Vestibulodynia / Vulvodynia
Vulvodynia refers to long-term pain in the outer part of the female genitals. When the pain is specifically in the vestibule, it is referred to as vestibulodynia. The root cause of the pain can vary, giving us several subtypes of vestibulodynia. Neuroproliferative vestibulodynia, hormonally-mediated vestibulodynia, and inflammatory vestibulodynia.
Neuroproliferative vestibulodynia can be caused by a congenital birth defect that increases the nerve endings in the vestibule or can develop later in life potentially due to an overgrowth of nerves driven by the immune response, either to infection or allergy. Treatment options include pain relief like topical lidocaine and gabapentin. Additionally, capsaicin cream has been shown to reduce hypersensitivity. Capsaicin is the chemical compound in peppers that makes them spicy. Patients apply capsaicin cream to the vestibule daily for longer and longer amounts of time, starting with only a few seconds by washing it off immediately. Over time, patients build up the amount of time they can tolerate the cream. The concept behind this treatment is that the capsaicin overloads the nerve endings and reduces their function. Surgery (vestibulectomy) is also a treatment option for neuroproliferative vestibulodynia.
Hormonally-mediated vestibulodynia can be caused by hormonal birth control pills, spironolactone, and several breast cancer medications because these medications result in the reduction of free, active testosterone in the body. Some new parents experience hormonally-mediated vestibulodynia because while breastfeeding, estrogen levels are low. Estrogen levels also drop in peri-menopause and menopause. The standard treatment is a topical hormone gel applied directly to the vestibule to restore the hormone signals to the tissue.
More Information
Neuroproliferative Vestibulodynia
Hormonally Mediated Vestibulodynia
Hormonally Mediated Vulvodynia
Current Uses of Surgery in the Treatment of Genital Pain