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Diagnosis

Women with vulvodynia may have to go see several doctors before they find one who is familiar with treating this condition.

Vulvodynia is diagnosed by eliminating other possible causes of vulvar pain. It is important to identify the cause of the pain to determine the best treatment for you.

During your initial visit, your doctor will likely ask questions about your condition and do a physical exam.

Discussing your symptoms | A physical exam | Diagnostic tests | Specialists

Discussing Your Symptoms

One of the best sources of information about your condition is you. Your doctor should be interested in:

  • when your symptoms began
  • what activities trigger pain
  • where and how you experience pain
  • other illnesses you have or symptoms or pain you experience
  • your history of using antibiotics and other medications
  • any accidents or surgery which may have damaged the nerves in your pelvic region
  • any skin sensitivities or conditions
  • any bladder or bowel symptoms

A Physical Exam

The doctor will do a thorough physical exam of your vulva, looking for swollen glands, irritation and sores. She or he will look for signs of genital infection, such as:

  • Molluscum contagiosum
  • Herpes
  • Human papillomavirus (HPV)
  • Yeast infection

Swabs of the vulva will be sent to a laboratory and tested for signs of infection.

Your doctor will also look for signs of skin conditions, such as lichen sclerosus or contact dermatitis. If there is evidence of a skin condition, you will likely be referred to a dermatologist.

The doctor will touch various areas of your vulva with a swab. This is to identify sensitive areas and test your reflexes, which can help identify nerve or muscle damage.

If your condition allows, your doctor may also do an internal exam, looking for tender areas and signs of infection, for signs of pelvic prolapse and weak points in the pelvic muscles.

Diagnostic Tests

When the results of your initial visit are available, your doctor will likely suggest some followup tests, to learn more about your condition. You should discuss the particulars of your situation with your doctor and decide together whether these tests would provide insights into your condition.

Colposcopy
A colposcope is a microscope-like device used to magnify and examine the cervix, vagina and vulva. It does not come into contact with your body. When a colposcopy is done, the area is washed with acetic acid (vinegar) to make abnormal cells more obvious. Genital warts and other infected areas turn white when exposed to vinegar. During a colposcopy, a biopsy and tests for HPV can also be done. A colposcopy can also be used to identify other viral infections, skin conditions and, in the rare cases when it occurs, vulvar cancer.

Hormone Testing
If indicated, your doctor may order blood tests to determine your levels of estrogen, progesterone and testosterone. Although the relationship between these hormones and vulvar pain is not entirely clear, many women find that their pain fluctuates in relation to their menstrual cycles. Hormonal tests will also rule out the possibility of early menopause, which may cause pain due to dryness and the thinning of vaginal tissue.

Tests for Autoimmune Disorders
Vulvar vestibulitis syndrome and vulvodynia occur more frequently in women with two autoimmune conditions, Sjogren's Syndrome and lupus erythematosus. Fibromyalgia, which many researchers also believe is an autoimmune disease, may also be associated with vulvodynia and VVS. Your physician may suggest you be tested for these as well.

Oxalate Levels
One possible explanation for some cases of vulvodynia is a build-up of oxalate in a woman's system. This is a controversial theory, championed primarily by those outside the conventional medical system. It attributes vulvar pain to a build-up of oxalate crystals in the affected tissues. Oxalates are found in many fruits and vegetables. High concentrations of oxalate have been found in the urine of women with vulvodynia; however, it is unclear how many women without vulvodynia also have high oxalate levels.

Neuropathic Pain
If no other specific cause is found the most common cause is “neuropathic pain”. This means that nerve fibres in the area are acting as if they were pain fibres interpreting touch or pressure as pain. Neuropathic pain typically has a burning quality.

Vestibulodynia often leads to spasms in the pelvic floor which can affect the vagina (vaginismus) and may be associated with bladder or bowel complaints.

Specialists

Your doctor may refer you to a specialist for further investigation or treatment:

A gynecologist
Your doctor will likely refer you to a gynecologist. It is important to see one who has experience treating women with vulvodynia.

A dermatologist
If your pain appears to be caused by skin irritation or an identifiable skin condition, your doctor will suggest that you visit a dermatologist. Many dermatologists also do allergy testing and can determine if an allergic reaction is contributing to your condition.

An allergist or environmental health specialist
Your doctor may suggest you visit a specialist to be tested for food and other allergies or for chemical sensitivities. Some women believe that this is the cause of these symptoms and have experienced relief by changing their diet, avoiding certain chemicals, or by having desensitization treatments.

A physiotherapist
If your pain appears to be caused by the nerves in your pelvis or by pelvic muscle tension or spasms, your doctor may refer you to a physiotherapist. A physiotherapist can help identify what is causing the problem, and teach you exercises, biofeedback or other techniques, to help relieve your pain.

A chronic pain specialist
If your doctor cannot determine and relieve the underlying cause of your pain, or if your pain is due to a problem with the nerves, you may be referred to a chronic pain specialist. Chronic pain specialists are experts in using medications and other methods, such as relaxation techniques, to help you deal with chronic pain.

 

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