topical hormones (estrogen +/- progesterone) which can help to improve vaginal atrophy
· Oral medications to alleviate nerve pain such as gabapentin pregabalin among others
· Injectable nerve blocks to help reduce the pain signals from the brain
· Physical therapy
· Surgery such as vistibulectomy to remove the painful vulvar tissues
· Antihistamines to reduce itching
· Acupuncture
· Transcutaneous electrical nerve stimulation (TENS) which sends electrical currents to the painful sites
· Hypnosis
· Counselling which may be helpful to repair your personal self and/or improve your sexual relationships

We would like to focus first on the non-pharmacological options to help minimize your discomfort. The key is to reduce any irritation to the vulva through the following do’s and don’ts practices;

– limit high-intensity exercise (running) as they cause friction on the vulva
– limit biking and horseback riding a they put extra pressure on the vulva
– apply a cold pack to the vulva after exercise for a maximum of 15 minutes
– take an Epsom salt bath or colloidal oatmeal as much as 2-3 times daily for 5-10 minutes at a time
– cleanse your vulva with a mild, unscented soap or consider just using water and avoid scrubbing which might cause more irritation and pat gently dry
– use cotton underwear in the daytime and no underwear overnight
– use unscented/unflavoured lubricants that do not have cooling or warming effects
– a foam ring or donut cushion reduces pressure on your vulva
– ensure 7 to 9 hours of sleep every night
– relaxation techniques to reduce stress
– avoid tight clothing (pantyhose, pants, jeans)
– avoid scented products vaginally (toilet paper, tampons, pads, panty liners)
– get out of wet clothing (swimsuit, sweaty exercise clothes) quickly
– avoid bubble baths
– use gentle laundry detergents and avoid fabric softener on your undergarments
– be sure to urinate soon after sexual intercourse to reduce the risk of getting an infection

Along with making an appointment to see your primary healthcare provider, you should strongly consider seeing a physiotherapist that specializes in the pelvic floor. Since the majority of women with vulvodynia also have increased tension in their pelvic floor muscles, a physical therapy regime could reduce both muscle tension and muscle spasms in the pelvic floor. These exercises will likely include a variety of stretching, lengthening and strengthening your pelvic floor muscles.

For more information on this or any other health related topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination