Vaginal and Vulvar Health- 06

Vaginal Self-Exam
Foreign Body in the Vagina
Vaginal Infections
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Bacterial Vaginosis (BV)
Bartholin's Gland Cyst
Vaginal Cysts
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Douching: Helpful or Harmful?
Vaginal Discharge: What’s Abnormal?
Vaginal Dryness: Causes and Moisturizing Treatments
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Itching, Burning, and Irritation
Vaginal Fistula
What Is Vulvodynia?
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Vulvodynia: Causes, Symptoms, and Treatments
What Can I Do About Vulvodynia?
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Treatment for Vulvodynia
What Is Vulvovaginitis?
Vulvar Vestibulitis

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Treatment for Vulvodynia

What's the Treatment for Vulvodynia?

Vulvodynia can be complicated. There's no known cause or catch-all cure. But the goal of vulvodynia treatment is simple: Make the pain stop.

If you have this condition, prepare to experiment with a lot of different methods. Consider seeing a vulvovaginal specialist, dermatologist, or neurologist in addition to your gynecologist. They may recommend some or all of the following treatments:

Biofeedback Therapy

In this technique, electrical sensors are placed on certain parts of your body. They give information about your body's response to pain. For vulvodynia, biofeedback therapy focuses on helping you relax your pelvic muscles. When you anticipate pain, you may contract those muscles, which can actually cause you to have pain.

Medication

Over-the-counter meds offer short-term relief. Antihistamines offset itching. Local anesthetics, like lidocaine ointment, numb the pain.

You can also apply prescription hormone creams directly to your skin. These contain estrogen or testosterone.

Oral prescription medications that block pain for other conditions may reduce the symptoms of vulvodynia. These include antidepressants and anti-seizure medications.

Nerve Block

You have certain nerves that carry pain signals from your vulva, or vaginal area, to your spinal cord. During a nerve block, your doctor injects anesthetic into those nerves to stop the signal. This may provide short-term or long-term relief, especially if other treatments haven't worked.

Pelvic Floor Therapy

The muscles of your pelvic floor support your uterus, bladder, and bowel. When you're in pain, you may tighten these muscles without even knowing it. Pelvic floor therapy -- a form of physical therapy -- involves exercise to relax those muscles, which may be causing additional pain when they're tight.

Trigger Point Therapy

When you have a knotted muscle in your neck, a massage helps smooth it out and get the blood flowing again. Trigger point therapy does something similar. This form of massage therapy locates the trigger point, or contracted muscle that's causing pain, and works it out.

Surgery

This is usually the last resort, if it’s used at all. Your doctor might recommend it if you have localized vulvodynia (doctors call this “vestibulodynia”), which means you feel pain in the skin around the opening of your vagina. Removing that tissue surgically may relieve the pain.

When looking for ways to relieve the pain caused by vulvodynia, you may lock in on the right path quickly. Or, it could take weeks or months to find the right combination of treatments. Be patient during the process. Every step toward a life with less pain is the right one.

What Is Vulvovaginitis?

What Is Vulvovaginitis?

Vulvovaginitis is inflammation of your vulva and vagina. It’s also called vaginitis. It’s a common condition -- as many as one-third of women will have it during their lifetime. It shows up most often during your reproductive years.

Types and Causes

You get vaginitis when the normal amount of yeast and bacteria in your vagina gets out of balance. This could happen for several reasons, including an infection, a change in hormones, or antibiotic use. It could also be because of a reaction you have to something that comes into contact with your vulva or vagina.

There are three common types of vaginal infections that cause vaginitis.

Yeast infection. Sometimes you can have too much of a fungus called C. albicans, or candida. You always have some candida in your vagina, but an overgrowth causes yeast infections and symptoms of vaginitis.

Bacterial vaginosis. A healthy vagina has several types of bacteria living in it. Some are “good” and some are “bad,” but they balance each other out. You get bacterial vaginosis when the bad bacteria start to outnumber the good bacteria.

Trichomoniasis. This type of vaginitis comes from a tiny, one-celled parasite called Trichomonas vaginalis. You get it through having sex with someone who’s infected. Men who have the parasite don’t usually have any symptoms.

Though those are usually the culprits behind most cases of vaginitis, you can also get it from:

• Sexually transmitted diseases (chlamydia and gonorrhea)
• Viruses, including herpes and HPV (human papillomavirus)
• A decrease in hormones, usually during menopause or after childbirth
• Allergic reactions to lubricants, lotions, detergent, etc.

Symptoms

Typically, the symptoms you get from vaginitis all happen in your vagina or just outside it, on your vulva. What you’ll feel will depend on what’s causing your vaginitis. It’s possible to have more than one type of vaginitis at a time.

Symptoms of vaginitis include:

• Itching
• Irritation
• Burning
• Redness
• Swelling
• Dryness

You may also notice:

• Discomfort when you urinate
• Pain during sex
• Light bleeding (spotting)
• Discharge and odor

Abnormal discharge is one of the most common symptoms of vaginitis. It may give your doctor clues to what’s causing your vaginitis.

Discharge from a yeast infection is typically white, odorless, and clumpy, similar to cottage cheese. Itching is also a common complaint.

Discharge from bacterial vaginosis is heavier than usual but thin, fishy-smelling, and grey or green in color.

Discharge from trichomoniasis also has a fishy odor, but is yellow-green, and sometimes frothy.

Diagnosing Vaginitis

If you’re noticing changes in your discharge, or other symptoms, your doctor can check things out to see how best to treat you. She’ll ask you about your medical history, including your sexual history. She’ll also want to know if you’ve been using anything that may be causing your vaginitis, like new detergent or spermicide.

Your doctor will also take a sample of your discharge so it can be examined under a microscope to see what kind of vaginitis you have.

If you’ve had vaginitis before and recognize your symptoms, you may be able to treat the problem yourself without seeing your doctor -- for instance, if you’ve had a yeast infection before and you’re sure your symptoms point to another yeast infection.

Treatment

It’s important to know exactly what’s causing your vaginitis. To treat vaginitis due to an allergic reaction or outside irritation, you need to figure out the source of the problem and eliminate it. Your doctor may suggest a topical cream to help soothe any itching or burning.

If your vaginitis is caused by an infection, you’ll need the right kind of medicine to treat it.

Yeast infections can be cured with antifungal medications. There are pills you can take, like fluconazole (Diflucan). You can also use a suppository (a pill you insert into your vagina) or a prescription antifungal cream.

Common antifungal creams and suppositories for yeast infections are:

• Clotrimazole (Gyne-Lotrimin)
• Miconazole (Monistat)
• Tioconazole (Vagistat)

There are many over-the-counter options for treating yeast infections that are safe and effective. If you’ve never had a yeast infection, check with your doctor before you take them. You should also talk to your doctor if you take over-the-counter medications and don’t see any change in your symptoms.

You can treat both bacterial vaginosis and trichomoniasis with a medication called metronidazole (Flagyl). When you’re treating trichomoniasis, you take it in pill form by mouth. You can also take metronidazole to treat bacterial vaginosis, or you can use clindamycin topical (Cleocin T) or metronidazole gel (MetroGel Vaginal) in your vagina or on your vulva.

Prevention

You may be able to reduce your chances of getting vaginitis by doing a few things, including:

• Avoid tight-fitting clothes that might hold in heat and moisture
• Don’t use perfumed soaps or sprays on or in your vagina
• Don’t douche
• Use a condom during sex

Talk to your doctor during menopause about whether you can take pills or use cream to help treat vaginal dryness.

Vulvar Vestibulitis

What Is Vulvar Vestibulitis?

Vulvar vestibulitis is a type of vulvodynia, or pain around the vulva – the sex organs outside a woman’s body. The pain is in your vestibule, the part of your vulva around the opening of your vagina. It can cause redness and irritation of the skin and pain in the glands inside the skin. This condition is also called “vestibulodynia” or “localized provoked vulvodynia.”

What Are the Symptoms?

They can be different for every woman. They may be mild and annoying, or severe enough to interfere with your life. Symptoms can be constant, or they can come and go. They include:

• Pain from pressure (sitting, biking, working out, tight clothes, touch)
• Pain from sex or using a tampon
• Burning or stinging
• Feeling raw
• Peeing a lot, or suddenly feeling like you have to pee

Usually, itching isn’t a symptom.

Vulvar vestibulitis can take a toll on your sex life and relationships. When you try to have sex, the muscles in your pelvis can tense up so it hurts even more. The pain may make you not want to have sex at all.

What Causes It?

Doctors don’t know, but some studies show it may be linked to the following:

• Human papillomavirus (HPV)
• Yeast infections
• Bacterial infections
• Changes in the acidity of the vagina
• Detergents and soaps
• Spermicides and lubricants
• Menopause
• Stress

Any woman can get vulvar vestibulitis. It doesn’t matter if you’ve had sex or not or how old you are. Your risk may be higher if you have interstitial cystitis(painful bladder syndrome), endometriosis, or problems with the muscles that support their bladder, uterus, vagina, or rectum. Doctors aren’t sure which comes first -- those conditions or vulvar vestibulitius.

How Is It Diagnosed?

Your doctor will look for redness around your vulva. She’ll use a cotton swab to touch different parts of your vulva to see where it hurts. She might also ask questions about your family medical history and run tests to make sure you don’t have an infection.

What’s the Treatment?

Once your doctor gives you a diagnosis, there’s a lot you can do to manage your symptoms. For example:

• Try different detergents
• Use a mild soap
• Avoid using pads, tampons, or other scented sanitary products
• Avoid tight clothes. Wear clothes that breathe, such as cotton. Cut back on alcohol, caffeine, and artificial sweeteners
• Try witch hazel pads
• Pour lukewarm water over your vulva after you pee
• Soak in a lukewarm bath with 4 or 5 tablespoons of baking soda for 10 to 15 minutes, and do it up to three times a day.
• Use petroleum jelly or vegetable shortening (Crisco) on your skin to keep it moist

Your doctor can offer you treatments, like medications and creams. She might suggest injections that will help your body fight infection. She may recommend physical therapy with a specialist who can teach you how to make the muscles in your pelvis stronger. If these treatments don’t work, your doctor might explore surgery or laser treatment to remove skin that’s involved. Counseling for you and your sex partner may help ease your fears about pain during sex.

You may have to try a few different treatments until you find one that helps most. You might also have to use more than one treatment at a time.