Number of women afflicted by vulvar pain underestimated

Townsend Letter for Doctors and Patients, Jan, 2005 by Jennifer Wider

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% 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, MD, 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% of the women decided not to seek help for their vulvar pain and 60% 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, PhD, 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, MD, 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 cureall has not yet been discovered.

About the Author: Jennifer Wider, MD

Jennifer Wider graduated from Princeton University in 1994 with BA in the humanities. She received her medical degree from the Mount Sinai School of Medicine in 1999. During medical school, she interned at CBS local news and 20/20 in New York City. Jennifer worked as a senior editor at Medscape/CBS Health Watch out of medical school. She has had many publications in newspapers, magazines and websites across the country and has been a guest on CBS News, National Public Radio and various cable channels. Jennifer was formerly the managing editor of the health channel at iVillage.com and currently reports on health and medical issues for the Society for Women's Health Research.

Society for Women's Health Research is the nation's only not-profit organization whose mission is to improve the health of all women through research, education and advocacy. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the need for more information about conditions affecting women disproportionately, predominately, or differently than men. The Society advocates increased funding for research on women's health; encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease; promotes the inclusion of women in medical research studies; and informs women, providers, policy makers and media about contemporary women's health issues. Visit the Society's Web site at www.womenshealthresearch.org for more information.