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Treatment

There are many approaches to treating vulvodynia and vulvar vestibulitis syndrome, but there is no single cure that is suitable for everyone. You and your doctor will likely have to take a trial and error approach to finding the right treatment. The results of your diagnostic tests will help determine what strategies are right for you.

Here are some of the approaches currently used to treat vulvodynia:

Topical creams | Oral medications | Physical therapies |
Dietary restrictions and nutritional supplements | Surgery

Topical Creams

Various topical creams are used to relieve a woman’s symptoms. Hormone creams may also help treat the underlying problem. Creams generally have few side effects and are relatively inexpensive. Several different types may be used:

  • anti-inflammatory creams
  • anesthetic creams
  • topical hormones

Anti-Inflammatory Creams
If your vulva is swollen, irritated or in pain, an anti-inflammatory cream may help. This will not relieve the underlying cause of your pain, but it may reduce your symptoms. The most common type of cream is a zinc oxide cream, commonly used to treat diaper rash.

Anesthetic Creams
Anesthetic creams numb the area and are most often recommended for women with vulvar vestibulitis to use immediately before sexual activity. If the cream is used only in the area immediately around the vaginal opening and not near the clitoris, the cream may effectively numb the pain without unduly limiting sensation. (Your sexual partner may also experience temporary numbness after sexual contact. Male partners might want to wear a condom.) Anesthetic creams can help reduce pain by reducing the stimulation of pain centres.

Topical Hormones
Post-menopausal women often use estrogen creams to prevent drying and thinning of the vaginal tissue. Women with vulvodynia can also apply this cream to the external genitals, to help thicken fragile tissue and increase blood flow in the area. A side effect of this treatment may be itchiness for the first four to six weeks of use.

Some women have also experienced relief using topical testosterone or progesterone creams. This is most clearly documented in women who have skin conditions, such as lichen sclerosus, but it may be effective for other women as well.

Oral Medications

Oral medications can be useful for treating vulvodynia and vulvar vestibulitis syndrome in the following situations:

  • when the pain is due to nerve damage
  • when the pain is due to an infection
  • when a woman needs pain relief and no other approach has been successful

Drugs to Treat Nerve Damage
Two types of drugs are used to treat nerve pain:

  • anticonvulsant drugs
  • antidepressants

Although originally developed to treat epilepsy, anticonvulsant drugs are now used in a number of situations where nerve damage causes pain. The drugs may relieve pain by making the nerves less sensitive to stimulation. These drugs are also used to treat nerve damage in people with diabetes.

Tricyclic antidepressants work by limiting the pain signals that damaged nerves send to the brain. They are an older class of antidepressants, which have more side effects than new antidepressants, such as Prozac; however, they appear to be more effective at treating vulvodynia. You are not being prescribed an antidepressant because the doctor thinks your condition is 'in your head.' These drugs modify how signals from the nerves are received.

Drugs to Fight Infection
Viral infections, such as the human papillomavirus (HPV), an overgrowth of bacteria and yeast infections under the skin, are all possible causes of vulvodynia. Depending on your circumstances, your doctor may prescribe drugs to treat these infections. This approach should be used with caution. For example, antibiotics that kill bacteria may actually make a yeast infection worse by killing off friendly bacteria that limit the growth of yeast.

Pain Relief Medication
If no underlying cause can be identified for your vulvodynia, one approach is to just treat the pain. Pain relief medication is best prescribed by a chronic pain specialist, if one is available to you. See our chronic pelvic pain pages for details.

Physical Therapies

A number of physical therapies may be helpful for women with vulvodynia. The most promising of these appears to be biofeedback.

Biofeedback Techniques
Biofeedback training for vulvodynia helps patients to strengthen and relax the muscles of the pelvic floor, which can result in reduced pain. The biofeedback approach is based on the idea that women with vulvodynia and vulvar vestibulitis syndrome have unstable muscles in the walls of the pelvis. This may explain the shooting and stabbing pains often described by women with vulvodynia, as well as pain that results from touch and stimulation. Biofeedback is based on the idea that these muscle problems may have developed in response to nerve damage and strain to the muscles. Biofeedback is used to teach people how to exercise and relax specific muscles.

Biofeedback manufacturers have developed software specifically for women with vulvodynia and special sensors, which are inserted into the vagina. (Regular biofeedback units use electrodes placed on the skin.)

Acupuncture
Some women have had their symptoms relieved with acupuncture. Most reports suggest that acupuncture offers temporary relief, not a long-term cure. Regulations governing the practice of acupuncture vary from province to province, and acupuncture remains unregulated in many provinces. Contact the Chinese Medicine and Acupuncture Association of Canada or the Canadian Association of Naturopathic Doctors for help finding a well-trained and reputable acupuncturist.

Other potentially useful therapies include the use of TENS units (mechanical units which use electrical impulses to control pain) and targeted exercises. TENS units are also used to treat chronic pelvic pain and are discussed in more depth in that section. A physiotherapist may be able to advise you about both of these approaches.

Dietary Restrictions and Nutrition Supplements

Some believe that vulvodynia is caused by a build-up of oxalate crystals under the skin. Foods high in oxalates include leafy green vegetables, beets, rhubarb, strawberries, nuts, seeds, wheat bran and chocolate. No successful studies on this approach have been published in the medical literature. However, some women have reported benefits from the low oxalate diet and nutritional supplements he suggests. Talk to your health-care provider about the pros and cons of reducing or eliminating high-oxalate foods from your diet.

Surgery

Surgery should be considered as a last resort for the treatment of severe vulvar vestibulitis syndrome (VVS). It is not appropriate for women with vulvodynia whose pain occurs throughout the vulva.

Surgery for VVS involves the complete removal of both the major and minor vestibular glands. In some cases, a skin graft to the vestibular area may also be necessary.

When a competent and knowledgeable surgeon performs the surgery, this treatment eventually allows 60 to 75 percent of women to participate in pain-free intercourse. Recovery from surgery is lengthy, typically taking six to eight weeks.

Laser Surgery
Some physicians have used laser surgery for women with vulvodynia and VVS. This treatment has not proven to be effective, and many women who tried laser surgery saw their symptoms worsen. In 1997, the National Institute of Health in the United States hosted the first symposium of health-care professionals specializing in treating vulvodynia and VVS. One of the recommendations of this gathering was that laser therapy NOT be used to treat vulvodynia or VVS.

 

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